バルサルタン内服を契機に発症し蛋白漏出性胃腸症を伴ったcollagenous gastroenterocolitisの1例

Collagenous Gastroenterocolitis with Protein-losing Enteropathy Associated with Valsartan, Report of a Case

要旨●患者は80歳代後半，女性．バルサルタン内服後より水様性下痢と両下肢浮腫が出現した．大腸内視鏡検査では粘膜血管網の不規則な増生と走行の乱れを認め，生検で上皮直下の肥厚した膠原線維束と粘膜固有層の慢性炎症細胞浸潤を認めた．上部消化管内視鏡検査では前庭部の顆粒状粘膜と胃体部・胃穹窿部に横走する短い溝状陥凹を認め，小腸内視鏡検査では空腸・回腸にびらんが多発していた．胃，十二指腸，空腸，および回腸から採取した生検組織でも膠原線維束を認めた．蛋白漏出シンチグラフィーとα₁-アンチトリプシンクリアランス試験では蛋白漏出性胃腸症が確認された．以上より，本症例は蛋白漏出性胃腸症を伴うcollagenous gastroenterocolitisであり，発症にバルサルタン内服が関与した可能性が考えられた．

　An 88-year-old woman presented at our institution with watery diarrhea and edema of the lower extremities occurring after the initiation of oral valsartan administration. Colonoscopy revealed minimally distorted hypervascularity throughout the colon. Histology of biopsy specimens from the colonic mucosa revealed a thickened subepithelial collagen band and inflammatory infiltrate in the lamina propria. Esophagogastroduodenoscopy revealed granular mucosa of the gastric antrum and multiple, diminutive, and linear scratches along the transverse axis in the gastric body. Balloon-assisted endoscopy revealed multiple erosions in the jejunum and ileum. Histological examination of the multiple biopsies obtained from the stomach, duodenum, jejunum, and ileum revealed a collagen band in the subepithelial layer. Both technetium-99m human serum albumin scintigraphy and alpha-1 antitrypsin clearance test showed findings consistent with protein-losing enteropathy. Based on these findings, we diagnosed the patient as having collagenous gastroenterocolitis with protein-losing enteropathy. The condition may have been associated with the use of valsartan.