NSAID起因性腸病変の臨床的検討

Clinical Study on Non-steroidal Antiinflammatory Drug (NSAID) Induced Intestinal Lesions

要旨　NSAID起因性腸疾患の診断は，既存の腸疾患が否定され，発症や経過からNSAIDとの関連が明瞭であることを基準とした．男性13例，女性10例を診断した．その臨床的特徴として，NSAID短期投与例（1か月未満）では，下血を主症状とし，病変は回盲弁や終末回腸に多く，浅い略円形潰瘍で多発し，易出血性のことが多い．噴出性の出血を認めた3例にクリップによる止血が効果的であった．発症はNSAID服用後最短で3日後に出現していた．長期投与例（1か月以上）では，腹痛や下痢，出血などを繰り返していたが診断されていなかったものが多く，略円形潰瘍のほか狭窄を伴うものがみられた．NSAID起因性腸病変の診断はその特徴を知り，可能性を疑うことが大切である．

　The NSAID induced intestinal lesions was diagnosed by the exclusion of the other disease and strong relation to NSAID administration. Thirteen men and 10 women were diagnosed based on our criteria. The characteristics of short term NSAID induced lesions which was defined as administration of drugs less than one month were as follows : The chief complaint was hematochezia, the lesions were often multiple, the ulcers were round and punched out with friable, three of them had spurt of bleeding to which clipping was effective, and the lesions were frequently located on the ileocecal valve and terminal ileum. Shortest duration of NSAID administration was three days before the disease appeared. In cases of long-term administration (more than one month), complains were diarrhea with abdominal pain and hemorrhage. Although recurrent symptoms, some of the patients were not diagnosed promptly. The lesions of long-term administration were round ulcers with stricture.

　For the diagnosis of the NSAID induced intestinal lesions, it is important to understand the characteristics and clinical feature of the lesions, as well as to suspect the disease.