抗TNF-α抗体療法により胃アフタ様病変が著明改善したCrohn病の1例

Anti-Tumor Necrosis Factor-Alpha Antibody Markedly Improved Aphthous Lesions of the Stomach in a Patient with Crohn's Disease, Report of a Case

要旨　患者は27歳，女性．6年前に小腸大腸型Crohn病と診断され，今回は痔瘻に対する抗TNF-α抗体療法目的で入院となった．入院前から心窩部不快感が持続し，上部消化管内視鏡検査を施行したところ，前庭部に多発するアフタ様病変が認められた．大腸内視鏡検査では，終末回腸に活動性縦走潰瘍を認めた．抗TNF-α抗体を投与すると，痔瘻の改善，肛門部痛の消失，回腸縦走潰瘍の瘢痕化とともに心窩部不快感も消失した．抗体投与4週後に再度上部消化管内視鏡検査を行ったところ，前庭部の多発アフタ様病変は完全に消失していた．Crohn病における胃アフタ様病変は比較的遭遇する機会の多い病態であるが発症機序に関する検討はない．自験例は，胃アフタ様病変の発症にTNF-αが直接的に関与することを示唆する興味深い症例と考えられた．

　A 27-year-old woman, who had been diagnosed as having Crohn's ileocolitis six years earlier, was admitted to our hospital with perianal pain due to anal fistulas and refractory epigastic discomfort due to reaction against a proton pump inhibitor. Upper gastrointestinal endoscopy revealed multiple aphthous lesions in the antrum of the stomach. To treat the fistulas, an anti-tumor necrosis factor-alpha antibody, infliximab, was administered. Several days later, her epigastric discomfort disappeared. Four weeks after administration of the antibody, a second upper gastrointestinal endoscopic examination demonstrated complete disappearance of the aphthous lesions. However, 24 weeks after the antibody administration, when the antibody had become ineffective, reddened patches recurred in her stomach.

　Although aphthous lesions of the stomach frequently develop in Crohn's disease, the mechanisms of the condition are still unknown. The present case suggests a close relationship between aphthous lesions of the stomach and tumor necrosis factor-alpha.

　1) Division of Gastroenterology, Department of Medicine, Kawasaki Medical School, Kurashiki, Japan