NSAIDs起因性小腸潰瘍と非特異性多発性小腸潰瘍症における小病変

A Comparative Enteroscopic Study of Nonsteroidal Anti-inflammatory Drug-induced Enteropathy and Chronic Nonspecific Ulcers of the Small Intestine

要旨　非特異性多発性小腸潰瘍症（CNSU）9例とNSAIDs起因性小腸潰瘍（NSAIDs腸症）14例の内視鏡所見を比較した．単発ないし多発性狭窄はCNSU 9例（100％）とNSAIDs腸症4例（29％）にみられ，前者の8例と後者の2例で開放性潰瘍を伴っていた．非狭窄性輪状潰瘍はCNSUの6例（67％）とNSAIDs腸症の7例（50％）にみられ，前者全例と後者の4例は開放性であった．CNSUの4例（44％）とNSAIDs腸症の1例（7％）で開放性の縦走・斜走潰瘍を認めた．一方，NSAIDs腸症7例（50％）で多発症潰瘍，アフタ，潰瘍瘢痕などの小病変が確認できたが，CNSUでは2例（22％）にすぎなかった．以上より，CNSUでは慢性開放性潰瘍が，NSAIDs腸症では治癒傾向の強い潰瘍と小病変が内視鏡的特徴と考えられた．

　We compared enterosopic findings between 14 patients with nonsteroidal anti-inflammatory drug-induced enteropathy（NSAIDs-enteropathy）and 9 patients with chronic nonspecific multiple ulcers of the small intestine（CNSU）. Single or multiple concentric sternosis was found in 29％ of NSAIDs enteropathy and in 100％ of CNSU. Non-stricturing circular ulcers were found in 50％ of NSAIDs-enteropathy and in 67％ of CNSU. Longitudinal or oblique ulcer was seen more frequently in CNSU（44％）than in NSAIDs-enteropathy（7％）. In contrast, diminutive or aphthous ulcers were found more frequently in NSAIDs enteropathy（50％）than in CNSU（22％）. These findings suggest that CNSU is characterized by intractable and large ulcers, while diminutive ulcers are characteristic of NSAIDs enteropathy.