Sakurai Y
Div. of Gastroenterology, Kanto Teishin Hospital.
Nihon Rinsho. 1998 Sep;56(9):2382-6.
Drug-associated hemorrhagic colitis are divided into antibiotic associated hemorrhagic colitis (AAHC) and other drug associated hemorrhagic colitis. AAHC are mainly caused by oral usage of Ampicillin and its derivatives (85%). Initially AAHC are believed to be caused by Klebsiella oxytoca overgrowth. However, these organisum has no exotoxin like Clostridium difficile and pathogenesis of AAHC are still unresolved. Typical AAHC are diagnosed by colonoscopy with diffuse hemorrhage and edema mainly found in descending colon and transverse colon. NSAIDs are also the cause of hemorrhagic colitis like AAHC. Mephenamic acid are famous for this complication. Diarrhea is one of the main complication of oral 5-fluorouracil administration and even causes hemorrhagic colitis. Its histology are characteristic in gland atrophy. Gold colitis are reported 36 cases in rheumatoid arthritis patients. Exact mechanism of bleeding are not understood. NSAIDs may cause collagenous colitis and or lymphocytic colitis in RA patients. Other rare hemorrhagic colitis are associated with azathioprine, methyl dopa, interferon alfa etc. NSAIDs and anticoagulants are well known drugs for complication of GI bleeding making hemorrhagic enteritis.
药物相关性出血性结肠炎分为抗生素相关性出血性结肠炎（AAHC）和其他药物相关性出血性结肠炎。AAHC主要由口服氨苄西林及其衍生物引起（85%）。起初，AAHC被认为是由产酸克雷伯菌过度生长所致。然而，这些微生物不像艰难梭菌那样产生外毒素，AAHC的发病机制仍未明确。典型的AAHC通过结肠镜检查诊断，主要在降结肠和横结肠发现弥漫性出血和水肿。非甾体抗炎药（NSAIDs）也是导致类似AAHC的出血性结肠炎的原因。甲芬那酸因这种并发症而闻名。腹泻是口服5-氟尿嘧啶给药的主要并发症之一，甚至可导致出血性结肠炎。其组织学特征为腺体萎缩。在类风湿关节炎患者中报告了36例金制剂结肠炎病例。出血的确切机制尚不清楚。NSAIDs可能在类风湿关节炎患者中导致胶原性结肠炎和/或淋巴细胞性结肠炎。其他罕见的出血性结肠炎与硫唑嘌呤、甲基多巴、干扰素α等有关。NSAIDs和抗凝剂是导致胃肠道出血并发症进而引起出血性肠炎的常见药物。
