NSAID坐剤起因性直腸病変の臨床的検討

A Clinical Study of NSAID Suppository-induced Rectal Lesions

要旨　非ステロイド性抗炎症坐剤起因性の直腸病変自験15例を対象に，その臨床像と内視鏡像について検討した．年齢は平均69.5歳，10例が65歳以上の高齢者で，男女比は6：9とやや女性に多かった．初発症状は無痛性の血便が10例と最も多く，下痢出現後の血便や貧血が4例とこれに次いでいた．入院時原疾患は骨関節疾患10例，悪性腫瘍5例で，併存症には糖尿病，高血圧など動脈硬化性疾患を比較的多く認めた．坐剤の使用期間は平均42.3日，10例が4週間以内で，1日使用量はdiclofenac sodium平均78.9mgであった．病変は主に多発性かつ全周性でRb～Raに分布していた．内視鏡像では出血・びらんを主体とする急性出血性粘膜病変が9例と最も多く，そのほか6例には明らかな潰瘍形成を認めた．潰瘍は輪状4例，不整形1例，Dieulafoy型1例で，輪状のうち2例は全周性狭窄を呈した．臨床像はいわゆる急性出血性直腸潰瘍に類似し，内視鏡像は急性出血性粘膜病変と狭窄を伴う輪状潰瘍が特徴的所見と考えられた．

　This study was conducted based on clinical and endoscopic features shown in 15 of our own clinical cases of patients who were diagnosed with non-steroidal anti-inflammatory drug-induced rectal lesions. The average age of the subjects was 69.5 years old, of whom 10 cases were senior patients over 65 years old. The male and female ratio was 6 to 9, with a slightly higher number of female patients. Ten cases showed the onset symptom of painless hematochezia, with the next 4 cases showing hematochezia and anemia after the occurrence of diarrhea. As for the primary diseases at hospitalization, 10 cases were osteoarthropathy, and 5 cases were malignant tumor. Relatively high incidences of concurrent disease of arteriosclerosis such as diabetes and high blood pressure were recognized. The average duration of suppository administration was 42.3 days, with 10 cases of less than 4 weeks. The average daily quantity administered was 78.9 mg of diclofenac sodium. The lesion formation was primarily multiple and circumferential, and distributed from Rb～Ra. Endoscopic features revealed acute hemorrhagic mucosal lesions such as mucosal bleeding and erosions in the largest 9 cases. Apparent formation of ulcer was recognized in the other 6 cases, of which 4 cases were circular, 1 case was irregular and 1 case was Dieulafoy ulcer. Of the 6 cases of circular ulcers, 2 cases revealed circumferential stenosis. The clinical features showed a similar symptoms similar to acute hemorrhagic rectal ulcer, and the endoscopic features suggested characteristic circular ulcer accompanied by stenosis and acute hemorrhagic mucosal lesions.