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)

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

• Literatur

• 1 Van Assche G, Dignass A, Panes J et al. The second European evidence-based Consensus on the diagnosis and management of Crohn’s disease: special situations. JCC 2010; 4: 63-101
• 2 Hoffmann JC, Preiss JC, Autschbach F et al. Diagnostik und Therapie des Morbus Crohn. Z Gastroenterol 2008; 46: 1094-1146
• 3 Mueller C, Compher C, Ellen DM. American Society for Parenteral and Enteral Nutrition (A. S. P. E.N.) Board of Directors. A. S. P. E.N. clinical guidelines: Nutrition screening, assessment, and intervention in adults. JPEN J Parenter 2011; 35 (01) 16-24
• 4 Kondrup J, Rasmussen HH, Hamberg O. Ad Hoc ESPEN Working Group et al. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr 2003; 22 (03) 321-336
• 5 Kajiura T, Takeda T, Sakata S et al. Change of intestinal microbiota with elemental diet and its impact on therapeutic effects in a murine model of chronic colitis. Dig Dis Sci 2009; 54 (09) 1892-1900
• 6 Hou JK, Abraham B, El-Serag H. Dietary intake and risk of developing inflammatory bowel disease: a systematic review of the literature. Am J Gastroenterol 2011; 106 (04) 563-573 ; Review
• 7 Kondrup J, Allison SP, Elia M et al. ESPEN Guidelines for Nutrition Screening 2002. Clinical Nutrition 2003; 22: 415-421
• 8 Hartmann C, Eliakim R, Shamir R. Nutritional status and nutritional therapy in inflammatory bowel diseases. World J Gastroenterol 2009; 15: 2570-2578
• 9 Lucendo AJ, De Rezende LC. Importance of nutrition in inflammatory bowel diease. World J Gastroenterol 2009; 15: 2081-2088
• 10 Filippi J, Al-Jaouni R, Wiroth JB et al. Nutrtional Deficiencies in Patients with Crohn’s disease in Remission.. Inflamm Bowel Dis 2006; 12: 185-1191
• 11 Motil KJ, Grand RJ, Davis-Kraft L et al. Growth Failure in Children With Inflammatory Bowel Disease: A Prospective Study. Gastroenterology 1993; 105: 681-691
• 12 Markowitz J, Grancher K, Rosa J et al. Growth Failure in Pediatric Inflammatory Bowel Disease. J Pediatr Gastroenterol Nutr 1993; 16: 373-380
• 13 Heuschkel R, Salvestrini C, Beattie M et al. Guidelines for the Management of Growth Failure in childhood Inflammatory Bowel Disease. Inflamm Bowel dis 2008; 14: 839-849
• 14 Norman K, Kirchner H, Lochs H et al. Malnutrition affects quality of life in gastroenterology patients. World J Gastroenterol 2006; 12: 3380-3385
• 15 Kulnigg S, Gasche C. Systematic review: manging anemia in Crohn’s disease. Aliment Pharmacol Ther 2006; 24: 1507-1523
• 16 Gasche C, Berstad A, Befrits R et al. Guidelines on the Diagnosis and Management of Iron Deficiency and anemia in Inflammatory Bowel Diseases. Inflamm Bowel Dis 2007; 13: 1545-1553
• 17 Sylvester FA, Wyzga N, Hyams J et al. Natural History of Bone Metabolism and Bone Mineral density in Children With Inflammatory Bowel Disease. Inflamm Bowel Dis 2007; 13: 42-50
• 18 Leslie WD, Miller N, Rogala L et al. Body Mass and Composition Affect Bone Density in Recently Diagnosed Inflammatory Bowel Disease: The Manitoba IBD Cohort Study. Inflamm Bowel Dis 2009; 15: 39-46
• 19 Pappa HM, Grand RJ, Gordon CM. Report on the Vitamin D Status of Adult and Pediatric Patients with Inflammatory Bowel Disease and ist significance for Bone Health and disease. Inflamm Bowel Dis 2006; 12: 1162-1174
• 20 Valentini L, Schaper L, Buning C et al. Malnutrition and impaired muscle strength in patients with Crohn’s disease and ulcerative colitis in remission. Nutrition 2008; 24: 694-702
