Ernährung in der perioperativen Phase bei chronisch entzündlichen Darmerkrankungen

Zusammenfassung.

Die perioperative Ernährungstherapie spielt eine wichtige Rolle in der Behandlung von Patienten mit chronisch entzündlichen Darmerkrankungen, da diese häufig eine präoperative Mangelernährung aufweisen und sich vielfachen operativen Eingriffen unterziehen müssen. Die klinische Bedeutung der prä- und postoperativen Ernährung wird im Hinblick auf Komplikationsrate, Rezidivrate und Kosten diskutiert. Ein Einsatz der totalen parenteralen oder enteralen Ernährung ist bei einem abdominellen Routineeingriff ohne Zeichen einer schweren Malnutrition nicht erforderlich. In der großen Mehrzahl der Fälle ist perioperativ die kosten- und komplikationsarme Zufuhr einer Wassser-Glucose-Elektrolytlösung ausreichend.

Schlüsselwörter:

Morbus Crohn - Colitis ulcerosa - Chirurgie - Malnutrition - Ernährung

Perioperative nutrition in inflammatory bowel disease.

Perioperative nutrition plays a main role in the treatment of patients with inflammatory bowel disease since they are often malnourished and undergo numeral operative interventions during their history. The clinical effect of a pre or postoperatively administered nutrition will be discussed in relation to complication rate, recurrence rate and costs. Use of total parenteral or enteral nutrition is not necessary in routine abdominal surgery. In the majority of cases the cost effective and complication reduced application of D5W is sufficient.

Key words:

Crohns disease - Ulcerative colitis - Surgery - Malnutrition - Perioperative nutrition

