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Z Gastroenterol 2014; 52(4): 376-386
DOI: 10.1055/s-0034-1366252
Mitteilungen aus Fachgesellschaften
© Georg Thieme Verlag KG Stuttgart · New York

Ernährung und chronisch entzündliche Darmerkrankungen – ein Konsensus der Arbeitsgruppe chronisch entzündliche Darmerkrankungen der Österreichischen Gesellschaft für Gastroenterologie und Hepatologie (Austrian Guidelines for nutrition in IBD)

Nutrition and IBD-Consensus of the Austrian Working Group of IBD (Inflammatory Bowel Diseases) of the ÖGGH
H. Fuchssteiner
1   Krankenhaus der Elisabethinen Linz GmbH, Interne Medizin 4
,
K. Nigl
2   Fachhochschule Gesundheitsberufe OÖ GmbH, Studiengang Diätologie, Linz
,
A. Mayer
3   Landesklinikum St. Pölten, 2. Medizin
,
B. Kristensen
4   Fachhochschule St. Pölten, Studiengang Diätologie
,
R. Platzer
5   Landesklinikum Wiener Neustadt, 1. Interne Abteilung
,
B. Brunner
5   Landesklinikum Wiener Neustadt, 1. Interne Abteilung
,
I. Weiß
6   Allgemeines Krankenhaus Wien, Univ.-Klinik Innere Medizin III
,
T. Haas
7   Salzburger Landeskliniken, 1. Medizin
,
M. Benedikt
8   Salzburger Landeskliniken, Ernährungsmedizinische Beratung
,
H. P. Gröchenig
9   Krankenhaus Barmherzige Brüder, St. Veit/Glan, Innere Medizin
,
A. Eisenberger
10   LKH Univ.-Klinikum Graz, Ernährungsmedizinischer Dienst
,
P. Hillebrand
6   Allgemeines Krankenhaus Wien, Univ.-Klinik Innere Medizin III
,
W. Reinisch
11   Medizinische Universität Wien, Univ.-Klinik Innere Medizin III, Abt. Gastroenterologie und Hepatologie
,
H. Vogelsang
11   Medizinische Universität Wien, Univ.-Klinik Innere Medizin III, Abt. Gastroenterologie und Hepatologie
› Author Affiliations
Further Information

Publication History

Publication Date:
09 April 2014 (online)

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Zusammenfassung

Dies ist ein Konsens der Arbeitsgruppe CED (chronisch entzündliche Darmerkrankungen) der ÖGGH zur Ernährung bei CED. Bei CED und Gewichtsverlust (> 5 % in 3 Monaten), Mangelerscheinungen, nach langstreckigen Darmresektionen sollte eine Mangelernährung (bei Morbus Crohn in 20 – 70 %) geprüft und dann auch behandelt werden. Insbesondere sollte wegen Auftretens von eingeschränkter Lebensqualität, opportunistischen Infekten, Osteopenie/Osteoporose, längerer Hospitalisierung und Mortalität der Mangelernährung sowohl durch Therapie der Grunderkrankung als auch spezielle, soweit möglich orale Ernährungstherapie begegnet werden. Bei Mangelernährung sollten Eisenstatus, Vitamin B12- und Folsäurespiegel, Vitamin D- und Zinkwerte im Blut untersucht werden. Die primäre Ernährungstherapie mit enteraler Füssigdiäten ist nur bei Kindern Therapie erster Wahl, bei Erwachsenen nur in speziellen Situationen. Es gibt dzt. keine allgemein wirksame orale Diät zur Remissionserhaltung bei CED. Probiotika mit E. coli Nissle können alternativ zu Mesalazin zur Remissionserhaltung bei Colitis ulcerosa eingesetzt werden. Patienten mit Ileostoma bzw. Kurzdarmsyndrom sollten speziell dietätisch beraten werden. Bei Patienten mit Kurzdarmsyndrom ist die Ernährungssituation von der Funktion und Länge des Restdarms abhängig, sodass hier die bestmögliche antientzündliche Therapie betrieben werden sollte.

Abstract

This is a consensus of the Austrian working group of IBD (inflammatory bowel diseases) of the ÖGGH on nutrition in IBD. Malnutrition should be assessed in case of IBD (in 20 – 70 % of Crohn’s patients) and weight loss(> 5 % within 3 months) or nutritional deficiencies or after extensive bowel resection and afterwards also treated. Malnutrition should be treated with medical therapy of IBD and also adequate – as far as possible – with oral nutritional therapy particularly because of reduced life quality, risk of opportunistic infections, osteopenia/osteoporosis, longer hospitalisations and higher mortality. Iron homeostasis, serum levels of Vitamin B12- and folic acid, 25-hydroxyvitamin D and zinc should be checked. Therapy with enteral liquid diets is only indicated as therapy of first choice in children and adolescents, but only in rare situations in adults with IBD. There is – up to now – no proven oral diet for maintenance of remission in IBD. Probiotics as E. coli Nissle could be used as alternative to mesalazine for maintenance of remission in patients with ulcerative colitis. A specific dietary counselling is mandatory in patients with ileostoma or short bowel syndrome. Malnutrition of short bowel patients is particularly dependent on the function and length of the remaining bowel, therefore the most effective medical therapy should be administered.

Schlüsselwörter

M. Crohn - Colitis ulcerosa - CED - Ernährung - Malnutrition - Mangel - Probiotika - Ernährungszustand

Key words

Crohn’s disease - ulcerative colitis - IBD - nutrition - malnutrition - deficiencies - probiotics - nutritional assessment
 

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