薬剤性大腸炎の最近の動向

Recent Trends in Drug-induced Colitis

要旨●薬剤性が原因または契機となり発症する大腸炎のうち，NSAIDs起因性大腸炎，抗菌薬関連出血性大腸炎，Clostridioides difficile感染症，薬剤起因性膠原線維性大腸炎，抗癌薬起因性大腸炎，腸間膜静脈硬化症，免疫チェックポイント阻害薬関連大腸炎，腸管囊腫様気腫症，青黛による虚血性腸病変を挙げ，それぞれの特徴について症例を提示しながら解説した．大腸病変を呈する薬剤性腸炎の頻度や注目度は，免疫チェックポイント阻害薬による免疫関連有害事象を除くと，いずれも近年低下傾向だが，特徴的な病歴や画像所見，病理所見を呈するものも多く，それぞれの特徴を把握して診療を行う必要がある．

　We reviewed and illustrated the characteristic features of various forms of drug‐induced colitis（DIC）, including NSAIDs-induced colitis, antibiotic‐associated hemorrhagic colitis, Clostridioides difficile infection, drug‐induced collagenous colitis, anticancer agent-induced colitis, mesenteric phlebosclerosis, immune checkpoint inhibitor-related colitis, pneumatosis intestinalis, and indigo naturalis-associated ischemic intestinal lesions by presenting representative clinical cases. Although the overall frequency and clinical prominence of DIC presenting with colonic lesions, except for immune‐related adverse events caused by immune checkpoint inhibitors, have been declining in recent years, many of these conditions exhibit distinctive clinical histories, imaging findings, and pathological features. Therefore, clinicians must acquaint themselves with these features to ensure appropriate diagnosis and management.