胃と腸44巻6号

2009年05月発行

今月の主題 小腸疾患─小病変の診断と治療の進歩

主題

NSAIDs起因性小腸潰瘍と非特異性多発性小腸潰瘍症における小病変

著者： 松本主之¹ 江崎幹宏¹ 矢田親一朗¹ 森山智彦¹ 古賀秀樹¹ 中村昌太郎¹ 平井郁仁² 松井敏幸² 飯田三雄¹ 八尾恒良²³

所属機関： ¹九州大学大学院医学研究院病態機能内科学 ²福岡大学筑紫病院消化器科 ³佐田病院

ページ範囲：P.951 - P.959

文献概要

要旨　非特異性多発性小腸潰瘍症（CNSU）9例とNSAIDs起因性小腸潰瘍（NSAIDs腸症）14例の内視鏡所見を比較した．単発ないし多発性狭窄はCNSU 9例（100％）とNSAIDs腸症4例（29％）にみられ，前者の8例と後者の2例で開放性潰瘍を伴っていた．非狭窄性輪状潰瘍はCNSUの6例（67％）とNSAIDs腸症の7例（50％）にみられ，前者全例と後者の4例は開放性であった．CNSUの4例（44％）とNSAIDs腸症の1例（7％）で開放性の縦走・斜走潰瘍を認めた．一方，NSAIDs腸症7例（50％）で多発症潰瘍，アフタ，潰瘍瘢痕などの小病変が確認できたが，CNSUでは2例（22％）にすぎなかった．以上より，CNSUでは慢性開放性潰瘍が，NSAIDs腸症では治癒傾向の強い潰瘍と小病変が内視鏡的特徴と考えられた．

参考文献

1）Graham DY, Opekun AR, Willingham FF, et al. Visible small-intesitnal mucosal injury in chronic NSAID users. Clin Gastroenterol Hepatol 3 : 55- 59, 2005

2）Goldstein JL, Eisen GM, Leweis B, et al. Video-capsule endoscopy to prospectively assess small bowel injury with celecoxib, naproxen plus omeprazole, and placebo. Clin Gastroenterol Hepatol 3 : 133-141, 2005

3）Maiden L, Thjodleifsson B, Theodors A, et al. A quantitative analysis of NSAID-induced small bowel pathology by capsule enteroscopy. Gastroenterology 128 : 1172-1178, 2005

4）岡部治弥，崎村正弘．仮称“非特異性多発性小腸潰瘍症"．胃と腸 3 : 1539-1549, 1968

5）崎村正弘．“非特異性多発性小腸潰瘍症"の臨床的研究─限局性腸炎との異同を中心として．福岡医誌 61 : 318-340, 1970

6）八尾恒良，飯田三雄，松本主之，他．慢性出血性小腸潰瘍─いわゆる非特異性多発性小腸潰瘍症．八尾恒良，飯田三雄（編），小腸疾患の臨床．医学書院，176-186, 2004．八尾恒良．非特性小腸潰瘍．臨床科学 13 : 789-797, 1977

7）松井敏幸，飯田三雄，桑野恭行，他．非特異性多発性小腸潰瘍症の長期経過．胃と腸 24 : 1157-1169, 1989

8）Matsumoto T, Iida M, Matsui T, et al. Non-specific multiple ulcers of the small intestine unrelated to non-steroidal anti-inflammatory drugs. J Clin Pathol 57 : 1145-1150, 2004

9）Matsumoto T, Nakamura S, Esaki M, et al. Endoscopic features of chronic nonspecific multiple ulcers of the small intestine : comparison with nonsteroidal anti-inflammatory drug-inuced enteropathy. Dig Dis Sci 51 : 1357-1363, 2006

10）松本主之，中村昌太郎，江 幹宏，他．非特異性多発性小腸潰瘍症の小腸内視鏡所見─非ステロイド性抗炎症剤起因性小腸潰瘍症との比較．胃と腸 41 : 1637-1648, 2006

11）Adler DH, Cogan JD, Phillips JA 3rd, et al. Inherited human cPLA（2 alpha）deficiency is associated with impaired eicosanoid biosynthesis, small intestinal ulceration, and platelet dysfunction. J Clin Invest 118 : 2121-2131, 2008

12）Matsumoto T, Kudo T, Esaki M, et al. Prevalence of non-steroidal anti-inflammatory drug-induced enteropathy determined by double-balloon endoscopy : a Japanese multicenter study. Scand J Gastroenterol 43 : 490-496, 2008

13）Maiden L, Thjodleifsson B, Seigal A, et al. Long-term effects of nonsteroidal anti-inflammatory drugs and cyclooxygenase-2 selective agents on the small bowel : a cross-sectional capsule endoscopy study. Clin Gastroenterol Hepatol 5 : 1040-1045, 2007

14）Goldstein JL, Eisen GM, Lewis B, et al. Small bowel mucosal injury is reduced in healthy subjects treated with celecoxib compared with ibuprofen plus omeprazole, as assessed by video capsule endoscopy. Aliment Pharmacol Ther 25 : 1211-1222, 2007

15）Niwa Y, Nakamura M, Ohmiya N, et al. Efficacy of rebamipide for diclofenac-induced small-intestinal mucosal injuries in healthy subjects : a prospective, randomized, double-blinded, placebo-controlled cross-over study. J Gastroenterol 43 : 270- 276, 2008

16）Fujimori S, Seo T, Gudis K, et al. Prevention of nonsteroidal anti-inflammatory drug-induced small-intestinal injury by prostaglandin : a pilot randomized controlled trial evaluated by capsule endoscopy. Gastrointest Endosc（Epub ahead of print）, 2009

17）Watanabe T, Sugimori S, Kameda N, et al. Small bowel injury by low-dose enteric-coated aspirin and treatment with misoprostol : a pilot study. Clin Gastroenterol Hepatol 6 : 1279-1282, 2008

18）Hayashi Y, Yamamoto H, Kita H, et al. Non-steroidal anti-inflammatory drug-induced small bowel injuries identified by double-balloon endoscopy. World J Gastroenterol 11 : 4861-4864, 2005

19）Hayashi Y, Yamamoto H, Taguchi H, et al. Nonsteroidal anti-inflammatory drug-induced small-bowel lesions identified by double-balloon endoscopy : endoscopic features of the lesions and endoscopic treatments for diaphragm disease. J Gastroenterol 44 : s57-63, 2009