在宅経腸栄養療法を施行中に増悪したCrohn病の2例

Crohn's Disease Unsuccessfully Treated with Long-term Home Enteral Nutrition, Report of Two Cases

要旨　活動期Crohn病に対する成分栄養剤による経腸栄養療法は，ステロイド治療と同等の緩解導入効果があり，活動期Crohn病に対するprimary therapyとして広く用いられているが，その長期的な効果は明らかではない．今回われわれは，10年間在宅経腸栄養療法を施行しているCrohn病の2症例について，その病勢の推移を画像上で検討した．いずれも1,200kcal/日以上の在宅経腸栄養療法を施行していたが，再燃を繰り返した．成分栄養療法をCrohn病の緩解維持に応用した在宅経腸栄養療法は当施設の成績では，1年で40％と長期間の緩解維持効果を十分に有するとは言い難く，長期経過を考えると，コンプライアンスなどを含めて問題が多く，今後の検討が必要である．

　Nutritional therapy with elemental diet formula (ED) is now widely accepted by Japanese physicians and patients as a potent remission-inducing therapy for active Crohn's disease. However, the effectiveness of this ED therapy for remission-maintenance in these patients is still controversial. We report two cases of Crohn's disease, who have undergone the home ED therapy for the last 10 years. In both cases, typical strictures in the small intestine due to cobblestone lesions of Crohn's disease were present. These lesions did not improve during the first several years, and they required surgery. After one or two years after the surgical resections of the small intestine, recurrent lesions at the site of the intestinal anastomosis were noted by radiological examination, but the patients continued the home ED. Through the experience of these cases, we think that the indication and/or cost-benefit of home ED therapy should be re-evaluated by a large-scale randomized controlled trial.