• 21 Schneider SM, Al-Jaouni R, Filippi J et al. Sarcopenia is Prevalent in Patients with Crohn’s Disease in Clinical Remission. Inflamm Bowel Dis 2008; 14: 1562-1568
• 22 Gershwin ME, Borcers AT, Keen CL. Phenotypic and Functional Considerations in the evaluation of Immunity in Nutritional compromised Hosts. JID 2000; 182: S108-S114
• 23 Schaible UE, Kaufmann SH. Malnutrition and Infection: Complex Mechanisms and Global Impacts. PLos Medicine 2007; 4: 806-812
• 24 Rahier JF, Ben-Horim S, Chowers Y et al. European evidence-based Consensus on the prevention, diagnosis and management of opportunistic infections in inflammatory bowel disease. J Crohns Colitis 2009; 3 (2) 47-91
• 25 Nguyen GC, Munsell M, Harris ML. Nationwide Prevalence and Prognostic Significance of Clinically Diagnosable Protein-calorie Malnutrition in Hospitalized inflammatory Bowel Disease Patients. Inflamm Bowel Dis 2008; 14: 1105-1111
• 26 Pirlich M, Schütz T, Norman K et al. The German hospital malnutrition study. Clinical Nutrition 2006; 25: 563-572
• 27 Isabel M, Correia TD, Waitzberg DL. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Cliical Nutrition 2003; 22: 235-239
• 28 Mijac DD, Jonkovic GLJ, Jorga J et al. Nutritional status in patients with active inflammatory bowel disease: Prevalence of malnutrition and methods for routine nutritional assessment. European Journal of Internal medicine 2010; 21: 315-319
• 29 Vagianos K, Bector S, Mcconnel J et al. Nutrition assessment of Patients With Inflammatory Bowel Disease. Journal of Parenteral and Enteral Nutrition 2007; 31: 311-319
• 30 Geerling BJ, Badart-Smook A, Stockbrügger RW et al. comprehensive nutritional status in patients with long-standing Crohn disease currently remission. Am J Clin Nutr 1998; 67: 919-926
• 31 Heatley RV. Assessing nutritional state in inflammatory bowel disease. Gut 1986; 27: 61-66
• 32 Guerreiro CS, Cravo M, Costa AR et al. A Comprehensive Approach to Evaluate Nutritional Status in Crohn’s Patients in the Era of Biologic Therapy: A Case-Control Study. Am J Gastronenterol 2007; 102: 2551-2556
• 33 Pirlich M, Schwenk A, Müller MJ et al. DGEM-Leitlinie Enterale Ernährung: Ernährungsstatus. Aktuel Ernaehr Med 2003; 28: S10-S25
• 34 Raslan M, Gonzalez MC, Torrinhas RS et al. Complementarity of Subjective Globals Assessment (SGA) and Nutritional Risk Screening 2002 (NRS 2002) for predicting poor clinical outcomes in hospitalized patients. Clinical Nutrition 2011; 30: 49-53
• 35 Lochs H, Steinhardt HJ, Klaus-Wentz B et al. Comparison of enteral nutrition and drug treatment in active Crohn’s disease. Results of the European Cooperative Crohn’s Disease Study IV. Gastroenterology 1991; 101: 881-888
• 36 Lochs H, Dejong C, Hammarqvist F et al. ESPEN Guidelines on Enteral Nutrition: Gastroenterology. Clinical Nutrition 2006; 25: 260-274
• 37 Van Gossum A, Cabre E, Hebuterne X et al. ESPEN Guidelines on Parenteral Nutrition: Gastroenterology. Clinical Nutrition 2009; 28: 415-427
• 38 Headstrom PD, Rulyak J, Lee SD. Prevalence of and Risk Factors for Vitamin B12 Deficiency in Patients with Crohn’s Disease. Inflamm Bowel Dis 2008; 14: 217-223
• 39 Buchman AL, Scolapio J, Freyer J. AGA Technical Review on Short Bowel Syndrome and Intestinal Transplantation. Gastroenterology 2003; 124: 1111-1134
• 40 Nightingale J, Woodward JM et al. Guidelines for management of patients with a short bowel. Gut 2006; 55: iv1-iv12
