ESPEN Guidelines on Parenteral Nutrition: Gastroenterology

Abstract

Undernutrition as well as specific nutrient deficiencies has been described in patients with Crohn's disease (CD), ulcerative colitis (UC) and short bowel syndrome. In the latter, water and electrolytes disturbances may be a major problem. The present guidelines provide evidence-based recommendations for the indications, application and type of parenteral formula to be used in acute and chronic phases of illness. Parenteral nutrition is not recommended as a primary treatment in CD and UC. The use of parenteral nutrition is however reliable when oral/enteral feeding is not possible. There is a lack of data supporting specific nutrients in these conditions. Parenteral nutrition is mandatory in case of intestinal failure, at least in the acute period. In patients with short bowel, specific attention should be paid to water and electrolyte supplementation. Currently, the use of growth hormone, glutamine and GLP-2 cannot be recommended in patients with short bowel.

Nutritional support with glutamine according to recommendations of the European Society for Clinical Nutrition and Metabolism (ESPEN)

“…Tak więc ESPEN nie zaleca stosowania glutaminy u pacjentów z tymi chorobami [35,36]. Wyniki dwóch badań z randomizacją nie wykazały korzystnego wpływu dojelitowego żywienia z glutaminą w porównaniu z żywieniem standardowym lub placebo na aktywność choroby Leśniowskiego-Crohna oraz na parametry kliniczne i antropometryczne [37,38].…”

“…Efekt ten utrzymywał się przez okres 3 miesięcy jedynie w grupie chorych otrzymujących hormon wzrostu wraz z glutaminą [46]. Na podstawie przedstawionych badań można wnioskować o korzystnym działaniu glutaminy podawanej z hormonem wzrostu, jednak zdaniem ESPEN dane te są niewystarczające, aby zalecać stosowanie tego aminokwasu u chorych z ZKJ [35,36].…”

Nutritional treatment in inflammatory bowel disease: An update

“…Moreover, undernutrition causes humoral and cellular immunodeficiency, leading to impairment of the mucosal barrier and a greater risk of infection by bacterial translocation (14). Taking all this into account, one of the most important goals of nutritional therapy should be to prevent and treat undernutrition, improving the growth and development of children and adolescents using TPN, EN, or by correcting micronutrient deficiency (1,2).…”

“…Nutritional therapy in IBD is carried out through total parenteral nutrition (TPN) or enteral nutrition (EN), the latter can be administered both via the nasogastric or oral route (1,2). Several studies have evaluated the effect of certain modifications to the composition of the parenteral and, in particular, enteral diets, including changes in the content of fats, proteins, carbohydrates, bioactive peptides (e.g.…”

Clinical case and short review of extreme short bowel syndrome: an update 21 years after

“…The clinical impact of SBS is farreaching because extensive resections can lead to malabsorption of macronutrients, micronutrients, electrolytes, and water, resulting in malnutrition, diarrhea, dehydration, weight loss, and to malnutritionand low-weight-related symptoms/signs (i.e., confusion, weakness, impaired growth and sexual development, and premature ageing). In addition, resection of the ileocecal valve may lead to bacterial contamination and growth of residual intestine, and to small intestinal bacterial overgrowth (SIBO) syndrome [1][2][3][4][5] ( Figure 1). In general, to obtain a favorable outcome in the absence of the ileocecal valve, a minimum of 25 cm of residual small intestine length, is required.…”