A case of child Crohn's disease markedly responded to TPN,ED, and HEEH treatment.

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A severe child Crohn's disease, in which remission was obtained only with sequential nutritional treatments without drugs effective for Crohn's disease or antibiotics, is reported. A 14-year-old girl was referred to our department on July 27, 1989 because of fever, bloody diarrhea, emaciation, and aphthas in the mouth. She developed fever and watery diarrhea in the beginning of June 1989. Laboratory data revealed strong inflammation (ESR 65 mm/hr, CRP 6.1 mg/dl), malnutrition (TP 6.5 g/dl, albumin 2.9 g/dl, cholesterol 75mg/dl), and anemia (Hb 7.4 g/dl). International Organization for Inflammatory Bowel Disease (IOIBD) score was 5. The findings of barium enema and colonoscopy were consistent with those of Crohn's disease ; discontinuous lesions, ulcer including longitudinal ulcers, redness, pseudopolyps, and so on. Non-caseous granulomas were found in the colon specimens. Upper gastrointestinal tract and the small intestine were normal. The diagnosis of severe Crohn's colitis was made. She was treated with total parenteral nutrition, then elemental diet followed by home elemental enteral hyperalimentation. She had clinical remission and was discharged on September 27, 1989. In January 1990, her body weight was more than that before the onset (IOIBD score 0). Most of active findings, except for a persistent longitudinal ulcer, disappeared endoscopically.
日本大腸肛門病学会の論文