INTESTINE Vol.18 No.4(5)


特集名 日常遭遇する大腸炎の鑑別─内視鏡を中心に
題名 NSAID起因性大腸炎
発刊年月 2014年 07月
著者 二宮 風夫 福岡大学筑紫病院消化器内科
著者 久部 高司 福岡大学筑紫病院消化器内科
著者 安川 重義 福岡大学筑紫病院消化器内科
著者 石原 裕士 福岡大学筑紫病院消化器内科
著者 長浜 孝 福岡大学筑紫病院消化器内科
著者 高木 靖寛 福岡大学筑紫病院消化器内科
著者 平井 郁仁 福岡大学筑紫病院消化器内科
著者 八尾 建史 福岡大学筑紫病院消化器内科
著者 松井 敏幸 福岡大学筑紫病院消化器内科
【 要旨 】 近年NSAID(非ステロイド性抗炎症薬)は,解熱・鎮痛のほかに,抗血栓療法を目的に使用頻度が増加している.NSAIDによる消化管粘膜傷害は上部消化管のみでなく,下部消化管にも発症することが報告されている.NSAID起因性大腸炎は内視鏡像より,潰瘍型と腸炎型に分類され,さらに潰瘍型は膜様狭窄合併の有無により分類される.潰瘍型では右側結腸が好発部位とされ,ハウストラに沿った輪状の境界明瞭な潰瘍を特徴とする.また,腸炎型ではアフタ性大腸炎や出血性大腸炎の所見を認める.ほかの炎症性腸疾患との鑑別に難渋する症例も存在し,診断には詳細な病歴や内服歴の聴取が重要である.
Theme Differential diagnosis for common enterocolitis, especially in endoscopic findings
Title NSAID-induced colopathy
Author Kazeo Ninomiya Department of Gastroenterology, Fukuoka University Chikushi Hospital
Author Takashi Hisabe Department of Gastroenterology, Fukuoka University Chikushi Hospital
Author Shigeyoshi Yasukawa Department of Gastroenterology, Fukuoka University Chikushi Hospital
Author Hiroshi Ishihara Department of Gastroenterology, Fukuoka University Chikushi Hospital
Author Takashi Nagahama Department of Gastroenterology, Fukuoka University Chikushi Hospital
Author Yasuhiro Takaki Department of Gastroenterology, Fukuoka University Chikushi Hospital
Author Fumihito Hirai Department of Gastroenterology, Fukuoka University Chikushi Hospital
Author Kenshi Yao Department of Gastroenterology, Fukuoka University Chikushi Hospital
Author Toshiyuki Matsui Department of Gastroenterology, Fukuoka University Chikushi Hospital
[ Summary ] In addition to its use for analgesia and as an overall antipyretic, an increase in the frequency of nonsteroidal anti-inflammatory drug (NSAID) use for antithrombotic therapy has been seen in recent years. NSAID-induced colopathy is observed in approximately 3 % of those classified endoscopically as being of the ulcerous type or being associated with colitis. The ulcerous type is further classified based on the presence or absence of complications with diaphragm-like strictures. It is commonly found in the right colon with characteristic annular, sharply demarcated ulcers along the haustra. Colitis types can be present when there are aphthous or hemorrhagic findings. While symptoms usually improve after discontinuation of the offending drug, stenotic lesions may remain, potentially requiring endoscopic or surgical therapy. Differentiation from other inflammatory bowel diseases can be challenging, in which case, obtaining detailed clinical and drug histories, in addition to diagnostic imaging, is important for diagnosis.
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