• 41 Ainley C, Cason J, Slavin M et al. The Influence of Zinc Status and Malnutrition on Immunological Function in Crohn’s Disease. Gastroenterology 1991; 100: 1616-1625
• 42 Saper RB, Rash R. Zinc: An Essential Micronutrient. Am Fam Physician 2009; 79: 1-10
• 43 Jacobson LO, Plantin S. Concentration of selenium in plasma and erythrocytes during total parenteral nutrition in Crohn’s disease. Gut 1985; 26: 50-54
• 44 Zauner C, Zauner A, Lindener G et al. Das Refeeding-Syndrom. J Gastroenterol Hepatol Erkr 2005; 3: 7-11
• 45 Khan LU, Ahmed J, Khan S et al. Refeeding syndrome: a literature review. Gastroenterol Res Pract 2011; pii: 410971
• 46 Royall D, Greenberg GR, Allard JP et al. Critical assessment of body-composition measurements in malnourished subjects with Crohn‘s disease: the role of bioelectric impedance analysis. Am J Clin Nutr 1994; 59: 325-330
• 47 Ballegaard M, Bjergstrøm A, Brøndum S et al. Self-reported food intolerance in chronic inflammatory bowel disease. Scand J Gastroenterol 1997; 32 (06) 569-571
• 48 Barrett JS, Irving PM, Shepherd SJ et al. Comparison of the prevalence of fructose and lactose malabsorption across chronic intestinal disorders. Aliment Pharmacol Ther 2009; 30 (02) 165-174
• 49 Baños Madrid R, Salama Benerroch H, Morán SánchezS et al. Lactose malabsorption in patients with inflammatory bowel disease without activity: would it be necessary to exclude lactose products in the diet of all patients. An Med Interna 2004; 21 (05) 212-214
• 50 Mishkin S. Dairy sensitivity, lactose malabsorption, and elimination diets in inflammatory bowel disease. Am J Clin Nutr 1997; 65 (02) 564-567
• 51 Hüppe D, Tromm A, Langhorst H et al. Lactose intolerance in chronic inflammatory bowel diseases. Dtsch Med Wochenschr 1992; 117 (41) 1550-1555
• 52 Seibold F. Food-induced immune responses as origin of bowel disease?. Digestion 2005; 71 (04) 251-260
• 53 Cashman KD, Shanahan F. Is nutrition an aetiological factor for inflammatory bowel disease?. Eur J Gastroenterol Hepatol 2003; 15 (06) 607-613
• 54 van den Bogaerde J, Kamm MA, Knight SC. Immune sensitization to food, yeast and bacteria in Crohn‘s disease. Aliment Pharmacol Ther 2001; 15 (10) 1647-1653
• 55 Brignola C, Miniero R, Campieri M et al. Dietary allergy evaluated by PRIST and RAST in inflammatory bowel disease. Hepatogastroenterology 1986; 33 (03) 128-130
• 56 Juste RA. Crohn’s disease and ruminant farming. Got lactase?. Med Hypotheses 2010; 75 (01) 7-13
• 57 Nanji AA, Denardi FG. Primary adult lactose intolerance protects against development of inflammatory bowel disease. Med Hypotheses 1986; 19 (01) 1-6
• 58 Bischoff SC, Herrmann A, Manns MI. Prevalence of adverse reactions to food in patients with gastrointestinal disease. Allergy 1996; 51: 811-818
• 59 Stange EF, Schmid U, Fleig WE et al. Exclusion diet in Crohn disease: a controlled, randomized study. Z Gastroenterol 1990; 28 (10) 561-564
• 60 Pearson M, Teahon K, Levi AJ et al. Food intolerance and Crohn’s disease. Gut 1993; 34: 783-787
• 61 Brunner B, Scheurer U, Seibold F. Differences in yeast intolerance between patients with Crohn’s disease and ulcerative colitis. Dis Colon Rectum 2007; 50 (01) 83-88
• 62 Rabast U, Horn M. Incidence of Non-Specific Food Intolerance in Patients Suffering from Chronic Inflammatory Bowel Diseases. Aktuelle Ernährungsmedizin 2003; 28 (02) 106-112
• 63 Brown AC, Roy M. Does evidence exist to include dietary therapy in the treatment of Crohn’s disease?. Gastroenterol Hepatol (Expert Rev) 2010; 4 (02) 191-215
