A Clinical Study of NSAID Suppository-induced Rectal Lesions Shiro Nakamura 1 , Yoshio Jinno 1 , Takayuki Matsumoto 1 , Kiyotaka Okawa 2 , Masaki Iimuro 3 , Nobuhide Oshitani 4 , Tetsuo Arakawa 4 , Tsutomu Nomura 5 , Atsuo Kitano 5 1Division of Lower Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishimiya, Japan 2Department of Gastroenterology, Osaka City General Hospital, Osaka, Japan 3Department of Gastroenterology, Higashisumiyoshi Morimoto Hospital, Osaka, Japan 4Depertment of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan 5Department of Gastroenterology, Wakakusa Daiichi Hospital, Higashiosaka, Japan Keyword: NSAID , 坐剤 , 直腸 , 下部消化管 , 血便 pp.1730-1738
Published Date 2007/11/25
DOI https://doi.org/10.11477/mf.1403101226
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 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.

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