臨牀消化器内科 Vol.32 No.2(4-3)


特集名 胃酸分泌抑制療法―その歴史的変遷と現状,今後の課題
題名 酸分泌抑制療法の課題と今後(3)その他の課題―肺炎・骨関節疾患・認知症など
発刊年月 2017年 02月
著者 白井 聖一 和歌山県立医科大学第二内科
著者 前北 隆雄 和歌山県立医科大学第二内科
著者 加藤 順 和歌山県立医科大学第二内科
著者 北野 雅之 和歌山県立医科大学第二内科
【 要旨 】 プロトンポンプ阻害薬は酸分泌抑制療法の中心的薬剤であるが,長期投与におけるさまざまな問題点が懸念されてきた.カルチノイドや大腸疾患以外に,当初は市中肺炎や骨関節疾患なども問題視されていたが,現在,長期投与ではリスク増加にならないと考えられている.最近,認知症や慢性腎臓病との関連,クロピドグレル活性化とは関連のない心血管イベントのリスクなどが報告されているが未だエビデンスとしては不十分である.今後また新たな問題点が明らかとなる可能性があり,新規薬剤であるカリウムイオン競合型アシッドブロッカーの発売に伴い,酸分泌抑制薬のメリットとデメリットを考えて使用する重要性はますます高まると考えられる.
Theme Treatment of Acid‒related Diseases -- the Past, Present and Future
Title Adverse Effects Other than Carcinoid and Colorectal Disease during Long—term Acid—suppressive Medication
Author Kiyokazu Shirai Second Department of Internal Medicine, Wakayama Medical University
Author Takao Maekita Second Department of Internal Medicine, Wakayama Medical University
Author Jun Kato Second Department of Internal Medicine, Wakayama Medical University
Author Masayuki Kitano Second Department of Internal Medicine, Wakayama Medical University
[ Summary ] With the advent of strong acid‒suppressive medication such as "proton pump inhibitors (PPIs)" ; PPIs have played a central role in the treatment of acid‒related disorders because of fewer side‒effects, superior effectiveness long‒term, and cost‒effectiveness.
Because of the insufficient data on its prolonged administration, the safety of the longer‒term use of PPIs is still controversial. In addition to carcinoid and colon disease, there is concern that the longer‒term use of PPIs might lead to adverse effects such as community‒acquired pneumonia, fractures, progression of atrophic gastritis, gastric cancer, vitamin B12 deficiency, iron deficiency, and hypomagnesemia. However, the findings from various studies demonstrate that the marked increase of the risk of these adverse effects was not confirmed in the longer‒term use of PPIs. Recently, the risk of dementia, chronic kidney disease, and cardiovascular events unrelated to the use of clopidogrel has been reported, but the evidence and mechanisms remain unclear. Furthermore, another adverse effects related to the long‒term use of PPIs may merge. It is expected that the use of acid‒suppressive medication will increase in the future. However, the advantages and disadvantages of PPI use still need to be considered.
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