Crohn病長期経過例での腸管病変に対する栄養療法の治療効果―薬物療法との比較を中心に

Clinical Usefulness of Nutritional Treatment for Morphological Findings of Long-Standing Crohn's Disease―Especially Focusing on Comparison with Drug Treatment

要旨　Crohn病(CD)に対する在宅経腸栄養療法(HEN)の長期の治療効果，特に腸管合併症への進展阻止におけるHENの有用性を，薬物療法主体の治療例と比較した．対象は初診時非手術で5年以上経過観察可能であったCDの中で，画像診断による腸管病変の評価を複数回行った80例である．対象のうちHEN主体の治療を行ったN群(51例)と，薬物療法主体のD群(29例)で，新たな腸管合併症への進展阻止における治療効果を比較した．N群の腸管合併症への進展率は17％で，D群の45％より有意に低率であった(p＜0.01)．なお病変部位別では，小腸病変に対する治療効果が優れていた．臨床経過の面では，患者年あたりの平均入院回数はN群0.14回，D群0.22回，平均手術回数は各々0.07回と0.13回で，ともにN群のほうが低頻度であった．以上の成績より，HENを主体とした内科的治療の継続は，Crohn病の腸管合併症への進展阻止や外科手術の回避に有用であると考える．

　We investigated the clinical usefulness of home enteral nutrition(HEN)to treat the morphological findings of long-standing Crohn's disease, especially focusing on comparison with drug treatment. Study subjects were80cases with Crohn's disease who had not undergone bowel resection at the time of their first visit to our hospital and who were followed up for more than5years by both radiography and colonoscopy. We mainly compared the therapeutic effects of HEN with those resulting from drug treatment in preventing the progression to intestinal complications, such as stenosis and fistula. Study subjects were divided into 2 groups, N group (51cases) and D group (29cases). The patients in N group were mainly treated by HEN and those in D group were treated by conventional drugs. The rate of progression to intestinal complications in the N group (17％) was significantly lower than that in the D group (45％). As regards clinical course, the mean number of hospitalizations and operations per patient-year were 0.14 and 0.07times in the N group, which were lower than those in the D group (0.22 and 0.13 times).

　Based on these results, it is concluded that continuous home enteral nutritional therapy is useful to prevent progression to intestinal complications and also to avoid surgical operations.

　1) Department of Gastroenterology, Kitasato University East Hospital, Sagamihara, Japan