Download PDF
Viszeralchirurgie 2000; 35(1): 44-47
DOI: 10.1055/s-2000-11233
ORIGINALARBEIT
© Georg Thieme Verlag Stuttgart · New York

Malabsorption und Malnutrition bei entzündlichen Darmerkrankungen

E. F. Stange, J. Scheibner, G. Ball, K. Lange
  • Medizinische Klinik 1, Bereich Gastroenterologie/Hepatologie, Universitätsklinikum Lübeck
Further Information

Publication History

Publication Date:
31 December 2000 (online)

    Permissions and Reprints

Zusammenfassung

Malnutrition ist ein häufiges Problem bei entzündlichen Darmerkrankungen und auf verminderte Nahrungsaufnahme, Malabsorption, intestinale Verluste und eine gesteigerte Utilisation zurückzuführen. Eigentliche Resorptionsstörungen sind auf eine verminderte Resorptionsfläche, das Gallensäureverlustsyndrom oder auf eine bakterielle Fehlbesiedlung zurückzuführen. Die wichtigsten Probleme sind Gewichtsverlust, Hypoproteinämie und Anämie sowie die spezifischen Defizite von Eisen, Vitamin B12, Kalzium und Vitamin D sowie Zink.

Malabsorption and malnutrition in inflammatory bowel diseases.

Malnutrition is a common problem in inflammatory bowel diseases and is due to diminished enteral nutrition, malabsorption, intestinal losses as well as enhanced utilisation. Specific malabsorption may be secondary to a reduced resorptive surface area, bile acid losses and bacterial overgrowth. Major problems are weight loss, hypoproteinemia and anemia associated with deficiencies of iron, vitamin B12, calcium and vitamin D as well as zinc.

Schlüsselwörter:

Malnutrition - Malabsorption - M. Crohn - Colitis ulcerosa - Entzündliche Darmerkrankungen - Übersichtsarbeit

Key words:

Malnutrition - Malabsorption - Crohn's disease - Ulcerative colitis - Inflammatory bowel diseases - Review

