内視鏡検査で経過観察しえたビスフォスフォネート製剤による薬剤性食道炎の1例

Bisphosphonate (Alendronate): Induced Esophagitis Observed by Endoscopy, Report of a Case

要旨●患者は69歳，女性．胸骨後部痛と嚥下痛，胸やけ，体重減少を認めたため入院した．内視鏡検査で切歯列より30〜35cmの胸部中下部食道に境界明瞭な地図状びらんを認め，病理組織学的所見は著明な好酸球浸潤を伴う肉芽組織であった．骨粗鬆症のため3年前からビスフォスフォネート製剤（BP）を処方されており，少量の水で内服した4日後に発症していたため，BPによる薬剤性食道炎と診断した．H₂拮抗薬と制酸薬投与で症状は速やかに軽快し，入院10日目の内視鏡再検査でびらんは治癒しており退院となった．BPによる薬剤性食道炎はよく知られた合併症であるが，鑑別診断のために早急な内視鏡検査を行うこと，また発症予防には適切な服薬指導とそれを順守させることが必要である．

　A 69-year-old woman was admitted to our hospital because of severe retrosternal pain, odynophagia, heartburn, and body weight loss. She had been generally well until a week before admission. Endoscopic examination revealed demarcated shallow esophageal erosions at 30〜35 cm from the incisors, with normal adjacent mucosa. Pathological examination of the biopsy specimen showed inflammatory exudates and inflamed granulation tissue accompanied with massive eosinophilic infiltration. The patient reported receiving alendronate for 3 years as a treatment for post-menopausal osteoporosis and had taken the tablet without adequate water 4 days before onset. Therefore, erosions were believed to be because of alendronate intake, and alendronate-induced esophagitis was diagnosed. All symptoms had immediately resolved by a temporary period parenteral hydration and administration of intravenous H₂-receptor antagonist and oral antacids. Ten days after admission, repeated endoscopic examination demonstrated ulcer healing. It is important to perform endoscopy immediately for accurate diagnosis. Moreover, we would like to emphasize the importance of providing proper instructions to minimize the risk of serious side effects of bisphosphonates.