Darmversagen

Der langstreckige Verlust von Dünndarm ist mit dem Leben nicht vereinbar. Aber mit der langfristigen parenteralen Ernährung steht ein wirksames, komplikationsarmes und mit guter Lebensqualität verbundenes Organersatzverfahren zur Verfügung – vergleichbar mit der Dialyse beim Nierenversagen. Die Zusammensetzung der parenteralen Substitution muss individuell für jeden Patienten festgelegt werden. Die Pathophysiologie des Darmversagens und die funktionelle Anatomie des Patienten stellen hierfür die Basis dar.

Abstract

Intestinal failure is defined as the reduction of gut function below the minimum necessary for the absorption of macronutrients and/or water and electrolytes, such that intravenous supplementation is required to maintain health and/or growth. Intestinal insufficiency is the corresponding condition that can be compensated by diet, supplements and medication. Short bowel following extensive small intestinal resection is the most common cause of intestinal failure. Parenteral nutrition is the effective organ replacement therapy for intestinal failure, associated with few complications and good quality of life. Parenteral supplementation should be individualized and be put together based on the individual remaining absorptive capacity of the intestine and the intestinal losses which are mainly a function of the functional anatomy – short bowel – jejunostomy (SB-J), SB – jejunocolonic anastomosis (SB-JC) or SB – jejuno-ileolcolonic anastomosis (SB-JIC). Because of the functional importance of the colon SB-JC and SB-JIC are recently often summarized as SB – colon-in continuity (SB-CiC). Central venous access is the Achillesʼ heel of parenteral nutrition. Tunneled single-lumen catheters (Broviac or Hickman) are the catheters of choice. Taurolidine-containing catheter lock solutions reduce the risk of catheter-related infections. Pharmacological therapy includes antisecretory, motility-inhibiting, and trophic strategies, as well as bile acid binding in cases of resected terminal ileum. Reconstructive surgery (usually reanastomosis of distal, disconected bowel segments) should be planned 6–12 months after the last operation, once postoperative conditions and the patient's overall health have stabilized.

Schlüsselwörter

Kurzdarm - chronisch-entzündliche Darmerkrankung - parenterale Ernährung - Ileus - intestinale Ischämie

Keywords

Short bowel syndrome - chronic inflammatory bowel disease - parenteral nutrition - ileus - intestinal ischemia

Publication History

Article published online:
06 June 2025

• Literatur

• 1 Pironi L, Arends J, Baxter J. et al. ESPEN endorsed recommendations. Definition and classification of intestinal failure in adults. Clin Nutr 2015; 34: 171-180
• 2 Keller J, Wedel T, Seidl H. et al. Update S3-Leitlinie Intestinale Motilitätsstörungen: Definition, Pathophysiologie, Diagnostik und Therapie. Gemeinsame Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) und der Deutschen Gesellschaft für Neurogastroenterologie und Motilität (DGNM). Z Gastroenterol 2022; 60: 192-218
• 3 Lamprecht G, Bodammer P. Nutritional strategies to enhance adaptation in intestinal failure. Curr Opin Organ Transplant 2016; 21: 140-146
• 4 Bannert K, Karbe C, Förster RH. et al. Orally compensated short bowel patients are thin, potentially malnourished but rarely sarcopenic. Clin Nutr 2023; 42: 1480-1490
• 5 Witte MB. Reconstructive Surgery for intestinal failure. Visc Med 2019; 35: 312-319
• 6 Jacob T, Glass A, Witte M. et al. Dynamic adjustments of parenteral support in early adult intestinal failure-essential role of sodium. Nutrients 2020; 12: 3426
• 7 Foerster RH, Lamprecht G, Rischmüller K. et al. Urinary acidbase excretion deciphers high acid load from colonic bicarbonate loss in intestinal failure patients with ileocolonic anastomosis – Guidance for composition of parenteral support. Clin Nutr 2024; 43: 1043-1050
• 8 Howard L, Ashley C. Management of complications in patients receiving home parenteral nutrition. Gastroenterology 2003; 124: 1651-1661
• 9 Wouters Y, Causevic E, Klek S. et al. Use of catheter lock solutions in patients receiving home parenteral nutrition: a systematic review and individual-patient data meta-analysis. J Parenteral Enteral Nutr 2020; 44: 1198-1209
• 10 Pironi L, Cuerda C, Jeppesen PB. et al. ESPEN guideline on chronic intestinal failure in adults – Update 2023. Clin Nutr 2023; 42: 1940-2021
• 11 Pironi L, Boeykens K, Bozzetti F. et al. ESPEN practical guideline: Home parenteral nutrition. Clin Nutr 2023; 42: 411-430
• 12 Pironi L, Cuerda C, Jeppesen PB. et al. Operational recommendations for the implementation of home parenteral nutrition program of care according to the guidelines of the European society for clinical nutrition and metabolism. Clin Nutr ESPEN 2024; 63: 668-675