胃と腸42巻12号

2007年11月発行

今月の主題 非ステロイド性抗炎症薬（NSAID）起因性消化管病変 主題

NSAID起因性大腸病変の臨床像と内視鏡像

著者： 蔵原晃一¹ 松本主之² 八尾隆史³ 小林広幸¹ 堺勇二¹ 吉野修郎¹ 渕上忠彦¹ 飯田三雄²

所属機関： ¹松山赤十字病院胃腸センター ²九州大学大学院医学研究院病態機能内科学 ³九州大学大学院医学研究院形態機能病理学

ページ範囲：P.1739 - P.1749

要旨　過去11年間に経験したNSAID起因性大腸病変32例の臨床像と内視鏡所見を解析した．その結果，限局性潰瘍性病変を認めた潰瘍型24例とびまん性大腸炎を呈した腸炎型8例の2型に大別された．潰瘍型にみられた粘膜病変は右半結腸，特に回盲部が好発部位で，回盲弁上あるいはhaustra上の境界明瞭な潰瘍を特徴とし，NSAIDの投与中止3～10週後に炎症性ポリープの合併なく治癒瘢痕化した．また，潰瘍型の1例は膜様狭窄を合併し，NSAID投与中止後に潰瘍は治癒したが，狭窄は改善しなかった．一方，腸炎型は下痢を主徴として急性発症し，投与中止2週以内に治癒した．内視鏡像から出血性大腸炎型とアフタ性腸炎型の2型に分類され，抗菌薬関連性腸炎に類似していた．以上より，NSAID起因性大腸病変は潰瘍型と腸炎型に区別して論ずるのが妥当と考えられた．

参考文献

1) Bjarnason I, Hayllar J, Macpherson AJ, et al. Side effects of nonsteroidal anti-inflammatory drugs on the small and large intestine in humans. Gastroenterology 104:1832-1847, 1993

2) Davies NM. Toxicity of nonsteroidal anti-inflammatory drugs in the large intestine. Dis Colon Rectum 38:1311-1321, 1995

3) Fernandez-Banares F, Esteve M, Espinos JC, et al. Drug consumption and risk of microscopic colitis. Am J Gastroenterol 102:324-330, 2007

4)松本主之，飯田三雄，蔵原晃一，他．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．胃と腸 35:1147-1158, 2000

5) Kurahara K, Matsumoto T, Iida M, et al. Clinical and endoscopic features of nonsteroidal anti-inflammatory drug-induced colonic ulcerations. Am J Gastroenterol 96:473-480, 2001

6)蔵原晃一，松本主之，飯田三雄，他．NSAID起因性大腸病変の臨床像と内視鏡像．消化器科 33:181-189, 2001

7)小堀陽一郎，飯田三雄，松本主之，他．偶然の再投与で再発したピリン系解熱鎮痛配合薬による出血性大腸炎の1例．胃と腸 35:1169-1174, 2000

8) Huber T, Ruchti C, Halter F. Nonsteroidal anti-inflammatory drug-induced colonic stricture:a case report. Gastroenterology 100:1119-1122, 1991

9) Halter F, Weber B, Huber T, et al. Diaphragm disease of the ascending colon:association with sustained-release diclofenac. J Clin Gastroenterol 16:74-80, 1993

10) Matsumoto T, Iida M, Kuroki F, et al. Effect of diet on experimentally induced intestinal ulcers:morphology and tissue leukotrienes. Gut 35:1058-1063, 1994

11) Koga H, Aoyagi K, Matsumoto T, et al. Experimental enteropathy in athymic and euthymic rats:synergistic role of lipopolysaccharide and indomethacin. Am J Physiol 276:G576-582, 1999

12) Kelly DA, Piasecki C, Anthony A, et al. Focal reduction of villous blood flow in early indomethacin enteropathy:A dynamic vascular study in the rat. Gut 42:366-373, 1998

13) Smith JA, Pineau BC. Endoscopic therapy of NSAID-induced colonic diaphragm disease. Two cases and a review of published reports. Gastrointest Endosc 52:120-125, 2000

14) Puspok A, Kiener HP, Oberhuber G. Clinical, endoscopic and histologic spectrum of nonsteroidal anti-inflammatory drug-induced lesions in the colon. Dis Colon Rectum 43:685-691, 2000

