S3-Leitlinie Klinische Ernährung bei
                Pankreaserkrankungen

Johann Ockenga; Sophie Fromhold-Treu; Christian Löser; Christian Madl; Marc Martignoni; Rémy Meier; Diana Rubin; Kerstin Schütte; Katharina Stang; Helga Paula Török; Lena Wehle; Arved Weimann

doi:10.1055/a-2328-6190

Aktuelle Ernährungsmedizin, Table of Contents

Aktuelle Ernährungsmedizin 2024; 49(06): 451-475
DOI: 10.1055/a-2328-6190

Leitlinie

S3-Leitlinie Klinische Ernährung bei Pankreaserkrankungen

herausgegeben von der Deutschen Gesellschaft für Ernährungsmedizin (DGEM)S3 guideline Clinical nutrition in pancreatic diseaseson behalf of the German Society for Nutritional Medicine (DGEM)

Johann Ockenga

¹Medizinische Klinik II, Klinikum Bremen-Mitte, Gesundheit Nord gGmbH, Bremen, Deutschland

,

Sophie Fromhold-Treu

²Abteilung für Gastroenterologie, Endokrinologie und Stoffwechselkrankheiten, Zentrum für Innere Medizin, Universitätsmedizin Rostock, Rostock, Deutschland

,

Christian Löser

³Medizinische Klinik, DRK-Kliniken Nordhessen, Kassel, Deutschland

,

Christian Madl

⁴Zentrum für Gastroenterologische und Hepatologische Erkrankungen und Gastrointestinale Endoskopie, Krankenanstalt Rudolfstiftung, Wien, Österreich

,

Marc Martignoni

⁵Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, Technische Universität München, Deutschland

,

Rémy Meier

⁶Arztpraxis MagenDarm Basel AG, Basel, Schweiz

,

Diana Rubin

⁷Zentrum für Ernährungsmedizin, Vivantes Klinikum Spandau, Berlin, Deutschland

,

Kerstin Schütte

⁸Klinik für Allgemeine Innere Medizin und Gastroenterologie, Niels-Stensen-Kliniken Marienhospital Osnabrück, Osnabrück, Deutschland

,

Katharina Stang

⁹TEB e.V. Selbsthilfe, Ludwigsburg, Deutschland

,

Helga Paula Török

¹⁰Medizinische Klinik und Poliklinik II, Campus Innenstadt, Klinikum der Ludwig-Maximilians-Universität München, München, Deutschland

,

Lena Wehle

¹¹Deutsche Gesellschaft für Ernährungsmedizin e.V., Berlin, Deutschland

,

Arved Weimann

¹²Abteilung für Allgemein-, Viszeral- und Onkologische Chirurgie, Klinikum St. Georg gGmbH, Leipzig, Deutschland

› Author Affiliations

Abstract

Zusammenfassung

Sowohl die akute als auch die chronische Pankreatitis sind häufige Erkrankungen, die ein erhebliches Risiko für eine Mangelernährung mit sich bringen und eine Ernährungstherapie erfordern können. In ca. 20% der akuten Pankreatitiden tritt eine nekrotisierende Pankreatitis auf, die mit einer erhöhten Morbidität und Mortalität verbunden ist. Hier ist oftmals eine Ernährungstherapie mittels einer enteralen oder parenteralen Ernährung notwendig, die neben medikamentösen, endoskopischen, radiologischen oder chirurgischen Maßnahmen eine etablierte Säule der multimodalen Therapie darstellt.

Bei der chronischen Pankreatitis handelt es sich um eine chronische Entzündung der Bauchspeicheldrüse mit Entwicklung einer Fibrose und langfristig Atrophie des Organs. Bauchschmerzen, die zu einer verminderten oralen Aufnahme von Nährstoffen führen, sowie exokrines und endokrines Versagen sind häufige Komplikationen der Krankheit. All diese Faktoren stellen Risikofaktoren für eine Unter- bzw. Mangelernährung dar. Daher sollten Patienten mit chronischer Pankreatitis als ernährungsmedizinische Risikopatienten betrachtet, untersucht und entsprechend behandelt werden. Darüber hinaus sollte bei Patienten mit chronischer Pankreatitis auf Osteoporose und ein erhöhtes Frakturrisiko geachtet werden, und entsprechende Präventivmaßnahmen erwogen werden.

Abstract

Both acute and chronic pancreatitis are frequent diseases of the pancreas, which are related to a significant risk of malnutrition and may require nutritional support. Acute necrotizing pancreatitis is encountered in 20% of patients with acute pancreatitis, is associated with increased morbidity and mortality, and may require artificial nutrition by enteral or parenteral route, as well as additional endoscopic, radiological or surgical interventions. Chronic pancreatitis represents a chronic inflammation of the pancreatic gland with development of fibrosis. Abdominal pain leading to decreased oral intake, as well as exocrine and endocrine failure are frequent complications of the disease. All of the above represent risk factors are related to malnutrition and metabolic disturbance. Therefore, patients with chronic pancreatitis should be considered at nutritional risk, screened and supplemented accordingly. Moreover, osteoporosis and increased facture risk should be acknowledged in patients with chronic pancreatitis, and preventive measures should be considered.

Schlüsselwörter

Akute Pankreatitis - chronische Pankreatitis - enterale Ernährung - parenterale Ernährung - Ernährungstherapie - medizinische Ernährung - Mangelernährung

Key words

acute pancreatitis - chronic pancreatitis - pancreatic diseases - enteral nutrition - parenteral nutrition - nutritional support - medical nutrition - malnutrition

Full Text

References

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