Henrik Højgaard Rasmussen, Mette Holst, Centre for Nutrition and Bowel Disease (CET), Department of Gastroenterology and Hepatology, Aalborg University Hospital, Faculty of Health, Aalborg University, 9000 Aalborg, Denmark.
World J Gastroenterol. 2013 Nov 14;19(42):7267-75. doi: 10.3748/wjg.v19.i42.7267.
The pancreas is a major player in nutrient digestion. In chronic pancreatitis both exocrine and endocrine insufficiency may develop leading to malnutrition over time. Maldigestion is often a late complication of chronic pancreatic and depends on the severity of the underlying disease. The severity of malnutrition is correlated with two major factors: (1) malabsorption and depletion of nutrients (e.g., alcoholism and pain) causes impaired nutritional status; and (2) increased metabolic activity due to the severity of the disease. Nutritional deficiencies negatively affect outcome if they are not treated. Nutritional assessment and the clinical severity of the disease are important for planning any nutritional intervention. Good nutritional practice includes screening to identify patients at risk, followed by a thoroughly nutritional assessment and nutrition plan for risk patients. Treatment should be multidisciplinary and the mainstay of treatment is abstinence from alcohol, pain treatment, dietary modifications and pancreatic enzyme supplementation. To achieve energy-end protein requirements, oral supplementation might be beneficial. Enteral nutrition may be used when patients do not have sufficient calorie intake as in pylero-duodenal-stenosis, inflammation or prior to surgery and can be necessary if weight loss continues. Parenteral nutrition is very seldom used in patients with chronic pancreatitis and should only be used in case of GI-tract obstruction or as a supplement to enteral nutrition.
胰腺是营养消化的主要参与者。在慢性胰腺炎中,外分泌和内分泌功能不全都可能发展,导致长期营养不良。消化不良通常是慢性胰腺疾病的晚期并发症,取决于潜在疾病的严重程度。营养不良的严重程度与两个主要因素相关:(1)营养物质吸收不良和消耗(例如,酒精中毒和疼痛)导致营养状况受损;(2)由于疾病的严重程度导致代谢活动增加。如果不加以治疗,营养缺乏会对预后产生负面影响。营养评估和疾病的临床严重程度对于计划任何营养干预措施非常重要。良好的营养实践包括筛查有风险的患者,然后对风险患者进行全面的营养评估和营养计划。治疗应是多学科的,治疗的主要方法是戒酒、疼痛治疗、饮食调整和胰腺酶补充。为了满足能量和蛋白质需求,口服补充可能是有益的。如果患者没有足够的热量摄入,例如幽门十二指肠狭窄、炎症或手术前,可以使用肠内营养,如果体重持续减轻,则需要使用肠内营养。慢性胰腺炎患者很少使用肠外营养,只有在胃肠道梗阻或作为肠内营养的补充时才使用。