ステロイド投与が必要であったlansoplazole-associated collagenous colitisの1例

Lansoprazole-associated Collagenous Colitis which was Required Steroid Therapy, Report of a Case

要旨　患者は60歳代の女性．胸焼け症状に対してランソプラゾールを服用中，持続する頻回の水様性下痢と低蛋白血症にて当科を紹介され入院となった．注腸X線検査にて下行結腸，横行結腸の細長い縦走潰瘍瘢痕を認めた．大腸内視鏡検査にて，縦走潰瘍瘢痕の他，大腸全域にわたる大腸粘膜の血管透見像の消失と微細顆粒状粘膜，および毛細血管の数珠状拡張所見を認めた．病理組織所見では被覆上皮直下の粘膜間質に厚さ25～40μmのcollagen bandの肥厚所見を認め，collagenous colitisと診断した．ランソプラゾールの中止後も症状は増悪し，ステロイド投与により症状は速やかに改善した．本例はランソプラゾールが原因と考えられるcollagenous colitisの典型例と考えられ，collagenous colitisを疑った場合には薬物服用歴を含む，詳細な病歴の聴取が重要と考えられた．

　A 60-year-old female was admitted with the complaint of frequent watery diarrhea and hypoproteinemia during the period when she was taking Lansoprazole for heartburn symptom. Barium enema study delineated long and narrow longitudinal ulcer scars in the left and transverse colon. Magnifying colonoscopy with indigocarmine dye spray revealed longitudinal ulcer scars as well and loss of submucosal transparency, granular mucosal change and capillary dilatation. Histopathological findings taken from all the colonoic regions revealed a 25～40μm thickened subepithelial collagen band and histological diagnosis was collagenous colitis. The patient's symptoms worsened though after Lansoprazole was stopped and required steroid therapy. This case was lean of as typical Lansoprazole-associated collagenous colitis. If a patient is suspected of collagenous colitis because of the symptom of sudden-onset watery diarrhea, detailed history taking including the patient's us of medicine is extremely important.