Literatur

• 1 Hugot J P, Zouali H, Lesage S, Thomas G. Etiology of the inflammatory bowel diseases.  Int J Colorectal Dis. 1999;  14 2-9
• 2 Solomon M J, Schnitzler M S. Cancer and inflammatory bowel disease: bias, epidemiology, surveillance and treatment.  World J Surg. 1998;  22 352-366
• 3 Burke A, Lichtenstein G R, Rombeau J L. Nutritional and metabolic advances in inflammatory bowel disease.  Curr Opin Clin Nutr Metab Care. 1998;  1 387-390
• 4 Kelly D G, Fleiming R. Nutritional considerations in inflammatory bowel diseases.  Gastroenerol Clin N Am. 1995;  24 597-611
• 5 Dielemann L A, Heizer W D. Nutritional issues in inflammatory bowel disease.  Gastroenterol Clin N Am. 1998;  27 435-451
• 6 Christie P M, Hill G L. Effect of intravenous nutrition on nutrition and function in acute attacks of inflammatory bowel disease.  Gastroenterology. 1990;  99 730-736
• 7 Foitzik T, Kruschewski M, Kroesen A, Buhr H J. Does microcirculation play a role in the pathogenesis of inflammatory bowel diseases? Answers from intravital microscopic studies in animal models.  Int J Colorectal Dis. 1999;  14 29-34
• 8 Ekbom A, Helmick C, Zack M, Adami H O. Ulcerative colitis and colorectal cancer: a population-based study.  N Eng J Med. 1990;  323 1228-1234
• 9 Andrews H A, Leiws P, Allan R N. Prognosis after surgery for colonic Crohn's disease.  Br J Surg. 1989;  76 1184-1186
• 10 Lautenbach E, Berlin J A, Lichtenstein G R. Risk factors for early postoperative recurrence of Crohn's disease.  Gastroenterology. 1998;  115 259-267
• 11 Betzler M, Schürmann G, Herfarth C. Surgical treatment of Crohn's disease.  Chirurg. 1995;  63 13-21
• 12 Buhr H J, Kroesen A J, Herfarth C. Morbus Crohn - chirurgische Therapie.  Chirurg. 1995;  66 764-773
• 13 Robinson P E. Life insurance and inflammatory bowel disease: is there discrimination against patients?.  Int J Colorectal Dis. 1997;  12 95-96
• 14 Wolff B G. Factors determining recurrence following surgery for Crohn's disease.  World J Surg. 1998;  22 364-369
• 15 Müller J M, Thul P, Ablaßmeier B. Perioperative nutritional therapy and its relevance for postoperative results.  Chirurg. 1997;  68 574-582
• 16 Klein S, Kinney J, Jeejeebhoy K. Nutrition support in clinical practice: review of published data and recommendations for future research directions.  JPEN. 1997;  21 133-156
• 17 Ludwig K A, Milsom J W, Church J M, Fazio V W. Preliminary experience with laparoscopic intestinal surgery for Crohn's disease.  Am J Surg. 1996;  171 52-57
• 18 Benoit J, Meddahi A, Ayoub N, Barritault D, Sezeur A. New healing agents for colonic anastomosis.  Int J Colorectal Dis. 1998;  13 78-81
• 19 Ferguson A, Glen M, Ghosh S. Crohn's disease: nutrition and nutritional therapy.  Baill Clin Gastroenterol. 1998;  12 93-113
• 20 Müller J M, Keller H W, Erasmi H. Total parenteral nutrition as the sole therapy in Crohn's disease - a prospective study.  Br J Surg. 1983;  70 40-43
• 21 Nordgren S, Mc Pheeters G, Svaninger G, Dresland T, Hulten L. Small bowel length in inflammatory bowel disease.  Int J Colorectal Dis. 1997;  12 230-234
• 22 Lipman T O. Grains or veins: is enteral nutrition really better than parenteral nutrition? A look at the evidence.  J PEN. 1998;  22 167-182
• 23 Mibu R, Oohata Y, Ishikawa M, Sakai M, Tanaka M. Terminal ileum transposition procedure in ileoanal anastomosis following proctocolectomy.  Int J Colorectal Dis. 1998;  13 17-20
• 24 Watanabe T, Kubota Y, Muto T. Substance P containing nerve fibers in ulcerative colitis.  Int J Colorectal Dis. 1998;  13 61-67
• 25 Sandström R, Drott C, Hyltander A, Arvidson B. The effect of postoperative intravenous feeding (TNP) on outcome following major abdominal surgery evaluated in a randomized study.  Ann Surg. 1993;  217 185-189
• 26 Avrahami R, Cohen J D, Singer P, Zelikovski A. Gastric emptying after elective abdominal aortic aneurysm surgery: the case for early postoperative enteral feeding.  Eur J Endovasc Surg. 1999;  17 241-244
