Ota Hidetaka, Honda Masayuki, Yamaguchi Yasuhiro, Akishita Masahiro, Ouchi Yasuyoshi
Department of Geriatric Medicine, Graduate School of Medicine, University of Tokyo.
Nihon Ronen Igakkai Zasshi. 2012;49(5):627-31. doi: 10.3143/geriatrics.49.627.
We report a case of a 75-year-old woman with urgent watery diarrhea, occurring 5 to 8 times per day, which began after starting lansoprazole (30 mg/day) for erosive gastritis. Her chronic watery diarrhea persisted for over 2 years with mild weight loss. Colonoscopy was performed and biopsies showed collagenous colitis in her transverse colon. We therefore replaced lansoprazole with famotidine (20 mg/day). Within 3 days after the discontinuation of lansoprazole, her watery diarrhea resolved and she recovered, and reported normal feces. Increasing age and female gender are major risk factors for collagenous colitis. The differential diagnosis of collagenous colitis should include: 1) an appropriate clinical history, excluding other etiologies, 2) normal or near-normal endoscopic and/or radiographic findings, and 3) colonoscopic biopsy histopathologic findings consistent with collagenous colitis. The histopathologic findings of colonoscopic biopsy are important for diagnosis. However, because of the colonoscopic burden in elderly patients, we first recommend the discontinuation of medications suspected to cause collagenous colitis.
我们报告一例75岁女性患者，因糜烂性胃炎开始服用兰索拉唑（30毫克/天）后，出现每日5至8次的紧急水样腹泻。她的慢性水样腹泻持续了两年多，伴有轻度体重减轻。进行了结肠镜检查，活检显示其横结肠存在胶原性结肠炎。因此，我们将兰索拉唑换成了法莫替丁（20毫克/天）。停用兰索拉唑后3天内，她的水样腹泻消失，身体康复，并报告粪便正常。年龄增长和女性性别是胶原性结肠炎的主要危险因素。胶原性结肠炎的鉴别诊断应包括：1）适当的临床病史，排除其他病因；2）正常或接近正常的内镜和/或影像学检查结果；3）结肠镜活检组织病理学检查结果与胶原性结肠炎一致。结肠镜活检的组织病理学检查结果对诊断很重要。然而，由于老年患者进行结肠镜检查的负担较大，我们首先建议停用疑似导致胶原性结肠炎的药物。
