薬剤関連消化管病変の病理学的特徴と鑑別

Pathological Characteristics and Differentiation of Drug-related Gastrointestinal Lesions

要旨●代表的な薬剤関連消化管病変（NSAIDs起因性消化管病変，抗癌剤性胃腸炎，薬剤関連食道炎，抗生物質起因性出血性大腸炎，抗生物質起因性偽膜性大腸炎，collagenous colitis，特発性腸間膜静脈硬化症，塩化カリウム，ケイキサレート/ソルビトール，PPI，大腸メラノーシス，炭酸ランタン）の病理組織学的特徴と鑑別の要点について言及した．薬剤による消化管病変は非特異的組織像を示すものが多く，病理学的所見のみで確定診断に至る疾患は多くはない．したがって詳細な服薬歴の聴取などの十分な臨床情報の把握が必要であり，他疾患の鑑別を十分に行ったうえで総合的な診断を行うことが肝要である．

　We noted the main points regarding the pathological characteristics and differentiation of typical drug-related gastrointestinal lesions, including non-steroidal anti-inflammatory drug-induced lesions, anticancer-drug-related gastroenteritis, drug-related esophagitis, antibiotic-induced colitis, collagenous colitis, idiopathic mesenteric phlebosclerosis, potassium chloride-related lesions, kayexalate-sorbitol-related lesions, proton-pump inhibitor-related lesions, melanosis coli, and lanthanum carbonate-related lesions. Often, drug-induced gastrointestinal lesions had a nonspecific histology ; hence, it was not possible to reach a definite diagnosis based on pathological findings alone. Therefore, as much clinical information regarding the patient's drug-taking history as possible should be obtained via various methods such as detailed interviews, and it is essential to make a comprehensive diagnosis after the careful exclusion of other conditions.