NSAID起因性下部消化管病変の臨床像―腸炎型と潰瘍型の対比

Clinical and Endoscopic Features in Patients with Nonsteroidal Anti-inflammatory Drug-induced Colopathy

要旨　3年間に経験した下部消化管病変のうち，抗生物質非投与かつ非ステロイド性抗炎症剤（NSAIDs）の投与歴が明らかで，薬剤の中止により病変の改善が確認できた16例の臨床像と大腸病変の経過を検討した．①3例はカルボン酸，プロピオン酸，エノール酸ないし合剤の内服で発症した出血性大腸炎あるいはアフタ性腸炎で，薬剤中止後早期に消失した．②3例はカルボン酸，プロピオン酸ないしエノール酸系薬剤内服中に終末回腸のアフタ性病変ないし浮腫像を認め，薬剤の中止で改善した．③10例は酢酸系ないしプロピオン酸系薬剤の投与中に発見された単発性ないし正常粘膜が介在する多発潰瘍で，瘢痕を残して治癒し，1例では膜様の輪状狭窄に至っていた．以上より，NSAIDs起因性大腸病変は原因薬剤や臨床像から腸炎型と潰瘍型に分類可能で，後者は分類不能の潰瘍性病変や基礎疾患に関連した腸病変に含まれてきた可能性が示唆された．

　To determine the clinical features of nonsteroidal anti-inflammatory drug (NSAID)-induced colopathy, we reviewed subjects with colonoscopically verified lesions who had been administered NSAIDs. Among 16 patients who satisfied our criteria for NSAIDs-induced colopathy, 10 patients, (group 1), had single or multiple discrete ulcers. One of these patients had developed ulcers in diaphragm-like strictures in the ascending colon. The remaining four patients, (group 2), had diffusely hemorrhagic lesions or aphthoid ulcers in the colon or in the terminal ileum. Diclofenac sodium and loxoprofen sodium had been more frequently administered in the former group, (group 1), of subjects than in the latter. In addition, underlying conditions including chronic renal failure and rheumatoid arthritis were more frequent in group 1 than in the group 2. These findings suggest that NSAIDs-induced colopathy includes two distinctive entities, and that the colopathy with discrete ulcers may often have been misdiagnosed as nonspecific ulcers or as enteropathy associated with underlying diseases, while actually such colopathy has been induced by nonsteroidal anti-inflammatory drugs.