Yasui Yukiko, Nakashima Akio, Sasuga Kosuke, Koike Kentaro, Yamamoto Izumi, Ueda Yoshimi, Tokudome Goro, Ohkido Ichiro, Yokoo Takashi
Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan.
Department of Pathology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan.
BMC Nephrol. 2024 Dec 2;25(1):443. doi: 10.1186/s12882-024-03890-7.
Sodium polystyrene sulfonate (SPS) is a cation-exchange resin used to treat hyperkalemia. Although colorectal ulcers are known side effects of long-term SPS use, few studies have reported SPS-associated gastric ulcers. Herein, we report a case of repeated gastric ulcers during SPS administration.
The patient was a 55-year-old man who was on SPS treatment of hyperkalemia since the initiation of hemodialysis (HD) at the age of 51 years. At the age of 54 years, he started taking vonoprazan fumarate after developing a bleeding duodenal ulcer. The patient underwent laparoscopic pylorus-preserving gastrectomy for four recurrent bleeding gastric ulcers. The resected specimen showed an ulcerative lesion in the pyloric curvature of the stomach, and pathological findings showed deposition of a basophilic crystalline substance resembling a cation-exchange resin at the base of the ulcer.
In this case, various factors, including diabetic gastroenteropathy, use of multiple calcium channel blockers and phosphate binders, obesity, and lifestyle, contributed to decreased gastrointestinal peristalsis. This may have promoted SPS deposition in the stomach, potentially leading to ulceration.
聚苯乙烯磺酸钠（SPS）是一种用于治疗高钾血症的阳离子交换树脂。虽然结直肠溃疡是长期使用SPS已知的副作用，但很少有研究报道SPS相关的胃溃疡。在此，我们报告一例在SPS给药期间反复出现胃溃疡的病例。
该患者为一名55岁男性，自51岁开始血液透析（HD）以来一直在接受SPS治疗高钾血症。54岁时，他在出现十二指肠溃疡出血后开始服用富马酸沃克索拉唑。该患者因四次复发性出血性胃溃疡接受了腹腔镜保留幽门胃切除术。切除标本显示胃幽门弯处有溃疡性病变，病理结果显示在溃疡底部有类似阳离子交换树脂的嗜碱性结晶物质沉积。
在本病例中，多种因素，包括糖尿病性胃肠病、多种钙通道阻滞剂和磷酸盐结合剂的使用、肥胖和生活方式，导致胃肠蠕动减弱。这可能促进了SPS在胃中的沉积，潜在地导致溃疡形成。
