在宅経腸栄養療法が長期の緩解維持に有用であったCrohn病の2例

Crohn's Disease, Successfully Treated with Home Enteral Nutrition (HEN) and Maintained in a State of Remission over a Long-term, Report of Two Cases

要旨　在宅経腸栄養療法(HEN)が長期の緩解維持に有用であったCrohn病の2例を経験した．〔症例1〕は19歳，男性．1987年の小腸造影で回腸に縦走潰瘍と敷石像を認め，小腸Crohn病と診断．完全静脈栄養療法により緩解導入後は，外来で低残渣食を継続した．6か月後に再発したが，HEN導入後は，現在まで緩解を維持している．〔症例2〕は35歳，男性．1990年の大腸内視鏡で，大腸の広範囲に多発潰瘍を認め大腸Crohn病と診断．成分栄養剤による経腸栄養療法で，緩解導入後も外来でHENを継続しているが，現在まで緩解を維持している．経腸栄養療法はCrohn病の緩解導入のみならず，外来でのHENの継続は長期の臨床経過の改善にも有用と考えられ，自験例での成績を加え報告する．

　We reported two cases of Crohn's disease, successfully treated with home enteral nutrition (HEN) and maintained in a state of remission over a long term.

　The first case was small-intestinal type of Crohn's disease. Small-intestinal radiography revealed typical cobblestone appearance and multiple longitudinal ulcers in the ileum. The second case was large-intestinal type of Crohn's disease. Barium enema and colonoscopic findings revealed multiple aphthoid and irregularshaped ulcers in the colon. Some of the ulcers were arranged in a longitudinal direction. In hospital, we treated both cases with total parenteral and/or enteral nutrition, and induced complete remission. After leaving hospital, the treatment with HEN was continued and both cases were maintained in a state of remission for more than f ive years. Home enteral nutrition is useful for maintaining remission and improving the long-term clinical course of Crohn's disease.