• 27 Demetriades H, Botsios D, Kazantzidou D, Sakkas L, Dadoukis I. Effect of early postoperative enteral feeding on the healing of colonic anastomoses in rats.  Eur Surg Res. 1998;  31 57-63
• 28 Parker M C. Early postoperative feeding after elective colorectal surgery is not a benefit unique to laparoscopy-assisted procedures.  Int J Colorectal Dis. 1997;  12 51-52
• 29 Schwenk W, Böhm B, Haase O, Junghans T, Müller J M. Laparoscopic versus conventional colorectal resection: a prospective randomised study of postoperative ileus and early postoperative feeding.  Lang Arch Surg. 1998;  383 49-55
• 30 Lashner B A, Alison A E, Hanauer S B. Preoperative total parenteral nutrition for bowel resection in Crohn's disease.  Dig Dis Sci. 1989;  34 741-746
• 31 Strong S A. Prognostic parameters of Crohn's disease recurrence.  Baill Clin Gastroenterol. 1998;  12 167-177
• 32 Singleton J W, Hanauer S B, Gitnick G L. Mersalamine capsules for the treatment of active Crohn's disease: results of a 16-week Pentasa Crohn's disease study group.  Gastroenterology. 1993;  104 1293-1301
• 33 Lake A M, Kim S, Mathis R K, Walker A W. Influence of perioperative parenteral alimentation on postoperative growth in adolescent Crohn's disease.  J Ped Gastro Nutr. 1985;  4 182-186
• 34 Rombeau J L, Barot L R, Williamson C E, Mullen J L. Preoperative total parenteral nutrition and surgical outcome in patients with inflammatory bowel disease.  Am J Surg. 1982;  143 139-143
• 35 Carraro P G, Talbot I C, Nicholls J R. Patterns of distribution of endoscopic and histological changes in the ileal reservoir after restorative proctocolectomy for ulcerative colitis. A long term follow-up.  Int J Colorectal Dis. 1998;  13 103-107
• 36 Fernandes-Banares F, Cabre E, Esteve-Comas M. How effective is enteral nutrition in inducing clinical remission in active Crohn's disease? A meta analysis of the randomized clinical trials.  JPEN. 1995;  19 356-363
• 37 Griffiths A M, Ohlsson A, Sherman P M. Meta-analysis of enteral nutrition as a primary treatment of active Crohn's disease.  Gastroenterology. 1995;  108 1056-1067
• 38 Steffes C, Fromm D. Is preoperative parenteral nutrition necessary for patients with predominantly ileal Crohn's disease?.  Arch Surg. 1992;  127 1210-1212
• 39 Kim W H, Cho Y S, Yoo H M, Park E C, Lim J G. Quality of life in Korean patients with inflammatory bowel disease: ulcerative colitis, Crohn's disease and intestinal Behcet's disease.  Int J Colorectal Dis. 1999;  14 52-57
• 40 Fujita T, Sakurai K. Efficacy of glutamine-enriched enteral nutrition in an experimental model of mucosal ulcerative colitis.  Br J Surg. 1995;  82 749-751
• 41 Plauth M, Schneider B H, Raible A, Hartmann F. Is glutamine essential for the maintenance of intestinal function? A study in the isolated perfused rat small intestine.  Int J Colorect Dis. 1999;  14 86-94
• 42 Morlion B J, Stehle P, Wachtler P. Total parenteral nutrition with glutamine dipeptide after major abdominal surgery.  Ann Surg. 1998;  227 302-308
• 43 Morlion B J, Stehle P, Wachtler P. Total parenteral nutrition with glutamine dipeptide shortened hospital stays and improved immune status and nitrogen economy after major abdominal surgery.  Gut. 1999;  44 155
• 44 Bellantone R, Doglietto G, Bossola M. Preoperative parenteral nutrition in the high risk surgical patient.  JPEN. 1988;  12 195-197
• 45 Bellantone R, Doglietto G, Bossola M. Preoperative parenteral nutrition of malnourished patients.  Acta Chir Scand. 1988;  22 249-251
• 46 Fan S, Lau W, Wong K. Pre-operative parenteral nutrition in patients with oesophageal cancer: a prospective, randomised clinical trial.  Clin Nutr. 1989;  8 23-27
• 47 Fan S, Lo C, Lai E. Perioperative nutritional support in patients undergoing hepatectomy for hepatocellular carcinoma.  N Engl J Med. 1994;  331 1547-1552
• 48 Meguid M, Curtas M, Meguid V. Effects of pre-operative TPN on surgical risk - preliminary status report.  Br J Clin Prac. 1988;  42 53-58
