アレンドロン酸ナトリウムによる食道潰瘍から狭窄を来した1例

Esophageal Stenosis due to Ulcer caused by Alendronate Sodium Hydrate, Report of a Case

要旨●患者は80歳代，女性．嚥下困難，嚥下痛，体重減少を認めたため当科に紹介され受診となった．内視鏡検査で切歯列から26〜30cmの胸部中部食道に全周性潰瘍と食道胃接合部に逆流性食道炎を認めた．ボノプラザン，スクラルファートを処方したところ，2週間後に症状の改善傾向を認めたが，さらにその1か月後に再度嚥下障害が増悪し胸骨後部痛も出現した．再検の内視鏡検査で胸部食道潰瘍は増悪しており，経鼻内視鏡が通過不可能な高度狭窄を生じていた．内服薬を再確認したところ，約1年前からアレンドロン酸ナトリウムを服用していることが判明し，同薬による薬剤性食道潰瘍と診断して内服中止とした．食道狭窄に対して2回にわたり内視鏡的バルーン拡張術を行い，経口摂取が可能となった．

　A woman in her 80s visited our hospital because of dysphagia, swallowing pain, and weight loss. Endoscopic examination revealed circumferential erosion and ulceration in the mid-thoracic esophagus 26 to 30cm from the incisor and reflux esophagitis corresponding to the esophagogastric junction. She received vonoprazan and sucralfate for 2 weeks, and her symptoms improved. However, 1 month later, she complained of severe dysphagia and retrosternal pain. When reexamined by endoscopy, the esophageal ulcer of the thoracic esophagus was exacerbated, causing massive stenosis that could not be passed by a nasal endoscope. When reconfirming the oral medications, it was identified that she had been taking alendronate sodium hydrate for about 1 year, and she was diagnosed with drug-induced esophageal ulcer. She underwent endoscopic balloon dilation twice for esophageal stenosis, which made her able to eat again.