オルメサルタン関連スプルー様腸疾患の1例

Spruelike Enteropathy Associated with Olmesartan, Report of a Case

要旨●患者は60歳代，女性．長期持続する下痢があり，当院に紹介され，受診となった．上部消化管内視鏡検査で十二指腸に粘膜萎縮，顆粒状隆起を認めた．カプセル内視鏡検査，ダブルバルーン内視鏡検査では小腸全域に絨毛萎縮，顆粒状隆起など多彩な所見を認めた．病理組織学的所見では絨毛萎縮と炎症細胞浸潤を認めた．以上よりセリアック病を疑ったが，関連する抗体は陰性であった．オルメサルタンを長期内服しており，中止後下痢は改善した．通常食摂取でも下痢は認めず，オルメサルタン関連スプルー様腸疾患と診断した．オルメサルタン関連スプルー様腸疾患は，新しい疾患概念であり強い吸収不良を呈する．本邦ではまれと思われるが，強い吸収不良を認めた際，鑑別として考える必要がある．

　A woman in her sixties was referred to us because of a 2-month history of watery diarrhea. Esophagogastroduodenoscopy revealed atrophy of the duodenal mucosa and nodular mucosa. Capsule enteroscopy and anterograde double-balloon enteroscopy revealed changes such as villous atrophy and nodular mucosa from the duodenum to the ileum. Pathological examination showed villous atrophy and chronic inflammatory cell infiltration. We suspected celiac disease until we learned that test results for antibodies associated with celiac disease were negative. When the patient disclosed that she had been taking olmesartan for 4.5 years, we suspected spruelike enteropathy associated with olmesartan. We confirmed a diagnosis of spruelike enteropathy associated with enteropathy on the basis of examinations and test findings and institution of a diet containing gluten that did not cause diarrhea. Spruelike enteropathy associated with olmesartan is a relatively new disease concept that is characterized by severe malabsorption. Although spruelike enteropathy associated with olmesartan is rare in Japan, the disease should be considered as a differential diagnosis when severe malabsorption is observed.