• 64 Rajendran N, Kumar D. Role of diet in the management of inflammatory bowel disease. World J Gastroenterol 2010; 16 (12) 1442-1448
• 65 Bentz S, Hausmann M, Piberger H et al. Clinical relevance of IgG antibodies against food antigens in Crohn’s disease: a double-blind cross-over diet intervention study. Digestion 2010; 81 (04) 252-264
• 66 Bischoff SC, Mayer JH, Manns MP. Allergy and the gut. Int Arch Allergy Immunol 2000; 121 (04) 270-283
• 67 Huber A, Genser D, Spitzauer S et al. IgE/anti-IgE immune complexes in sera from patients with Crohn’s disease do not contain food-specific IgE. Int Arch Allergy Immunol 1998; 115 (01) 67-72
• 68 Voitk AJ, Echave V, Feller JH et al. Experience with elemental diet in the treatment of inflammatory bowel disease. Is this primary therapy?. Arch Surg 1973; 107 (02) 329-333
• 69 Rocchio MA, Cha CJ, Haas KF et al. Use of chemically defined diets in the management of patients with acute inflammatory bowel disease. Am J Surg 1974; 127 (04) 469-475
• 70 O’Morain C, Segal AW, Levi AJ. Elemental diets in treatment of acute Crohn’s disease. Br Med J 1980; 281 (6249) 1173-1175
• 71 Fernández-Bañares F, Cabré E, Esteve-Comas M et al. How effective is enteral nutrition in inducing clinical remission in active Crohn’s disease? A meta-analysis of the randomized clinical trials. JPEN 1995; 19: 356-364
• 72 Griffiths AM, Ohlsson A, Sherman PM et al. Meta-analysis of enteral nutrition as a primary treatment of active Crohn’s disease. Gastroenterology 1995; 108: 1056-1067
• 73 Trallori SG, D'Albasio G, Milla M et al. Defined-formula diets versus steroids in the treatment of active Crohn’s disease: a meta-analysis. Scand J Gastroenterol 1996; 31 (03) 267-272
• 74 Zachos M, Tondeur M, Griffiths AM. Enteral nutritional therapy for induction of remission in Crohn’s disease. Cochrane Database Syst Rev 2007; 24 (01) CD000542
• 75 Heuschkel RB, Menache CC, Megerian JT et al. Enteral nutrition and corticosteroids in the treatment of acute Crohn’s disease in children. J Pediatr Gastroenterol Nutr 2000; 31: 8-15
• 76 Dziechciarz P, Horvath A, Shamir R et al. Meta-analysis: enteral nutrition in active Crohn’s disease in children. Aliment Pharmacol Ther 2007; 26: 795-803
• 77 Beattie RM, Bentsen BS, MacDonald TT. Childhood Crohn’s disease and the efficacy of enteral diets. Nutrition 1998; 14 (04) 345-350
• 78 Heuschkel RB. Enteral nutrition should be used to induce remission in childhood Crohn’s disease. Dig Dis 2009; 27: 297-305
• 79 Beeken WL, Busch HJ, Sylwester DL. Intestinal protein loss in Crohn’s disease. Gastroenterology 1972; 62: 207-215
• 80 Kanof ME, Lake AM, Bayless TM. Decreased height velocity in children and adolescents before the diagnosis of Crohn’s disease. Gastroenterology 1998; 95: 1523-1527
• 81 Navas López VM, Blasco Alonso J, Sierra Salinas C et al. Efficacy of exclusive enteral feeding as primary therapy for paediatric Crohn’s disease. An Pediatr 2008; 69: 506-514
• 82 Day AS, Whitten KE, Lemberg DA et al. Exclusive enteral feeding as primary therapy for Crohn’s disease in Australian children and adolescents: a feasible and effective approach. J Gastroenterol Hepatol 2006; 21 (10) 1609-1614
• 83 Borelli O, Cordischi L, Cirulli M et al. Polymeric diet alone versus corticosteroids in the treatment of active pediatric Crohn’s disease: a randomized controlled open-label trial. Clin Gastroenterol H 2006; 21 (10) 1609-1614
