Bächle T, Dreher U, Rühl U, Walker S
Innere Medizin I, Schwerpunkt Gastroenterologie, Infektionskrankheiten, Onkologie, Krankenhaus Bietigheim, Kliniken Ludwigsburg-Bietigheim gGmbH.
Med Klin (Munich). 2001 Mar 15;96(3):166-70. doi: 10.1007/pl00002189.
A 67-year-old woman was admitted to our hospital for spasmodic abdominal pain, diarrhea, and general weakness. She had lost 5 kg of weight over the past few weeks. The patient had a 20-year history of chronic analgetic abuse, mainly consuming over-the-counter nonsteroidal anti-inflammatory drugs (NSAID).
Laboratory examination was remarkable for a low serum albumin (2.3 g/dl), an increased erythrocyte sedimentation rate of 70 mm/h, and a profound anemia of 8.5 g/dl. Ultrasound of the abdomen showed thickening of the colonic wall and distended colon loops filled with fluid. On colonoscopy several ulcerations from the sigmoid to the ileum were seen. Histologic examination showed a nonspecific ileocolitis.
DIAGNOSIS, THERAPY AND CLINICAL COURSE: After cessation of NSAID intake diarrhea stopped within a few days. Abdominal pain resolved, anemia improved and the patient gained weight. A second colonoscopy revealed healing of the colonic ulcerations. Additional examinations regarding differential diagnoses showed no pathological results. Clinical course and subsequent clinical and endoscopic controls revealing further improvement confirmed the diagnosis of an NSAID-induced ileocolitis.
This patient is a typical example for NSAID-induced colonic ulcerations. It should be recognized that NSAID induce ulcers not only in the upper gastrointestinal tract. A careful drug history may provide the clue for the cause of lower gastrointestinal tract ulcerations.
一名67岁女性因痉挛性腹痛、腹泻和全身乏力入院。在过去几周内，她体重减轻了5千克。该患者有20年慢性镇痛药滥用史，主要服用非处方非甾体抗炎药（NSAID）。
实验室检查结果显著，血清白蛋白低（2.3g/dl），红细胞沉降率增至70mm/h，严重贫血，血红蛋白为8.5g/dl。腹部超声显示结肠壁增厚，结肠袢扩张并充满液体。结肠镜检查发现从乙状结肠至回肠有多处溃疡。组织学检查显示为非特异性回结肠炎症。
诊断、治疗与临床过程：停用NSAID后，腹泻在数天内停止。腹痛缓解，贫血改善，患者体重增加。第二次结肠镜检查显示结肠溃疡愈合。关于鉴别诊断的其他检查未发现病理结果。临床过程以及随后的临床和内镜检查显示进一步改善，证实了NSAID诱导的回结肠炎症的诊断。
该患者是NSAID诱导的结肠溃疡的典型病例。应当认识到，NSAID不仅会在上消化道诱发溃疡。详细的用药史可能为下消化道溃疡的病因提供线索。
