NSAID起因性大腸病変の臨床像と内視鏡像

Clinical and Endoscopic Features of Nonsteroidal Anti-inflammatory Drug-induced Colopathy

要旨　過去11年間に経験したNSAID起因性大腸病変32例の臨床像と内視鏡所見を解析した．その結果，限局性潰瘍性病変を認めた潰瘍型24例とびまん性大腸炎を呈した腸炎型8例の2型に大別された．潰瘍型にみられた粘膜病変は右半結腸，特に回盲部が好発部位で，回盲弁上あるいはhaustra上の境界明瞭な潰瘍を特徴とし，NSAIDの投与中止3～10週後に炎症性ポリープの合併なく治癒瘢痕化した．また，潰瘍型の1例は膜様狭窄を合併し，NSAID投与中止後に潰瘍は治癒したが，狭窄は改善しなかった．一方，腸炎型は下痢を主徴として急性発症し，投与中止2週以内に治癒した．内視鏡像から出血性大腸炎型とアフタ性腸炎型の2型に分類され，抗菌薬関連性腸炎に類似していた．以上より，NSAID起因性大腸病変は潰瘍型と腸炎型に区別して論ずるのが妥当と考えられた．

　To determine the clinical and endoscopic features of nonsteroidal anti-inflammatory drug (NSAID)-induced colopathy, we reviewed subjects with colonoscopically verified lesions who had been administered NSAID. Among 32 patients who satisfied our criteria for NSAID-induced colopathy, 24 patients had single or multiple discrete ulcers. In 23 of 24 patients, initial colonoscopy demonstrated sharply demarcated, semilunar or cicumferential ulcers without stricture formation. After discontinuance of NSAID, improvement of the ulcers without stricture or inflammatory polyps was able to be confirmed 3～10 weeks later. In one patient with diaphragm-like stricture, follow-up colonoscopy performed 6 months later showed resolution of the circumferential ulcer. The remaining 8 patients had hemorrhagic or aphthoid colitis. During periods from 1 to 2 weeks after discontinuance of the causative NSAID, the colitis had improved without any specific treatment.