胃と腸44巻13号

2009年12月発行

今月の主題 collagenous colitisの現況と新知見 主題

薬剤起因性collagenous colitis―ランソプラゾールに関連した内視鏡的特徴を中心に

著者： 梅野淳嗣¹ 松本主之¹ 中村昌太郎¹ 梁井俊一¹ 平川克哉² 矢田親一朗¹ 城由起彦¹ 山縣元³ 吉村龍司⁴ 渡邉隆⁵ 具嶋正樹⁶ 八尾隆史⁷ 中島豊⁸ 飯田三雄¹

所属機関： ¹九州大学大学院病態機能内科学 ²福岡赤十字病院消化器科 ³国立病院機構小倉医療センター消化器科 ⁴吉村内科 ⁵福岡大学医学部消化器内科 ⁶九州大学大学院形態機能病理学 ⁷順天堂大学医学部人体病理病態学 ⁸福岡赤十字病院病理部

ページ範囲：P.1973 - P.1982

要旨　collagenous colitis 24例を対象とし，臨床像を遡及的に検討した．何らかの薬剤投与を受けていたのは24例中23例であり，最も頻度が高かったランソプラゾールは20例（83％）で投与されていた．ランソプラゾール内服例は，すべて内服中止のみで症状が改善した．ランソプラゾール内服例の11例（55％）に細長い縦走潰瘍が観察されたが，ランソプラゾール非内服例ではみられなかった（p＝0.07）．縦走潰瘍は左側結腸を中心に分布し，境界が明瞭で周囲の浮腫性変化に乏しかった．組織学的には，ランソプラゾール内服例で非内服例よりも膠原線維帯が厚い傾向がみられた（p＝0.08）．以上より，本邦ではランソプラゾールに関連したcollagenous colitisが比較的多く，その内視鏡所見として左側結腸の縦走潰瘍が特徴的である可能性が示唆された．

参考文献

1）Nyhlin N, Bohr J, Eriksson S, et al. Systematic review : microscopic colitis. Aliment Pharmacol Ther 23 : 1525-1534, 2006

2）Bohr J, Tysk C, Eriksson S, et al. Collagenous colitis : a retrospective study of clinical presentation and treatment in 163 patients. Gut 39 : 846-851, 1996

3）Sato S, Benoni C, To´th E, et al. Chromoendoscopic appearance of collagenous colitis─a case report using indigo carmine. Endoscopy 30 : S80-81, 1998

4）Katsinelos P, Katsos I, Patsiaoura K, et al. A new endoscopic appearance of collagenous colitis. Endoscopy 29 : 135, 1997

5）Richieri JP, Bonneau HP, Cano N, et al. Collagenous colitis : an unusual endoscopic appearance. Gastrointest Endosc 39 : 192-194, 1993

6）Cruz-Correa M, Milligan F, Giardiello FM, et al. Collagenous colitis with mucosal tears on endoscopic insufflation : a unique presentation. Gut 51 : 600, 2002

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

8）Poupardin-Moulin C, Atlani M, Sabate JM, et al. ［Mucosal tears in a patient with collagenous colitis］. Gastroenterol Clin Biol 28 : 310-311, 2004

9）Sherman A, Ackert JJ, Rajapaksa R, et al. Fractured colon : an endoscopically distinctive lesion associated with colonic perforation following colonoscopy in patients with collagenous colitis. J Clin Gastroenterol 38 : 341-345, 2004

10）Koulaouzidis A, Henry JA, Saeed AA. Mucosal tears can occur spontaneously in collagenous colitis. Endoscopy 38 : 549, 2006

11）Wickbom A, Lindqvist M, Bohr J, et al. Colonic mucosal tears in collagenous colitis. Scand J Gastroenterol 41 : 726-729, 2006

12）Umeno J, Matsumoto T, Nakamura S, et al. Linear mucosal defect may be characteristic of lansoprazole-associated collagenous colitis. Gastrointest Endosc 67 : 1185-1191, 2008

13）Smith RR, Ragput A. Mucosal tears on endoscopic insufflation resulting in perforation : an interesting presentation of collagenous colitis. J Am Coll Surg 205 : 725, 2007

14）Hashimoto Y, Endo Y, Kuroki Y, et al. Collagenous colitis with unique colonoscopic findings. Endoscopy 40（Suppl 2） : E162, 2008

15）Dunzendorfer T, Wilkins S, Johnson R. Mucosal tear in collagenous colitis. Clin Gastroenterol Hepatol, 2008

16）Allende DS, Taylor SL, Bronner MP. Colonic perforation as a complication of collagenous colitis in a series of 12 patients. Am J Gastroenterol 103 : 2598-2604, 2008

17）Couto G, Bispo M, Barreiro P, et al. Unique endoscopy findings in collagenous colitis. Gastrointest Endosc 69 : 1186-1188, 2009

18）Cuoco L, Bertoncello V, Salvagnini M. Colonic perforation after colonoscopy in patients with collagenous colitis. Am J Gastroenterol 104 : 1846-1847, 2009

