Das Kurzdarmsyndrom: Eine interdisziplinäre Herausforderung

Zusammenfassung

Die Behandlung und Betreuung von Patienten mit Kurzdarmsyndrom (KDS) stellt eine große Herausforderung für die betreuenden Ärzte, Ernährungsberaterinnen und Pflegefachpersonal dar. Die optimale ernährungsmedizinische, medikamentöse und chirurgische Behandlung setzt ein grundlegendes Verständnis der pathophysiologischen Konsequenzen der geänderten Länge und Struktur des Intestinaltraktes voraus. Die Behandlung erfordert eine koordinierte Zusammenarbeit von verschiedenen Spezialisten. In dieser Übersichtsarbeit werden Ursachen, anatomische und pathophysiologische Aspekte beim KDS beschrieben. Die Ernähungstherapie während den verschiedenen Phasen des Krankheitsverlaufes, die Diagnostik und neuere medikamentöse Therapieformen werden besprochen. Die zu Beginn eingeleitete parenterale Ernährung soll frühzeitig durch eine enterale Ernährung ergänzt werden, um die intestinale Adaptation zu begünstigen, den Flüssigkeitsverlust zu reduzieren und die Nährstoffresorption zu verbessern. Die langfristige Ernährungstherapie hängt von der Anatomie des Restdarms ab (Vorhandensein oder Fehlen von Dickdarm und Ileum). Im weiteren wird auf besondere Aspekte beim KDS eingegangen, welche unbedingt beachtet werden müssen. Ziele der Behandlung sind die Gewichtsstabilisierung und ggf. die Gewichtszunahme, der Ausgleich von Mikronährstoffdefiziten, bedarfgerechte Energie- und Nährstoffversorgung, weitgehende Symptomfreiheit und Steigerung des Wohlbefindens.

Abstract

The treatment and care of patients with Short Bowel Syndrome (SBS) is a challenge for physicians, dieticians and nursing staff. The optimal nutrition, drug and surgical management are based on the specific knowledge of the pathophysiologic consequences of the changed length and structure of the involved intestine. The optimal management require an multidisciplinary teamwork of all specialists involved. The content of this present review are etiological factors, functional and anatomic aspects, and treatment strategies of the SBS. In the postoperative period it is essential that parenteral nutrition is followed by an enteral diet to stimulate bowel adaptation, reduce fluid loss and increase nutrient absorption. The final nutritional support is based on the anatomy of the remaining bowel (presence or absence of a colon and ileum). In addition we give advice about the optimal nutritional support and new drug medication in the different phases of the disease are discussed. Furthermore we report about particular features of the SBS where we call attention to. The aim of the treatment is to stabilize or increase the bodyweight, the compensation of the micronutrients deficits, the adequate provision of energy and nutrient requirements, the reduction of symptoms and increased well-being.

Kurzdarmsyndrom - Ernährungstherapie - Mangelernährung - Malabsorption - Maldigestion

Short bowel syndrome - nutritional therapy - malnutrition - malabsorption - maldigestion

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