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Aktuelle Ernährungsmedizin 2012; 37(04): 235-246
DOI: 10.1055/s-0032-1305068
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© Georg Thieme Verlag KG Stuttgart · New York

Ernährungstherapie bei akuter und chronischer Pankreatitis

Nutritional Management in Acute and Chronic Pancreatitis
J. Ockenga
Medizinische Klinik II m. S. Gastroenterologie, Endokrinologie und Ernährungsmedizin, Klinikum Bremen Mitte
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Publication History

Publication Date:
01 August 2012 (online)

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Zusammenfassung

Die akute Pankreatitis ist ein häufiges Krankheitsbild. Während ca. 80 % der Patienten eine interstitielle ödematöse Pankreatitis erleiden, die in der Regel innerhalb von einigen Tagen wieder ausheilt, entwickeln ca. 20 % eine nekrotisierende Pankreatitis. Hierbei handelt es sich um eine Erkrankung mit substanzieller Morbidität und Mortalität. Eine frühe enterale Ernährung ist in der Lage, den Krankheitsverlauf bei nekrotisierender Pankreatitis positiv zu beeinflussen. Zum Einsatz kommt hier eine initiale gastrale enterale Sondenernährung. Nur wenn diese aufgrund eines erhöhten gastralen Residualvolumens nicht möglich ist, sollte eine jejunale Sondenanlage erfolgen. Ist auch hierüber innerhalb von 5 – 7 Tagen keine ausreichende Kalorienzufuhr möglich, ist eine parenterale Ernährung notwendig.

Bei der chronischen Pankreatitis steht eine ausreichende Nahrungszufuhr im Mittelpunkt der ernährungsmedizinischen Bemühungen. Wenn eine exokrine Pankreasinsuffizienz vorliegt, ist neben der Kalorienzufuhr eine adäquate Pankreasenzymsubstitution wichtig. Eine Fettreduktion ist in den meisten Fällen nicht notwendig bzw. sogar kontraproduktiv. Die individualisierte Ernährungsberatung hat hier einen großen Stellenwert, um eine adäquate Nahrungszufuhr sicherzustellen. Nur selten ist eine künstliche Ernährung notwendig.

Abstract

In the western world acute pancreatitis is a frequent clinical entity. About 80 % of patients with acute pancreatitis develop an oedematous pancreatitis, whereas, 20 % develop a necrotizing pancreatitis: the later one, a potential life threatening disease. In this case an early enteral nutrition has been proven to improve the course of the disease. Usually, a gastric enteral nutrition via a nasogastric tube is possible; only in a minority a jejunal feeding is necessary due to a high gastric residual volume. If enteral feeding is not feasible within 5 – 7 days, parenteral nutrition has to be considered.

Chronic pancreatitis is characterised by reduced caloric intake and a high risk for malnutrition. Next to adequate pain management and pancreatic enzyme supplementation an individualized nutritional counselling should be provided with the aim to maintain caloric intake. Artificial feeding is uncommon.

Schlüsselwörter

Ernährung - akute Pankreatitis - chronische Pankreatitis - Ernährungsstatus - nekrotisierende Pankreatitistherapie - Intensivmedizin/-therapie

Keywords

nutrition - acute pancreatitis - chronic pancreatitis - nutritional status - pancreatitis, acute necrotizing/therapy - intensive care/therapy
 

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