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薬理と治療
Abstract
Bisphosphonates can cause chemical ulcerations in the esophagus in some patients. The postulated pathophysiological mechanism of underlying ulcer formation due to bisphosphonate tablets use is direct mucosal irritation. An 83-year-old woman who had been treated for osteoporosis and vertebral fractures was admitted to Tsuboi hospital owing to complain of tarry stools since two days. The patient had anemia and was malnourished. Five days before manifestation of these symptoms, the patient had taken risedronate with a full glass of water, after which she had remained upright for 30 minutes. At admission endoscopy showed severe circumferential ulceration of the distal esophagus close to the esophagogastric mucosal junction. She was treated with an intravenous proton-pump inhibitor, and received a blood transfusion. After her recovery, a large hiatal hernia of the esophagus was noted on barium studies. A longer duration of high pressure zone in the esophageal hiatal hernia leads to a disturbance of peristalsis, which may have prolonged the contact time of risedronate tablets on the esophageal mucosa. This case suggests that we should exercise caution when using bisphosphonates in patients with hiatal hernias of the esophagus.
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