• 49 Müller J, Keller H W, Brenner U. Indications and effects of preoperative parenteral nutrition.  World J Surg. 1986;  10 53-63
• 50 Müller J, Brenner U, Dienst C. Preoperative parenteral feeding in patients with gastrointestinal carcinoma.  Lancet. 1982;  327 68-71
• 51 Müller J, Keller H W, Brenner U. Parenteral nutrition in carcinoma treated by surgery: nitrogen balance and clinical studies.  Br J Surg. 1977;  64 125-128
• 52 Smith R, Hartemink R. Improvement of nutritional measures during preoperative parenteral nutrition in patients selected by the prognostic nutritional index: a randomized controlled trial.  JPEN. 1988;  12 587-591
• 53 Thompson B, Julian T, Stremple J. Perioperative total parenteral nutrition in patients with gastrointestinal cancer.  J Surg Res. 1981;  30 447-450
• 54 VA TPN Cooperative Study: perioperative total parenteral nutrition in surgical patients. N Engl J Med 1991 325: 525-532
• 55 Von Meyenfeldt M, Meijerink W, Rouflart M. Perioperative nutritional support: a randomised clinical trial.  Clin Nutr. 1992;  11 180-186
• 56 Abel R, Fischer J, Buckley M. Malnutrition in cardiac surgical patients: results of a prospective randomized evaluation of early postoperative parenteral nutrition.  Arch Surg. 1976;  111 45-50
• 57 Brennan M, Pisters P, Posner M. A prospective randomized trial of total parenteral nutrition after major pancreatic resection for malignancy.  Ann Surg. 1993;  217 185-195
• 58 Collins J, Oxby C, Hill G. Intravenous amino-acids and intravenous hyperalimentation as protein-sparing therapy after major surgery: a controlled clinical trial.  Lancet. 1978;  327 778-791
• 59 Holter A, Fischer J E. The effeccts of perioperative hyperalimentation on complications in patients with carcinoma and weight loss.  J Surg Res. 1977;  23 31-37
• 60 Jensen S. Clinical effects of enteral and parenteral nutrition preceeding cancer surgery.  Med Oncol Tumor Pharmacother. 1985;  2 225-229
• 61 Preshaw R, Attisha R, Hollingworth W. Randomized sequential trial of parenteral nutrition in healing of colonic anastomoses in man.  Can J Surg. 1979;  22 437-439
• 62 Sandstrom R, Drott C, Hyltander A. The effect of postoperative intravenous feeding (TPN) on outcome following major surgery evaluated in a randomized study.  Ann Surg. 1993;  217 185-195
• 63 Woolfson A, Smith J. Elective nutritional support after major surgery: a prospective randomized trial.  Clin Nutr. 1989;  8 15-19
• 64 Gonzales-Huix F, de Leon R, Fernandes-Banares F. Polymeric enteral diets as primary treatment of active Crohn's disease. A prospective steroid controlled trial.  Gut. 1993;  34 778-782
• 65 Gorard D A, Hunt J B, Payne-James J J. Initial response and subsequent course of Crohn's disease treated with elemental diet or prednisolone.  Gut. 1993;  34 1198-1202
• 66 Lindor K D, Fleming C R, Burnes J U. A randomized prospective trial comparing a defined formula diet, corticosteroids, and a defined formula diet plus corticosteroids in active Crohn's disease.  Mayo Clin Proc. 1992;  67 328-333
• 67 Lochs H, Steinhardt H J, Klaus-Wentz B. Comparison of enteral nutrition and drug treatment in active Crohn's disease. Results of the European Cooperative Crohn's disease study IV.  Gastroenterology. 1991;  101 881-888
• 68 Malchow H, Steinhardt H J, Lorenz-Meyer H. Feasibility and effectiveness of a defined formula diet regimen in treating active Crohn's disease. European Cooperative Crohn's disease study III.  Scand J Gastroenterol. 1990;  25 235-244
• 69 O'Morain C, Segal A W, Levi A J. Elemental diet as primary treatment of acute Crohn's disease. A controlled study.  Br Med J. 1984;  288 1859-1862
• 70 Sanderson I R, Udeen S, Davies P SW. Remission induced by an elemental diet in small bowel Crohn's disease.  Arch Dis Child. 1987;  61 123-127
• 71 Seidman E G, Bouthillier L, Weber A M. Elemental diet versus prednisone as primary treatment of Crohn's disease.  Gastroenterology. 1986;  90 A1625 (abstract)