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Stomach and Intestine(Tokyo) Volume 29, Issue 13 （December 1994）

胃と腸 29巻13号（1994年12月発行）

Japanese English

今月の主題上部消化管病変の特徴からみた全身性疾患

主題症例食道・胃・十二指腸に特徴的な所見を認めた全身性疾患

胃に多発性隆起性病変を認めた好酸球性胃腸炎の1例 Eosinophilic Gastroenteritis Showing Multiple Polypoid Lesions of the Stomach, Report of a Case 垂石正樹 ¹ , 斉藤裕輔 ¹ , 蘆田知史 ¹ , 野村昌史 ¹ , 榮浪克也 ¹ , 綾部時芳 ¹ , 横田欽一 ¹ , 柴田好 ¹ , 坂田葉子 ² masaki Taruishi ¹ ¹旭川医科大学第3内科 ²旭川医科大学小児科 ¹The Third Department of Internal Medicine, Asahikawa Medical College キーワード：好酸球性胃腸炎 , 経腸栄養療法 , 食物アレルギー Keyword: 好酸球性胃腸炎 , 経腸栄養療法 , 食物アレルギー pp.1451-1456

発行日 1994年12月25日 Published Date 1994/12/25

DOI https://doi.org/10.11477/mf.1403106029

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要旨　患者は13歳，男児．4歳から鉄欠乏性貧血，5歳から腹痛，下痢がみられ，当院小児科で低蛋白血症，低グロブリン血症，好酸球増多症およびIgE異常高値を指摘された．食物抗原に対する著明なアレルギーが認められ，抗アレルギー剤の投与と抗原除去食で経過をみていたが，コントロール不良のため消化管精査の目的で当科を紹介された．上部消化管内視鏡検査で，胃前庭部に縦に並ぶverrucosa様の隆起性病変を認め，同部位からの生検組織で好酸球の浸潤がみられた．大腸内視鏡検査では，粘膜の発赤と浮腫性変化がみられ，生検組織では同様に好酸球の浸潤を認めた．小腸X線検査では明らかな異常はみられなかった．以上の所見から，食物アレルギーに基づく好酸球性胃腸炎と診断し，食物抗原除去を目的に成分栄養による経腸栄養療法を導入した．約40日の完全経腸栄養により，末梢血好酸球は著明に減少し，体重，血清総蛋白は改善した．その後，抗原除去食を併用した在宅経腸栄養療法で経過をみているが，経過は順調で10か月後の上部消化管内視鏡検査では胃病変の改善が認められた．好酸球性胃腸炎は高頻度に胃病変がみられるが，本症例のような形態はまれである．また，食物アレルギーが明らかな例には経腸栄養療法は試みるべき治療法と考えられた．

　A 13-year-old boy was referred to our department after diagnosis of uncontrolled protein-losing gastroenteropathy. He had been manifesting growth retardation from two years of age, and an iron-deficiency anemia from four years and three months of age. He was admitted to the pediatric department in our hospital at five years of age because of stomachache, diarrhea, and generalized edema. He was diagnosed as having protein-losing gastroenteropathy due to allergic stroenteritis. Since then, he had been treated with anti-allergic medicines and with foods eliminating possible allergens (pork, salmon, soybean oil). Since his general status was unchanged irrespective of this treatment, he was referred to our department for a further examination of his gastrointestinal tract. Laboratory data on admission showed eosinophilia (40% of leukocytes), a high IgE concentration (4,684.5U/ml), and hypoproteinemia (total protein 5.4g/dl, albumin 3.2g/dl). Endoscopic examination showed polypoid lesions with aphthas standing in five longitudinal lines on the gastric antrum. Colonoscopic examination showed extensive mucosal flare, opacity, and increase in lymphoid follicles. Eosinophil infiltration was confirmed by biopsies from both the stomach and colon. With a diagnosis of eosinophilic gastroenteritis due to food allergy, total enteral nutrition therapy (TEN) with Elental® was given for 40 days to get complete elimination of food allergens. TEN led to decrease in eosinophilia, a gain in weight, and increase in serum protein concentration. His general health status has been preserved with foods eliminating allergens two times a day and a nocturnal EN (1,500kcal/day) therapy at home. TEN therapy should be considered in cases of intractable eosinophilic gastroenteritis.