• 84 Yamamoto T, Nakahigashi M, Umegae S et al. Impact of elemental diet on mucosal inflammation in patients with active Crohn’s disease: cytokine production and endoscopic and histological findings. Inflamm Bowel Dis 2005; 11: 580-588
• 85 Verma S, Brown S, Kirkwood B. Polymeric versus elemetal diet as primary treatment in active Crohn’s disease: a randomized-double blind trial. Am J Gastroenterol 2000; 95: 735-739
• 86 Lochs H, Dejong C, Hammarqvist F et al. ESPEN Guidelines on Enteral Nutrition: Gastroenterology. Clinical Nutrition 2006; 25: 260-274
• 87 Ludviggson JF, Krantz M, Bodin L et al. Elemental versus polymeric enteral nutrition in paediatric Crohn’s disease: a multicentre randomized controlled trial. Acta paediatr 2004; 93: 327-335
• 88 Anstee QM, Forbes A. The safe use of percutaneous gastrostomy for enteral nutrition in patients with Crohn’s disease. Eur J Gastroenterol Hepatol 2000; 12: 1089-1093 (IIa)
• 89 Thomas TS, Berto E, Scribano ML et al. Treatment of esophageal Crohn’s disease by enteral feeding via percutaneous endoscopic gastrostomy. J Parenter Enteral Nutr 2000; 24: 176-179 (III)
• 90 Johnson T, Macdonald S, Hill SM et al. Treatment of active Crohn’s disease in children using partial enteral nutrition with liquid formula: a randomised controlled trial. Gut 2006; 55: 356-361
• 91 Rajendran N, Kumar D. Role of diet in the management of inflammatory bowel disease. World J Gastroenterol 2010; 16 (12) 1442-1448
• 92 Greenberg GR, Fleming CR, Jeejeebhoy KN et al. Controlled trial of bowel rest and nutritional support in the management of Crohn’s disease. Gut 1988; 29: 1309-1315
• 93 Duerksen DR, Nehra V, Bistrian BR et al. Appropriate nutrional support in acute and complicated Crohn’s disease. Nutrition 1998; 14: 462-465
• 94 Lochs H, Meryn S, Marosi L et al. Has total bowel rest a beneficial effect in the treatment of Crohn’s disease. Clin Nutr 1983; 2: 61-64
• 95 Cabré Gelada E, Gassull Duró MA. Parenteral nutrition versus enteral nutrition. When and why?. Med Clin 1991; 96: 692-693
• 96 Dignass A, Van Asche G, Lindsay JO et al. The second European evidence-based consenus on the diagnosis and management of Crohn’s disease: Current management. Journal of Crohn’s and Colitis 2010; 4: 28-62
• 97 Stein J. Leitlinien der DGVS: Ernährung. Z Gastroenterol 2003; 41: 62-68
• 98 Van Gossum A, Cabre E, Hébuterne X et al. ESPEN Guidelines on Parenteral Nutrition: Gastroenterology. Clinical Nutrition 2009; 28: 415-427
• 99 Sartor RB. Therapeutic manipulation of the enteric microflora in inflammatory bowel diseases: antibiotics, probiotics, and prebiotics. Gastroenterology 2004; 126: 1620-1633
• 100 Packey CD, Sartor RB. Interplay of commensal and pathogenic bacteria, genetic mutations, and immunoregulatory defects in the pathogenesis of inflammatory bowel diseases. J Intern Med 2008; 263: 597-606
• 101 Lindsay JO, Whelan K, Stagg AJ et al. Clinical, microbiological, and immunological effects of fructo-oligosaccharide in patients with Crohn’s disease. Gut 2006; 55 (03) 348-355
• 102 Hedin C, Whelan K, Lindsay JO. Evidence for the use of probiotics and prebiotics in inflammatory bowel disease: a review of clinical trials. Proc Nutr Soc 2007; 66 (03) 307-315
• 103 Leenen CH, Dieleman L. Inulin and oligofructose in chronic inflammatory bowel disease. J Nutr 2007; 137 (Suppl. 11) 2572S-2575S
• 104 Benjamin JL, Hedin C, Koutsoumpas A et al. Randomised, double-blind, placebo-controlled trial of fructo-oligosaccharides in active Crohn’s disease. Gut 2011; 60 (7) 923-929
