薬剤の関与が示唆された良性食道潰瘍の1例

Benign Esophageal Ulcer Associated with Drug Use, Report of a Case

要旨●患者は70歳代，男性．心房細動，脳梗塞にて当院外来で，ワルファリンを内服中であった．5か月前より心窩部痛が出現した．症状の改善を認めなかったため，当科外来を受診した．内視鏡検査では，下部食道に不整形の大きな潰瘍を認め，形態的には悪性所見を否定できなかったが，アルギン酸ナトリウムの投与で病変は縮小し，生検組織では確診は得られなかった．食道内圧検査では，上〜中部食道の蠕動の消失を認めた．ワルファリンによる食道潰瘍を考え，内服を中止し，ダビガトランエテキシラートメタンスルホン酸塩に変更した．2年後には潰瘍は瘢痕化しており，食道運動機能異常を背景に出現した，ワルファリン起因性の良性食道潰瘍と診断した．

　We report a case of benign esophageal ulcer associated with drug use. The patient, a man in his 70s, had previous history of atrial fibrillation and cerebral infarction and had been prescribed warfarin in our hospital. He underwent upper gastrointestinal endoscopy because of epigastralgia that lasted for 5 months. Endoscopic examination revealed an irregularly shaped ulceration in the inferior part of the esophagus. Histological examination of biopsy samples did not reveal malignant cells and infectious esophagitis. Manometry showed disappearance of peristalsis in the upper and middle part of the esophagus. His therapy was switched from warfarin to dabigatran etexilate following which the esophageal ulcer resolved and scars had formed 2 years later. On the basis of these findings, the patient was diagnosed with benign esophageal ulcer with warfarin abnormal esophageal motility associated with warfarin administration.