胃と腸53巻6号

2018年05月発行

今月の主題 小腸出血性疾患の診断と治療─最近の進歩

主題

出血を主徴とする小腸非腫瘍性病変の診断と治療─NSAIDs起因性小腸粘膜傷害

著者： 太田和寛¹ 竹内利寿¹ 能田貞治¹ 小嶋融一¹ 原田智¹ 尾崎晴彦¹ 原あずさ¹ 東野健² 樋口和秀¹

所属機関： ¹大阪医科大学第2内科 ²春秋会城山病院消化器内科

ページ範囲：P.829 - P.836

文献概要

要旨●非ステロイド性抗炎症薬（NSAIDs）を服用している患者の小腸粘膜傷害の有病率は80%以上と言われているが，その予防方法や治療方法は確立されていない．プロトンポンプ阻害薬（PPI）はNSAIDsによる上部消化管粘膜傷害予防に有効であるが，酸の存在しない小腸の粘膜傷害には無効である．NSAIDs起因性小腸粘膜傷害の病態は解明されつつあり，その中でも腸内細菌叢の変化が大きな影響を与えていることがわかってきている．また，PPIが腸内細菌叢に影響して小腸粘膜傷害を悪化させているとの報告もある．胃粘膜防御因子増強薬，プロバイオティクス，メトロニダゾールなどの既存の薬物がNSAIDsに起因する小腸粘膜傷害の予防・治療に有効であるとの報告があるが，確固たる方法を確立することがわれわれの急務である．

参考文献

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