Inflammatory bowel diseases: principles of nutritional therapy

Abstract

Inflammatory Bowel Diseases - ulcerative colitis and Crohn's disease- are chronic gastrointestinal inflammatory diseases of unknown etiology. Decreased oral intake, malabsorption, accelerated nutrient losses, increased requirements, and drug-nutrient interactions cause nutritional and functional deficiencies that require proper correction by nutritional therapy. The goals of the different forms of nutritional therapy are to correct nutritional disturbances and to modulate inflammatory response, thus influencing disease activity. Total parenteral nutrition has been used to correct and to prevent nutritional disturbances and to promote bowel rest during active disease, mainly in cases of digestive fistulae with high output. Its use should be reserved for patients who cannot tolerate enteral nutrition. Enteral nutrition is effective in inducing clinical remission in adults and promoting growth in children. Due to its low complication rate and lower costs, enteral nutrition should be preferred over total parenteral nutrition whenever possible. Both present equal effectiveness in primary therapy for remission of active Crohn's disease. Nutritional intervention may improve outcome in certain individuals; however, because of the costs and complications of such therapy, careful selection is warranted, especially in patients presumed to need total parenteral nutrition. Recent research has focused on the use of nutrients as primary treatment agents. Immunonutrition is an important therapeutic alternative in the management of inflammatory bowel diseases, modulating the inflammation and changing the eicosanoid synthesis profile. However, beneficial reported effects have yet to be translated into the clinical practice. The real efficacy of these and other nutrients (glutamine, short-chain fatty acids, antioxidants) still need further evaluation through prospective and randomized trials.

Nutritional problems in inflammatory bowel disease patients

“…Do bezwzględnych przeciwwskazań dla ŻD należą zespół krót-kiego jelita lub niedrożność mechaniczna. Całkowite ŻP jest wskazane w nietolerancji diet bezresztkowych, przygotowaniu do zabiegu chirurgicznego w przetokowej postaci ChLC [8,16,19,20].…”

“…W Polsce ŻD przez sondę może być stosowane w warunkach domowych od stycznia 2007 r. [23]. Obecnie zainteresowanie wzbudza immunożywie-nie modulujące przebieg procesu zapalnego i zmieniają-ce profil syntezy eikozanoidów, ale potrzebne są dalsze badania w tym kierunku [19]. Dieta immunomodulująca zawiera składniki modyfikujące (wzmacniające lub osła-biające) czynność układu immunologicznego, w tym np.…”

“…Kwasy te są dostarczane egzogennie w oleju rybim, który zapewnia szybkie zwiększenie stężenia kwasów omega-3, normalizuje stosunek kwasów omega-3 do kwasu arachidonowego (AA), zmniejsza stęże-nie mediatorów prozapalnych syntetyzowanych z AA i zwiększa stężenie słabszych mediatorów zapalnych syntetyzowanych z kwasów omega-3 (pochodzący z EPA leukotrien B 5 jest 30-krotnie słabszym czynnikiem chemotaksji neutrofilów niż leukotrien B 4 , pochodzący z AA) [8,19,52]. Kwas eikozapentaenowy dzięki właściwoś -ciom przeciwzapalnym redukuje procesy zapalne w przebiegu różnych chorób, w tym NChZJ [53,54].…”

Nutritional therapy for active Crohn’s disease

“…The constituents of an elemental diet are primarily absorbed in the proximal small bowel-proximal to the most commonly affected sites of inflammation in CD. The reduction in the workload of digestion and absorption, and a reduction in peristalsis and digestive tract secretions may also play a role [7] . In general, elemental diets contain a low proportion of fat compared to polymeric or normal diets.…”

Nutritional abnormalities in inflammatory bowel disease

“…Not all of the nutritional issues have been squarely addressed in the article that follows 5 , which adopted a somewhat diferent approach, and in fact many ongoing investigations are still aiming to find the correct answers to some of these complex and relevant questions. In any case, the extensive and up-to-date review will shed precious light on the advantages and disadvantages of available dietetic alternatives.…”