NSAID起因性上部消化管病変の臨床像と画像所見

Clinical Features and Endoscopic Findings of NSAID-related Mucosal Lesions in the Upper Gastrointestinal Tract

要旨　非ステロイド性抗炎症薬（non-steroidal anti-inflammatory drugs；NSAID）は薬物性潰瘍の中では最も頻度が高いことが，20年以上前から指摘されている．また高齢化社会の到来で，虚血性心疾患，脳血管障害が増加しており，二次予防として低用量aspirin（low-dose aspirin；L-Asp）の処方が急増していて，L-Asp起因性上部消化管病変も指摘されている．当院での消化性潰瘍をA群（L-Asp投与），N群（非aspirin NSAID投与），C群（L-Asp，NSAID非投与）に分類した検討では，潰瘍症例全体の25％で広義のNSAID（L-Aspおよび非aspirin NSAID）を投与されていて，7％でL-Aspを投与されていた．出血症状（吐血，下血，貧血）の割合はA群，N群ではC群と比し有意に高率であった．潰瘍発生部位は幽門前庭部潰瘍の比率はA群N群両群間で有意差は認められず，A群では胃体部の発症も31％に認められた．A群はN群と比較し10mm以下の小型の潰瘍が多かった．また潰瘍の数は多発性，単発性の割合で検討したが3群間で有意差は認めなかった．広義のNSAID（N群＋A群）ではC群と比較しHP感染率は低率であったがA群単独ではC群とでHP感染率に有意差は認められなかった．

　It has been demonstrated that Non-steroidal anti-inflammatory drugs (NSAID) have been the most common cause of drug-induced ulceration in the last 20 years. With the advent of our aging society, the number of patients with ischemic heart disease and cerebrovascular disease has increased. This has resulted in the widespread use of Low-dose aspirin (L-Asp). It is suggested that L-Asp induces gastrointestinal mucosal injury. In this study, we classified peptic ulcers diagnosed in our hospital into the low-dose aspirin-induced group (Group A), the non-aspirin-NSAID-induced group (Group N), aspirin and non-aspirin-NSAID free group (Group C). The proportion of Group N and Group A was 25％and 7％. Bleeding events such as hematemesis, melena and anemia occurred in 53.6％, 45.2％and 31.2％in Group A, N and C. The ratio of ulcers located in the antrum were 24％, 32％and 16％in Group A, N and C. The ratio of ulcers located in the antrum was higher in Group A and N than in Group C. There was a tendency for the size of ulcers to be smaller in Group A than in Group N. There was no difference in the number of ulcers in each group. The prevalence of H. pylori was significantly lower in group N than in Group C. There was no diffrence in the prevalence of H. pylori in Group A and C.

　It has been suggested that typical NSAID-induced ulcers have decreased and on the other hand, L-Asp-related ulcers located in the corpus have increased. Prevention of L-Asp-related gastrointestinal mucosal damage is needed.