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[炎症性肠病:当今营养的重要性]

[Inflammatory bowel disease: importance of nutrition today].

作者信息

Jorquera Plaza F, Espinel Díez J, Olcoz Goñi J L

机构信息

Sección de Digestivo, Hospital de León, España.

出版信息

Nutr Hosp. 1997 Nov-Dec;12(6):289-98.

PMID:9477654
Abstract

Malnutrition is a very common situation in patients inflammatory with intestinal disease (IID), which can be caused by a multitude of factors. It has been shown that nutritional support not only improves the nutritional condition of the patients, but in Crohn's disease it also has an effect on the activity of the disease, although this effect is smaller than that of steroids. Elemental diets are no more efficient than polymeric diets except under very special circumstances, but they are more expensive and patients tolerate them worse. A digestive pause is not recommended unless there is an absolute contraindication for the use of the digestive tract. Therefore, parenteral nutrition, which is more expensive and can cause serious complications, will be reserved for very specific indications. The use of fish oil supplements, either because it competes with arachidonic acid and prevents the initiation of the inflammatory cascade, or because it decreases the production of cytokines, has shown to be potentially useful in inflammatory intestinal disease, and this must be confirmed by further studies. Short chain fatty acids enemas have shown promising results in distal ulcerative colitis but the lack of homogeneity in the studies makes it necessary for these results to be consolidated in new studies. Nutritional support is especially interesting in children with inflammatory intestinal disease given that the growth retardation which is often seen in severe cases, can be controlled by adequate enteral or parenteral diets.

摘要

营养不良在炎症性肠病(IID)患者中非常常见,其可由多种因素引起。研究表明,营养支持不仅能改善患者的营养状况,而且在克罗恩病中对疾病活动也有影响,尽管这种影响比类固醇的影响小。除了在非常特殊的情况下,要素饮食并不比聚合物饮食更有效,但它们更昂贵,患者对其耐受性更差。除非存在使用消化道的绝对禁忌症,否则不建议进行消化暂停。因此,肠外营养更昂贵且会导致严重并发症,将仅用于非常特殊的适应症。使用鱼油补充剂,要么是因为它与花生四烯酸竞争并阻止炎症级联反应的启动,要么是因为它减少细胞因子的产生,已显示在炎症性肠病中可能有用,这一点必须通过进一步研究加以证实。短链脂肪酸灌肠剂在远端溃疡性结肠炎中已显示出有前景的结果,但研究缺乏同质性使得有必要在新的研究中巩固这些结果。鉴于在严重病例中经常出现的生长发育迟缓可以通过适当的肠内或肠外饮食得到控制,营养支持对炎症性肠病患儿尤其有意义。

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