Ernährungskonzepte bei akuter Pankreatitis

Zusammenfassung

In den letzten Jahrzehnten fand bezüglich der Ernährungstherapie im Rahmen der akuten Pankreatitis ein grundsätzlicher Paradigmenwechsel statt: Wurden früher eher eine parenterale Ernährung und eine orale Nahrungskarenz favorisiert, so wird nach aktuellen Leitlinien eine frühe enterale Ernährung empfohlen. Bei der häufigen milden akuten Pankreatitis, die durch einen selbstlimitierenden Verlauf ohne zusätzliches Organversagen gekennzeichnet ist, können die Patienten nach Abklingen der Beschwerden frühzeitig mit einer leichten oralen Vollkost beginnen. Bei der selteneren schweren Pankreatitis sollte nach den aktuellen Leitlinien innerhalb der ersten 24 – 48 h eine enterale Ernährungstherapie, vorzugsweise über eine nasogastrale Sonde, initiiert werden. Hierdurch konnte in randomisierten Studien sowohl die Häufigkeit von Infektionen als auch Mortalität der Patienten signifikant gesenkt werden, wobei der Erhalt der gastrointestinalen Integrität als zugrunde liegender Mechanismus vermutet wurde.

Abstract

In recent decades, a fundamental paradigm shift took place with respect to nutritional therapy in acute pancreatitis: While formerly parenteral nutrition and oral fasting was favored, recent guidelines recommend early enteral nutrition in most circumstances. In mild and moderately severe acute pancreatitis, which is in most cases a self-limited disease without persistent organ failure, nutrition can be started as an oral diet after a few days depending on their gastrointestinal symptoms. In severe acute pancreatitis with persistent organ failure, however, enteral nutrition should be initiated preferably through a nasogastric tube within the first 24 – 48 hours. In randomized studies early enteral nutrition significantly reduced infection rates and mortality rates, possibly by maintaining gastrointestinal integrity.

Schlüsselwörter

akute Pankreatitis - enterale Ernährung - parenterale Ernährung

Keywords

acute pancreatitis - enteral nutrition - parenteral nutrition

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