15) Pan YS, Chen LT, Tseng CA, et al. Clinical and endoscopic features of non-steroidal anti-inflammatory drug-induced colorectal ulcerations. J Formos Med Assoc 104:804-810, 2005

16) Matuk R, Crawford J, Abereu MT, et al. The spectrum of gastrointestinal toxicity and effect on disease activity of selective cyclooxygenase-2 inhibitors in patients with inflammatory bowel disease. Inflamm Bowel Dis 10:352-356, 2004

17)中尾健太郎，角田明良，竹中弘二，他．多種NSAIDsを使用し生じた進行性下部消化管多発潰瘍瘢痕隔膜様狭窄の1手術例．昭和医会誌 66:52-56, 2006

18)今枝博之，岩男泰，井上詠，他．NSAIDs起因性下部消化管病変の臨床像．消化器科 33:198-205, 2001

19) Buchman AL, Schwarz MR. Colonic ulceration associated with the systemic use of nonsteroidal antiinflammatory medication. J Clin Gastroenterol 22:224-226, 1996

20) Kaufman HL, Fischer AH, Carroll M, et al. Colonic ulceration associated with nonsteroidal anti-inflammatory drugs:report of three cases. Dis Colon Rectum 39:705-710, 1996

21)五十嵐正広，勝又伴栄，小林清典，他．NSAID起因性腸病変の臨床的検討．胃と腸 35:1135-1145, 2000

22)大井秀久，西俣寛人，島岡俊治，他．大腸感染症の画像診断．胃と腸 37:275-285, 2002

23) Matsumoto T, Iida M, Matsui T, et al. Endoscopic finding in Yersinia enterocolitica enterocolitis. Gastrointest Endosc 36:583-587, 1990

24)牛尾恭輔，川元健二，岩下生久子，他．寄生虫性感染症―アメーバ性大腸炎:X線・内視鏡診断を主体に．胃と腸 37:415-427, 2002

25)清水誠治，木本邦彦，多田正大，他．細菌性感染症―キャンピロバクター腸炎．胃と腸 37:347-351, 2002

26)渕上忠彦，八尾恒良．大腸結核の診断．消化器外科 3:1945-1952, 1980

27) Yao T, Matsui T, Hiwatashi N. Crohn's disease in Japan:diagnostic criteria and epidemiology. Dis Colon Rectum 43:S85-93, 2000

28)松本主之，中村昌太郎，矢田親一朗，他．長期経過例からみた腸型Behcet病と単純性潰瘍の病態．胃と腸 38:159-172, 2002

29) Kirsch M. Nonsteroidal anti-inflammatory drug colopathy:mimicry of Crohn's disease and colonic carcinoma. J Clin Gastroenterol 24:121-123, 1997

30) Kakar S, Pardi DS, Burgart LJ. Colonic ulcers accompanying collagenous colitis. Implication of nonsteroidal anti-inflammatory drugs. Am J Gastroenterol 98:1834-1837, 2003

31) Hall RI, Petty AH, Cobden I, et al. Enteritis and colitis associated with mefenamic acid. BMJ 287:1182, 1983

32) Gibson GR, Whitacre EB, Ricotti CA. Colitis induced by nonsteroidal anti-inflammatory drugs:Report of four cases and review of the literature. Arch Intern Med 152:625-632, 1992

33)斉藤裕輔，渡二郎，藤谷幹浩，他．薬剤性腸炎の起因薬剤と病態・発症機序．胃と腸 35:1117-1124, 2000

34)岩瀬正典，飯田三雄，名西史夫，他．メフェナム酸による大腸炎の2例．Gastroenterol Endosc 28:1619-1624, 1986

35) Goldstein NS, Cinenza N. The histopathology of nonsteroidal anti-inflammatory drug-associated colitis. Am J Clin Pathol 110:622-628, 1998

36) Baert F, Hart J, Blackstone MO. A case of diclofenac-induced colitis with focal granulomatous change. Am J Gastroenterol 90:1871-1873, 1995

37) Högenauer C, Langner C, Beubler E, et al. Klebsiella oxytoca as a causative organism of antibiotic-associated hemorrhagic colitis. N Engl J Med 355:2418-2426, 2006

38) Beaugerie L, Metz M, Barbut F, et al. Klebsiella oxytoca as an agent of antibiotic-associated hemorrhagic colitis. Clin Gastroenterol Hepatol 1:370-376, 2003