臨牀透析 Vol.22 No.8(12)


特集名 維持透析患者の消化管疾患
題名 維持透析患者の薬剤性胃腸障害
発刊年月 2006年 07月
著者 嶋田 英敬 嶋田病院腎臓内科
【 要旨 】 維持透析患者は多数の薬剤を投与されることが多く,薬剤性胃腸障害のリスクが高い.NSAIDs潰瘍は消化管出血の原因となりうるが,なかでもアスピリンは使用頻度が高い割に低用量のため,副作用が見過ごされがちである.自験例ではアスピリンの潰瘍合併率は57.9 %に及んだ.透析患者では抗凝固薬の使用が消化管出血を助長する危険性が高い.薬剤性腸管機能異常では単純性下痢や便秘がよくみられるが,原因薬剤の中止が難しいことも多く対症療法が中心となる.偽膜性腸炎や出血性大腸炎といった重篤なものの場合は,原因薬剤の中止と然るべき治療が必要なため,速やかな鑑別が重要である.また,維持透析患者の高齢化に伴い,薬剤投与自体がリスクになることもある.
Theme Diseases of Alimentary Tract in Maintenance Dialysis Patients
Title Drug-induced gastrointestinal disorders in chronic dialysis patients
Author Hidetaka Shimada Department of Nephrology, Shimada Hospital
[ Summary ] Chronic dialysis patients are often treated with many kinds of medications, and are a high risk group for gastrointestinal disorders. NSAIDs sometimes cause gastrointestinal bleeding, due to ulcer formation. Although aspirin is frequently prescribed, adverse effects tend to be overlooked because of the low dosage. In our hospital, 57.9 % of patients treated with aspirin had gastrointestinal ulcers. Chronic hemodialysis patients are at high risk for gastrointestinal bleeding because of the intermittent anticoagulant therapy received during dialysis sessions. Simple diarrhea and constipation are often seen in dialysis patients as a result of drug induced gastrointestinal complications. However, since, in most cases, it is difficult to suspend these causal medications, for a variety of reasons, symptomatic treatment is widely used. In cases with critical conditions, such as pseudomembranous enterocolitis and hemorrhagic colitis, immediate diagnosis and appropriate treatment, including the withdrawal of the causal drugs, is required. Moreover, for older patients, careful attention should be paid to the non-pharmacological side effects associated with prescription, drugs such as mis-swallowing of PTP sheet-coated pills.
戻る