A case of nonspecific multiple ulcers of the small intestine successfully managed with home elemental enteral nutrition

Abstract

Nonspecific multiple ulcers the small intestine (NMUS) is a clinical entity proposed in Japan with characteristic clinical features different from other inflammatory bowel disease. Treatments with conventional drugs such as corticosteroids, aminosalicylate or immunosuppressant are known to be ineffective for patients with NMUS. We report a case who has been managed successfully with long-term home elemental enteral nutrition. A 60-year-old woman who underwent ileocecal resection due to NMUS when she was 35 years old was admitted to our hospital because of refractory anemia and hypoproteinemia in 2007. She didn't have the history of hematomesis nor melena, but fecal occult blood tests were always positive and the anemia was progressive requiring multiple blood transfusions. Then she was introduced home elemental enteral nutrition in 2007. The small-bore nasogastric tube and commercially available elemental diet were used. Total of 900ml (1kcal/ml) of elemental diet solutions were infused continuously during the night-time using an infusion pump at a speed of 100ml/hr supplementing her day-time oral diet. After the introduction of nutritional therapy, she has been maintained in good conditions for 3 years. Home elemental enteral nutrition may be a useful treatment as maintenance therapy for patients with NMUS.