Fuchssteiner H, Nigl K, Mayer A, Kristensen B, Platzer R, Brunner B, Weiß I, Haas T, Benedikt M, Gröchenig H P, Eisenberger A, Hillebrand P, Reinisch W, Vogelsang H
Krankenhaus der Elisabethinen Linz GmbH, Interne Medizin 4.
Fachhochschule Gesundheitsberufe OÖ GmbH, Studiengang Diätologie, Linz.
Z Gastroenterol. 2014 Apr;52(4):376-86. doi: 10.1055/s-0034-1366252. Epub 2014 Apr 9.
This is a consensus of the Austrian working group of IBD (inflammatory bowel diseases) of the ÖGGH on nutrition in IBD. Malnutrition should be assessed in case of IBD (in 20 - 70 % of Crohn's patients) and weight loss(> 5 % within 3 months) or nutritional deficiencies or after extensive bowel resection and afterwards also treated. Malnutrition should be treated with medical therapy of IBD and also adequate - as far as possible - with oral nutritional therapy particularly because of reduced life quality, risk of opportunistic infections, osteopenia/osteoporosis, longer hospitalisations and higher mortality. Iron homeostasis, serum levels of Vitamin B12- and folic acid, 25-hydroxyvitamin D and zinc should be checked. Therapy with enteral liquid diets is only indicated as therapy of first choice in children and adolescents, but only in rare situations in adults with IBD. There is - up to now - no proven oral diet for maintenance of remission in IBD. Probiotics as E. coli Nissle could be used as alternative to mesalazine for maintenance of remission in patients with ulcerative colitis. A specific dietary counselling is mandatory in patients with ileostoma or short bowel syndrome. Malnutrition of short bowel patients is particularly dependent on the function and length of the remaining bowel, therefore the most effective medical therapy should be administered.
这是奥地利奥洛穆茨医科大学医院炎症性肠病(IBD)工作组关于IBD营养问题的共识。IBD患者(20%-70%的克罗恩病患者)若出现体重减轻(3个月内体重下降>5%)、营养缺乏或广泛肠切除术后,应评估是否存在营养不良,并进行相应治疗。营养不良应采用IBD药物治疗,并尽可能采用口服营养治疗,尤其是考虑到生活质量下降、机会性感染风险、骨质减少/骨质疏松、住院时间延长和死亡率增加等因素。应检查铁稳态、维生素B12和叶酸的血清水平、25-羟基维生素D和锌。肠内流食治疗仅作为儿童和青少年的首选治疗方法,但在IBD成人患者中仅在极少数情况下使用。目前,尚无经证实的用于维持IBD缓解的口服饮食方案。益生菌如大肠杆菌Nissle可作为美沙拉嗪的替代品,用于维持溃疡性结肠炎患者的缓解。对于回肠造口术或短肠综合征患者,必须进行特定的饮食咨询。短肠患者的营养不良尤其取决于剩余肠道的功能和长度,因此应给予最有效的药物治疗。