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NSAR-Kolopathie

NSAID-colonopathy

Zusammenfassung

Schon lange sind die schmerzstillenden Eigenschaften von NSAR/ASS-Präparaten bekannt. Besonders der Gastrointestinaltrakt ist von Nebenwirkungen wie Einblutungen, Erosionen, Ulzerationen und Perforationen betroffen. Für den oberen Gastrointestinaltrakt konnte unsere Gruppe in einem großen Prozentsatz histologisch die korrekte Diagnose einer NSAR/ASS-induzierten Läsion auf der Basis einer ischämischen Genese stellen. Seltener können auch im unteren Gastrointestinaltrakt NASR/ASS-induzierte Läsionen beobachtet werden. Unsere Arbeitsgruppe konnte auch hier zeigen, dass in einem hohen Prozentsatz die Diagnose einer NSAR-Kolopathie auf der Basis einer ischämischen Nekrose histologisch richtig gestellt werden kann.

Neben den bekannten Komplikationen wie Ulzerationen mit Perforation können im Dünn- und Dickdarm darüber hinaus diaphragmaartige Stenosen als Folge einer NSAR-Einnahme beobachtet werden, die nicht mit Tumorstenosen verwechselt werden dürfen.

Rein histologisch ist eine ischämische Kolitis nicht von einer NSAR-induzierten Läsion zu unterscheiden. Notwendig sind daher die Ergebnisse der Endoskopie. Zuweilen werden die Veränderungen aufgrund des diskontinuierlichen Charakters auch als Morbus Crohn fehlinterpretiert.

Da all unsere Analysen retrospektiver Natur sind, sollten die Ergebnisse in prospektiven Studien geprüft werden.

Abstract

The pain-relief properties of NSAID/ASA preparations have been known for a long time. In particular, the gastrointestinal tract shows side effects such as: erosion, ulceration, and even perforation. In the upper gastrointestinal tract, our group has shown that a correct histological diagnosis of NSAID/ASA induced lesions can be made in a high percentage of cases on the basis of recognition of ischemic necrosis. NSAID/ASA induced lesions are less commonly found in the lower gastrointestinal tract. We could also demonstrate a correct histological diagnosis of NSAID-colonopathy on the basis of finding ischemic necrosis.

Besides the known complications, another typical complication is diaphragm-like stenosis, which must not be mistaken for tumor stenosis.

The differential diagnosis of NSAID-colonopathy includes ischemic colitis, which cannot be distinguished histologically if the exact endoscopic description is not available. Sometimes NSAID/ASA induced lesions are misdiagnosed as Crohn’s disease due to the focal character of the lesions.

Since all of our analyses are retrospective, the criteria developed by our group should be checked prospectively.

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Correspondence to M. Vieth.

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Herrn Professor Stolte zum 65. Geburtstag gewidmet.

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Vieth, M. NSAR-Kolopathie. Pathologe 27, 65–72 (2006). https://doi.org/10.1007/s00292-005-0810-1

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Schlüsselwörter

  • Nichtsteroidale Antirheumatika (NSAR)
  • Acetylsalicylsäure (ASS)
  • Kolopathie
  • Ischämische Kolitis

Keywords

  • Non-steroid anti-inflammatory drugs
  • Acetylsalicylic acid
  • Colitis
  • Diaphragm
  • Ischemic necrosis