Welche Rolle spielt die ern�hrung bei der colitis ulcerosa?

Abstract

Nutritional therapy for ulcerative colitis (UC) is controversial. Studies are usually designed to investigate total parenteral (TPN) or total enteral nutrition (TEN), and before these can be compared it is necessary to differentiate between the different therapeutic aims. The aims of artificial nutritional support in patients with UC are the readjustment of the nutritional status, possible remission of disease activity, and decrease in the incidence of surgical intervention or postoperative complication. Owing to the heterogeneity of the results published so far, it is still difficult to compare studies. Nevertheless, they indicate that the extent and severity of the colitis and the patient selection are of paramount importance in the implementation of nutritional therapy. Positive effects of TPN reported from non-controlled studies were not confirmed by controlled trials. Moreover, TPN was no more effective than an oral diet. Regarding remission rates or operative interventions needed, TPN had more side effects than and no defined advantages over TEN. TEN seems to be useful for certain patients. In some patients with UC, it seems to be accompanied by fewer postoperative complications. However, a definitive conclusion on the effects of TEN or TPN is not yet possible. In this context, certain fatty acids may have an important role in the treatment of UC. In prospective, randomized and controlled studies omega-3 fatty acids were found to be therapeutically useful. A reduction of the steroid doses needed is particularly important. Another therapeutic approach in distal UC is seen in the rectal administration of short chain fatty acids.

Gastroenterology – Guidelines on Parenteral Nutrition, Chapter 15

“…PN is indicated in cases of toxic megacolon, malabsorption syndrome, particularly short bowel syndrome, insufficient growth and disturbance of growth in children as well as when enteral nutrition is not tolerated [2], [3], [4], [5], [6], [7], [8], [9], [10]. …”

“…Clinical symptoms, inflammatory and nutritional parameters in Crohn's disease can improve under enteral/oral nutrition [2], [6], [10], [12], [13], [14]. There is no standardised data available regarding the remission rate with PN.…”

“…No significant improvement in clinical parameters was observed in patients with ulcerative colitis with the use of PN [2], [29]. There is no standardised data available regarding the remission rate with PN.…”

Welche Rolle spielt die Ern�hrung bei colitis ulcerosa?

“…Der Stellenwert der Ernfihrung in der Behandlung von Patienten mit Colitis ulcerosa wird in der yon Bartels et al vorgestellten Obersichtsarbeit [4] einerseits unter dem Gesichtspunkt einer Verbesserung der Ern~ihrungssituation diskutiert, andererseits unter der (hypothetischen) Vorstellung, mit di~itetischen Magnahmen direkt in den zugrundeliegenden Entzi]ndungsmechanismus eingreifen zu k6nnen. Trotz einer Ftille von Publikationen liegen bisher nur wenige gesicherte Studien zur Rolle der Ernfihrung in der Behandlung der Colitis ulcerosa vor.…”