Literatur

  • 1 Rath H C, Caesar I, Roth M, Schölmerich J. Mangelzustände und Komplikationen bei chronisch entzündlichen Darmerkrankungen.  Med Klinik. 1998;  1 6-10
    PubMedSearch in Google Scholar
  • 2 Weterman I T, Biemond I, Peña A S. Mortality and causes of death in Crohn's disease. Review of 50 years' experience in Leiden University Hostpital.  Gut. 1990;  31 1387-1390
    CrossrefPubMedSearch in Google Scholar
  • 3 Rigaud D, Angel L A, Cerf M, Carduner M J, Melchior J C, Sautier C, Rene E, Apfelbaum M, Mignon M. Mechanisms of decreased food intake during weight loss in adult Crohn's disease patients without obvious malabsorption.  Am J Clin Nutr. 1994;  60 775-781
    PubMedSearch in Google Scholar
  • 4 Andersson H, Dotevall G, Gillberg R, Jagenburg R, Kock N G. Absorption studies in patients with Crohn's disease and in patients with ulcerative colitis.  Acta med scand. 1971;  190 407-410
    PubMedSearch in Google Scholar
  • 5 Park R HR, Duncan A, Russell R I. Hypolactasia and Crohn's disease: a myth.  Am J Gastroenterol. 1990;  85 708-710
    PubMedSearch in Google Scholar
  • 6 Mishkin B, Yalovsky M, Mishkin S. Increased prevalence of lactose malabsorption in Crohn's disease patients at low risk for lactose malabsorption based on ethnic origin.  Am J Gastroenterol. 1997;  92 1148-1153
    PubMedSearch in Google Scholar
  • 7 Peña A S, Truelove S C. Hypolactasia and ulcerative colitis.  Gastroenterology. 1973;  64 400-404
    PubMedSearch in Google Scholar
  • 8 Dyer N H, Dawson A M. Malnutrition and malabsorption in Crohn's disease with reference to the effect of surgery.  Brit J Surg. 1973;  60 134-140
    PubMedSearch in Google Scholar
  • 9 Balzer K, Schmitt G, Reiners C, Goebell H. Befunde mit dem 75Selen-Homotaurocholsäure-Retentionstest (SeHCAT-Test) in der Diagnostik von Diarrhöen.  Med Klinik. 1995;  1 27-32
    PubMedSearch in Google Scholar
  • 10 Nyhlin H, Merrick M V, Eastwood M A. Bile acid malabsorption in Crohn's disease and indications for its assessment using SeHCAT.  Gut. 1994;  35 90-93
    PubMedSearch in Google Scholar
  • 11 Picarelli A, Greco M, Di Giovambattista F, Ramazzotti A, Cedrone C, Corazziari E, Torsoli A. Quantitative deterrnination of faecal fat, nitrogen and water by means of a spectrophotometric technique: near infrared reflectance analysis (NIRA). Assessment of its accuracy and reproducibility compared with chemical methods.  Clin Chim Acta. 1995;  31 147-156
    PubMedSearch in Google Scholar
  • 12 Schölmerich J, Hoppe-Seyler P, Gerok W. Extraintestinale Manifestationen bei entzündlichen Darmerkrankungen.  Therapiewoche. 1986;  36 520-532
    PubMedSearch in Google Scholar
  • 13 Jeppesen P B, Mortensen P B. The influence of a preserved colon on the absorption of medium chain fat in patients with small bowel resection.  Gut. 1998;  43 478-483
    CrossrefPubMedSearch in Google Scholar
  • 14 Meryn S, Lochs H, Bettelheim P, Sertl K, Mulak K. Serumproteinkonzentrationen - Parameter für die Krankheitsaktivität bei Morbus Crohn?.  Leber Magen Darm. 1985;  15 160-164
    PubMedSearch in Google Scholar
  • 15 Beeken W L, Busch H J, Sylwester D L. Intestinal protein in Crohn's disease.  Gastroenterology. 1972;  62 207-215
    PubMedSearch in Google Scholar
  • 16 Meyers S, Wolke A, Field S P, Feuer E J, Johnson J W, Janowitz H D. Fecal α1-antitrypsin measurement: an indicator of Crohn's disease activity.  Gastroenterology. 1985;  89 13-18
    PubMedSearch in Google Scholar
  • 17 Schreiber S, Wedel S. Diagnosis and Treatment of anemia in inflammatory bowel disease.  Inflammatory Bowel Diseases. 1997;  3 204-216
    PubMedSearch in Google Scholar
  • 18 Gerson C D, Cohen N, Janowitz H D. Small intestinal absorptive function in regional enteritis.  Gastroenterology. 1973;  64 907-912
    PubMedSearch in Google Scholar
  • 19 Filipsson S, Hultén L, Lindstedt G. Malabsorption of fat and vitamin B12 before and after intestinal resection for Crohn's disease.  Scand J Gastroent. 1978;  13 529-536
    PubMedSearch in Google Scholar
  • 20 Vogelsang H, Ferenci P, Schilling R, Woloszczuk W, Haschke F, Lochs H, Meryn S, Gang A. Vitamin D Status in outpatients with Crohn's disease.  Eur J Gastroenterol Hepatol. 1994;  6 513-517
    PubMedSearch in Google Scholar
  • 21 Ghosh S, Cowen S, Hannan W J, Ferguson A. Low bone mineral density in Crohn's disease, but not in ulcerative colitis, at diagnosis.  Gastroenterology. 1994;  107 1031 -1039
    CrossrefPubMedSearch in Google Scholar
  • 22 Jahnsen J, Falch J A, Aadland E, Mowinckel P. Bone mineral density is reduced in patients with Crohn's disease but not in patients with ulcerative colitis: a population based study.  Gut. 1997;  40 313-319
    CrossrefPubMedSearch in Google Scholar
  • 23 Schulte C, Dignass A U, Mann K, Goebell H. Reduced bone mineral density and unbalanced bone metabolism in patients with inflammatory bowel disease.  Inflammatory Bowel Disease. 1998;  4 268-275
    PubMedSearch in Google Scholar
  • 24 Krawitt E L, Beeken W L, Janney C D. Calcium absorption in Crohn's disease.  Gastroenterology. 1976;  71 251-254
    PubMedSearch in Google Scholar
  • 25 Bischoff S C, Herrmann A, Göke M, Manns M P, von zur Mühlen A, Brabant G. Altered bone metabolism in inflammatory bowel disease.  Am J Gastroenterol. 1997;  92 1157-1163
    PubMedSearch in Google Scholar
  • 26 Driscoll R H, Meredith S C, Sitrin M, Rosenberg I H. Vitamin D deficiency and bone disease in patients with Crohn's disease.  Gastroenterology. 1982;  83 1252-1258
    PubMedSearch in Google Scholar
  • 27 Silvennoinen J. Relationships between vitamin D, parathyroid hormone and bone mineral density in inflammatory bowel disease.  J Intern Med. 1996;  239 131-137
    CrossrefPubMedSearch in Google Scholar
  • 28 Robinson R J, Al Azzawi F, Iqbal S J, Kryswcki T, Almond L, Abrams K, Mayberry J F. Osteoporosis and determinants of bone density in patients with Crohn's disease.  Dig Dis Sci. 1998;  43 2500-2506
    CrossrefPubMedSearch in Google Scholar
  • 29 Schoelmerich J, Becher M S, Hoppe-Seyler P, Matern S, Haeussinger D, Loehle E, Keottgen E, Gerok W. Zinc and vitamin A deficiency in patients with Crohn's disease is correlated with activity but not with localization or extent of the disease.  Hepato Gastroenterol. 1985;  32 34-38
    PubMedSearch in Google Scholar
  • 30 Howard L, Ovesen L, Satya-Murti S, Chu R. Reversible neurological symptoms caused by vitamin E deficiency in a patient with short bowel syndrome.  Am J Clin Nutr. 1982;  36 1243-1249
    PubMedSearch in Google Scholar
  • 31 Stange E F, Schreiber S, Raedler A, Stallmach A, Schölmerich J, Loeschke K, Starlinger M, Fischbach W, Caspary WF. Therapie des Morbus Crohn - Ergebnisse einer Konsensuskonferenz der Deutschen Gesellschaft für Verdauungs- und Stoffwechselkrankheiten.  Z Gastroenterol. 1997;  35 541-554
    PubMedSearch in Google Scholar
  • 32 Rannem T, Ladefoged K, Hylander E, Hegnhoj J, Staun M. Selenium depletion in patients with gastrointestinal diseases: are there any predictive factors?.  Scand J Gastroenterol. 1998;  33 1057-1061
    CrossrefPubMedSearch in Google Scholar
  • 33 Ringstad J, Kildebo S, Thomassen Y. Serum selenium, copper and zinc concentrations in Crohn's disease and ulcerative Colitis.  Scand J Gastroenterol. 1993;  28 605-608
    PubMedSearch in Google Scholar

Prof. Dr. Eduard F. Stange

Medizinische Klinik IBereich Gastroenterologie/HepatologieUniversitätsklinikum Lübeck

Ratzeburger Allee 16023538 Lübeck