S3-Leitlinie der Deutschen Gesellschaft für Ernährungsmedizin (DGEM) in Zusammenarbeit mit der Gesellschaft für klinische Ernährung der Schweiz (GESKES), der Österreichischen Arbeitsgemeinschaft für klinische Ernährung (AKE) und der Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS)

Zusammenfassung

Fragestellung: Die Bedeutung der Ernährung bei der Entstehung und Behandlung von chronisch-entzündlichen Darmerkrankungen (CED) wird teilweise kontrovers diskutiert. Klar ist, dass bei CED die Prävalenz von Mangelernährung erhöht ist und dass Mangelernährung die Prognose verschlechtert. In der vorliegenden Leitlinie werden evidenzbasierte Empfehlungen zur ernährungsmedizinischen Diagnostik und Therapie bei CED präsentiert.

Methodik: Die Leitlinie basiert auf den früheren Leitlinien der DGEM (2006/2007), der ESPEN (2006, 2009), der ECCO (2010) und des NICE (2012). Es wurde eine systematische Analyse der Literatur 2007 – 2013 zur oralen, enteralen und parenteralen Ernährung bei CED vorgenommen und gegenüber den früheren Leitlinien um die Themen Prävention und Screening von Malnutrition bei CED ergänzt. Die Empfehlungen wurden auf einer Konsensuskonferenz am 18.10.2013 verabschiedet.

Ergebnisse: Die Leitlinie umfasst 24 Empfehlungen zur Klinischen Ernährung bei CED. Screening auf Mangel- und Unterernährung sowie auf Mikronährstoffmangel wird bei CED empfohlen. Die Therapie der nachgewiesenen Malnutrition basiert auf Ernährungsberatung für eine bedarfsgerechte orale Ernährung und adäquater Ernährungstherapie. Neben Supplementen und oraler Trinknahrung kommen enterale und parenterale Ernährung als supplementäre Therapie infrage. Während die parenterale Ernährung nur in wenigen Sonderfällen meist passager durchgeführt wird, spielen die enterale Ernährung und orale Nahrungssupplemente eine bedeutsamere Rolle. Gerade bei Kindern wird die enterale Ernährung auch als primäre Therapie des akuten Schubs eines Morbus Crohn verwendet, um die unerwünschten Wirkungen von Medikamenten zu vermeiden.

Schlussfolgerung: Fachgerechte ernährungsmedizinische Diagnostik, Ernährungsberatung und enterale Ernährung spielen eine wichtige Rolle in der Behandlung von CED, sie können den Krankheitsverlauf sowie die Lebensqualität verbessern.

Abstract

Purpose: The importance of nutrition in the development and treatment of inflammatory bowel disease (IBD) is partially controversial. It is clear that in IBD, the prevalence of malnutrition is increased and that malnutrition worsens the prognosis. In the present guideline evidence-based recommendations for nutritional diagnostics and therapy in IBD are presented.

Methods: The guideline is based on the previous guidelines of DGEM (2006/2007), ESPEN (2006, 2009), ECCO (2010) and NICE (2012). We performed a systematic review of the literature 2007 – 2013 on oral, enteral and parenteral nutrition in IBD and we extended the earlier guidelines on the topics of prevention and screening of malnutrition in IBD. The recommendations were approved at a consensus conference on October 18th, 2013.

Results: The guideline includes 24 recommendations for clinical nutrition in IBD. Screening for malnutrition/undernutrition and micronutrient deficiency is recommended in IBD. The treatment of proven malnutrition is based on diet counseling for an appropriate oral nutrition and adequate nutrition therapy. In addition to micronutrient supplements and oral nutrition supplements enteral and parenteral nutrition are used as supplementary therapy. While parenteral nutrition is usually performed only in a few special cases, enteral nutrition as well as oral supplements play a significant role. Especially in children, enteral nutrition is also used as primary treatment of active Crohn’s disease in order to avoid the undesirable effects of drugs.

Conclusion: Professional nutritional diagnostics, dietary counseling and enteral nutrition play an important role in the management of IBD, they can improve the course of disease and quality of life.

Schlüsselwörter

Morbus Crohn - Colitis ulcerosa - orale Trinknahrung - enterale Ernährung - parenterale Ernährung

Keywords

Crohn’s disease - ulcerative colitis - oral nutritional supplement - enteral nutrition - parenteral nutrition

^* DGEM Steering Committee: Bischoff SC, Lochs H, Weimann A sowie das DGEM-Präsidium.

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