19）Loftus EV. Microscopic colitis : epidemiology and treatment. Am J Gastroenterol 98 : S31-36, 2003

20）渡邉隆，平川克哉，佐藤茂，他．縦走潰瘍が多発したcollagenous colitisの1例．Gastroenterol Endosc 50 : 27-33, 2008

21）松原亜季子，九嶋亮治，柿木里枝，他．Collagenous colitis─日本人症例の特徴．病理と臨 26 : 823-832, 2008

22）堀田欣一，小山恒男，宮田佳典，他．慢性下痢症におけるMicroscopic Colitisの頻度．消内視鏡 20 : 1357-1361, 2008

23）Sano S, Yamagami K, Tanaka A, et al. A unique case of collagenous colitis presenting as protein-losing enteropathy successfully treated with prednisolone. World J Gastroenterol 14 : 6083-6086, 2008

24）古賀秀樹，松本主之，梅野淳嗣，他．特徴的な縦走潰瘍を伴ったcollagenous colitis．月刊レジデント 1 : 36-45, 2008

25）Chiba M, Sugawara T, Tozawa H, et al. Lansoprazole-associated collagenous colitis : diffuse mucosal cloudiness mimicking ulcerative colitis. World J Gastroenterol 15 : 2166-2169, 2009

26）Giardiello FM, Bayless TM, Yardley JH. Collagenous colitis. Compr Ther 15 : 49-54, 1989

27）Lazenby AJ, Yardley JH, Giardiello FM, et al. Lymphocytic（“microscopic”）colitis : a comparative histopathologic study with particular reference to collagenous colitis. Hum Pathol 20 : 18-28, 1989

28）Giardiello FM, Hansen FC 3rd, Lazenby AJ, et al. Collagenous colitis in setting of nonsteroidal antiinflammatory drugs and antibiotics. Dig Dis Sci 35 : 257-260, 1990

29）Riddell RH, Tanaka M, Mazzoleni G. Non-steroidal anti-inflammatory drugs as a possible cause of collagenous colitis : a case-control study. Gut 33 : 683-686, 1992

30）Macaigne G, Boivin JF, Simon P, et al. Lansoprazole-associated collagenous colitis. Gastroenterol Clin Biol 25 : 1030, 2001

31）Thomson RD, Lestina LS, Bensen SP, et al. Lansoprazole-associated microscopic colitis : a case series. Am J Gastroenterol 97 : 2908-2913, 2002

32）Veress B, Löfberg R, Bergman L. Microscopic colitis syndrome. Gut 36 : 880-886, 1995

33）Baert F, Wouters K, D'Haens G, et al. Lymphocytic colitis : a distinct clinical entity? A clinicopathological confrontation of lymphocytic and collagenous colitis. Gut 45 : 375-381, 1999

34）Goff JS, Barnett JL, Pelke T, et al. Collagenous colitis : histopathology and clinical course. Am J Gastroenterol 92 : 57-60, 1997

35）Ferna´ndez-Banares F, Esteve M, Espino´s JC, et al. Drug consumption and the risk of microscopic colitis. Am J Gastroenterol 102 : 324-330, 2007

36）Beaugerie L, Pardi DS. Review article : drug-induced microscopic colitis─proposal for a scoring system and review of the literature. Aliment Pharmacol Ther 22 : 277-284, 2005

37）Wilcox GM, Mattia AR. Microscopic colitis associated with omeprazole and esomeprazole exposure. J Clin Gastroenterol 43 : 551-553, 2009

38）Ishizaki T, Horai Y. Review article : cytochrome P450 and the metabolism of proton pump inhibitors─emphasis on rabeprazole. Aliment Pharmacol Ther 13 : 27-36, 1999

39）Andersson T. Pharmacokinetics, metabolism and interactions of acid pump inhibitors. Focus on omeprazole, lansoprazole and pantoprazole. Clin Pharmacokinet 31 : 9-28, 1996

40）Rammer M, Kirchgatterer A, Höbling W, et al. Lansoprazole-associated collagenous colitis : a case report. Z Gastroenterol 43 : 657-660, 2005

41）Chande N, Driman DK. Microscopic colitis associated with lansoprazole : report of two cases and a review of the literature. Scand J Gastroenterol 42 : 530-533, 2007

42）Abdo A, Raboud J, Freeman HJ, et al. Clinical and histological predictors of response to medical therapy in collagenous colitis. Am J Gastroenterol 97 : 1164-1168, 2002

43）Komuro Y, Watanabe T, Hata K, et al. Diversion colitis with a mucosal tear on endoscopic insufflation. Gut 52 : 1388-1389, 2003

44）Freeman HJ, James D, Mahoney CJ. Spontaneous peritonitis from perforation of the colon in collagenous colitis. Can J Gastroenterol 15 : 265-267, 2001

45）Bohr J, Larsson LG, Eriksson S, et al. Colonic perforation in collagenous colitis : an unusual complication. Eur J Gastroenterol Hepatol 17 : 121-124, 2005