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起因性消化管病変の治療と予防

著者： 三宅一昌¹ 楠正典¹ 進藤智隆¹ 平塚哲郎¹ 二神生爾¹ 藤森俊二¹ 坂本長逸¹

所属機関： ¹日本医科大学消化器内科

ページ範囲：P.1751 - P.1758

要旨　非ステロイド性抗炎症薬（non-steroidal anti-inflammatory drug；NSAID）はその使用量の増加とともに，NSAIDによる粘膜傷害が上部だけでなく下部消化管においても注目されている．その予防的治療は抗潰瘍薬を用いて経験的に行われてきた．しかしながら，近年，抗潰瘍薬だけでなく，選択的COX-2阻害薬，Helicobacter pylori（H. pylori）除菌療法によるNSAID潰瘍予防に関する大規模臨床試験が，欧米を中心に精力的に行われ，PPI，prostaglandin製剤による予防効果および選択的COX-2阻害薬の有効性が明らかとなりつつある．除菌療法の効果については結論が得られていないが，NSAID投与前に除菌することが推奨されている．日本人は，酸分泌量が少なく，H. pylori感染率も高いことを考慮すると，今後，わが国独自のNSAID潰瘍の実態調査ならびに治療と予防に関する介入試験が望まれる．

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