家族性大腸腺腫症の消化管病変に対するsulindacの効果

Short-term and Long-term Effects of Sulindac on Colonic and Duodenal Lesions in Uncolectomized Familial Adenomatous Polyposis

要旨　sulindac（SU）を投与した家族性大腸腺腫症（FAP）11例の消化管病変の経過を検討し，大腸病変の短期経過については，SU非投与6例の経過と比較した．① SU投与例では12か月後の注腸X線上の隆起密度と最大隆起サイズは投与前より有意に低下したが，SU非投与例ではいずれも不変であった．②SU投与例では遠位大腸よりも近位大腸において隆起密度が低下する傾向がみられた．③SUの効果はAPC変異部位には明らかな影響を受けなかった．④12か月以上継続投与した8例では大腸の表面型腺腫が残存し，1例では投与前に存在した隆起型腺腫が，3例では経過中に出現した亜有茎性隆起ないし結節集簇様病変が増大し内視鏡的切除を要したが，癌発生はなかった．⑤SU投与前に十二指腸腺腫を認めた5例では，SU投与後に十二指腸病変の性状に変化はなかった．以上より，SUはFAPの大腸腺腫に対して退縮効果を有するが，その効果は小型かつ隆起型腺腫にとどまると推測した．

　We retrospectively investigated short-term and long-term effects of sulindac (SU) on colonic and duodenal lesions in patients with uncolectomized familial adenomatous polyposis (FAP). Oral SU for 12 months induced significant decreases in the number and the size of colonic polyps in 11 patients with FAP. In contrast, colonic lesions in 6 FAP patients without SU remained unchanged for 12 months. The effect of SU was more predominant in the proximal colon than in the disatal colorectum, but it was unrelated to the site of germline APC mutation. In 8 patients who were treated by SU during the subsequent clinical course, small and nonpolypoid lesions were continuously identified. Furthermore, colonoscopy showed that in 3 patients semipedunculated or nodular-aggregating lesions increased in size. In 5 patients with duodenal adenomatosis, the duodenal lesions remained unchanged even after long-term SU administration. These findings suggest that SU induces regression of colorectal lesions in FAP, although the effect seems to be restricted to diminutive lesions.