NSAIDs・LDAによる消化管粘膜傷害─NSAIDs（LDAを含む）起因性上部消化管粘膜傷害の診断と予防

Diagnosis and Prevention of NSAIDs-induced (including LDA） Upper Gastrointestinal Mucosal Injury

要旨●H. pylori感染率の低下に伴い，上部消化管粘膜傷害の病態や治療のパラダイムは急速に変遷した．今日では低用量アスピリン（LDA）を含むNSAIDsがその主因となり，それらを的確に診断し可能な限り予防することが肝要である．内視鏡像は，幽門部に好発する比較的浅い病変であるが多発傾向を有し，形態は地図状多形性や類楕円形など多彩である．また出血のリスクが高い点に特徴がある．予防に関しては処方開始前に高危険群を拾い上げ，プロトンポンプ阻害薬やPG製剤を併用することで消化管粘膜傷害の発症回避が可能となる．筆者らのデータでもびらん性胃炎の検出率は，抑制されつつある傾向が示された．今後もさらなるエビデンスの蓄積が望まれる．

　Pathology and treatment paradigms of upper gastrointestinal mucosal injury have rapidly changed with a decline in the rate of Helicobacter pylori infections. Today, nonsteroidal anti-inflammatory drugs, including LDA（low-dose aspirin）, have become the leading cause of upper gastrointestinal mucosal injury, therefore accurate diagnosis and prevention are essential. Endoscopic findings show relatively shallow albeit multiple lesions commonly occurring in the pylorus that manifest with a variety of morphologies, such as geographical polymorphism and oval shapes. These lesions are often associated with a high risk of bleeding. Thus, high-risk groups should be considered for prevention before initiating treatment, in addition to the administration of proton pump inhibitors and/or prostaglandins, which may prevent the occurrence of upper gastrointestinal mucosal injury. Our data showed that these preventive approaches effectively suppressed the incidence of LDA-induced erosive gastritis, and studies are being conducted to collect further information.