药源性显微镜结肠炎及其防治

Drug-induced microscopic colitis and its prevention and treatment

药源性显微镜结肠炎(DIMC)临床表现主要为慢性(持续性或间断性)非血性水样腹泻,内镜检查正常或大致正常,具有特殊的组织病理学表现。致病药物主要为非甾体抗炎药物、质子泵抑制剂及选择性5-羟色胺再摄取抑制剂等。发病机制主要与免疫异常有关。中老年、女性及联合用药为危险因素。处理措施为停用致病药物;症状轻者可使用洛哌丁胺,症状严重者可使用布地奈德;药物治疗无效者可手术治疗。过敏体质及自身免疫性疾病、过敏性疾病患者应慎用可导致DIMC的药物。

Clinical manifestations of drug-induced microscopic colitis （DIMC） are mainly chronic （continuous or intermittent） non-bloody watery diarrhea, a normal or almost normal endoscopic examination, and special histopathological characteristics. The drugs which cause DIMC mainly include nonsteroidal anti-inflammatory drugs, proton pump inhibitors, selective serotonin reuptake inhibitors, and others. The mechanism is associated with abnormal immunization. Risk factors for DIMC are middle-aged and elderly people, female, and combination therapy. The measures for treatment and prevention are as follows： the causative drugs should be discontinued; the patients with mild symptoms of DIMC could be treated with loperamide; the patients with severe symptoms of DIMC could be treated with budesonide; if drug treatment is ineffective, patients might undergo surgery; the drugs known to induce DIMC should be used with caution in patients with allergic diathesis, autoimmune disease, and allergic disease.