ビスホスホネート製剤（アレンドロン酸ナトリウム）による食道潰瘍の1例

Esophageal Ulcer Caused by Bisphosphonate（Alendronate Sodium）, Report of a Case

要旨●患者は60歳代，女性．嚥下時に増強する心窩部痛，食欲低下を主訴に当科を受診した．EGDでは，食道切歯より25〜35cmにびらんや浅い潰瘍を伴うほぼ全周性の粘膜傷害を認めた．患者は，ビスホスホネート製剤を処方されており，少量の水で服薬していることが判明した．そこで，ビスホスホネート製剤による食道粘膜傷害を考え，同薬剤の休薬，制酸剤・粘膜保護剤併用を行い，症状は速やかに改善した．ビスホスホネート製剤による食道粘膜傷害が疑われる場合は，詳細な服薬方法の聴取，EGDを行い，適切な対応を速やかに行うことが重要である．また，発症予防のため適切な服薬方法の指導が大切である．

　A 60-year-old woman complained of loss of appetite and epigastric pain during swallowing. Upper gastrointestinal endoscopy revealed almost complete mucosal injury with erosion and a shallow ulcer 25-35cm from the esophageal incisor. The patient was found to be taking a bisphosphonate preparation and was consuming only a small amount of water with it. Subsequently, the bisphosphonate preparation was withdrawn because of the esophageal mucosal injury caused by it, and a combination of antacid and mucosal protective agent was used.

　Hence, in the cases where esophageal mucosal injury due to bisphosphonates is suspected, it is important to understand the detailed history of medications used by the patient, conduct upper gastrointestinal endoscopy, and take appropriate measures promptly. Moreover, appropriate instructions should be given to the patients regarding the correct way to take medications to prevent the onset of esophageal mucosal injury.