• 105 Mallon P, McKay D, Kirk S et al. Probiotics for induction of remission in ulcerative colitis. Cochrane Database Syst Rev 2007 Oct 17, (4): CD005573
• 106 Sang LX, Chang B, Zhang WL et al. Remission induction and maintenance effect of probiotics on ulcerative colitis: a meta-analysis. World J Gastroenterol 2010; 16 (15) 1908-1915
• 107 Tursi A, Brandimarte G, Papa A et al. Treatment of relapsing mild-to-moderate ulcerative colitis with the probiotic VSL#3 as adjunctive to a standard pharmaceutical treatment: a double-blind, randomized, placebo-controlled study. J Gastroenterol 2010; 105 (10) 2218-2227
• 108 Chapman TM, Plosker GL, Figgitt DP. VSL#3 probiotic mixture: a review of its use in chronic inflammatory bowel diseases. Drugs 2006; 66 (10) 1371-1387
• 109 Travis SPL, Stange EF, Lémann M et al. European evidence-based Consensus on the management of ulcerative colitis: Current management. Journal of Crohn’s and colitis 2008; 2: 24-62
• 110 Kruis W, Schutz E, Fric P et al. Double-blind comparison of an oral Escherichia coli preparation and mesalazine in maintaining remission of ulcerative colitis. Aliment Pharmacol Ther 1997; 11: 853-858
• 111 Rembacken BJ, Snelling AM, Hawkey PM et al. Non-pathogenic Escherichia coli vs mesalazine for the treatment of ulcerative colitis: a randomised trial. Lancet 1999; 354: 635-639
• 112 Kruis W, Fric P, Pokrotnieks J et al. Maintaining remission of ulcerative colitis with the probiotic Escherichia coli Nissle 1917 is as effective as with standard mesalazine. Gut 2004; 53: 1617-1623
• 113 Piquet MA, Gloro R, Justum AM et al. Nutritional therapy in inflammatory bowel disease. Gastroenterol Clin Biol 2006; 30: 262-272
• 114 Bibiloni R, Fedorak RN, Tannock GW et al. VSL#3 probiotic-mixture induces remission in patients with active ulcerative colitis. Am J Gastroenterol 2005; 100: 1539-1546
• 115 Segain JP, Raingeard de la Blétière D, Bourreille A et al. Butyrate inhibits inflammatory responses through NFkappaB inhibition: implications for Crohn’s disease. Gut 2000; 47: 397-403
• 116 Steinhart AH, Hiruki T, Brzezinski A et al. Treatment of left-sided ulcerative colitis with butyrate enemas: a controlled trial. Aliment Pharmacol Ther 1996; 10: 729-736
• 117 Akobeng AK, Miller V, Stanton J et al. Double-blind randomized controlled trial of glutamine-enriched polymeric diet in the treatment of active Crohn’s disease. J Pediatr Gastroenterol 2000; 30 (01) 78-84
• 118 Jones AV. Comparison of total parenteral nutrition and elemental diet in induction of remission of Crohn’s disease. Long-term maintenance of remission by personalized food exclusion diets. Dig Dis Sci 1987; 32: 100-107
• 119 Riordan AM, Hunter JO, Cowan RE et al. Treatment of active Crohn’s disease by exclusion diet: East Anglian Multicentre Controlled Trial. Lancet 1993; 342: 1131-1134
• 120 Jones AV, Workman E, Freeman AH et al. Crohn’s Disease: Maintenance of remission by diet. Lancet 1985; 326: 177-180
• 121 Triggs CM, Munday K, Hu R et al. Dietary factors in chronic inflammation: Food tolerances and intolerances of a New Zealand Caucasian Crohn’s disease population. Mutation Research 2010; 690: 123-138
• 122 Brandes JW, Lorenz-Meyer H. Sugar free diet: a new perspective in the treatment of Crohn disease? Randomized, control study. Z Gastroenterol 1981; 19: 1-12
• 123 Ritchie JK, Wadsworth J, Lennard-Jones JE et al. Controlled multicentre therapeutic trial of an unrefined carbohydrate, fibre rich diet in Crohn’s disease. Br Med J (Clin Res Ed) 1987; 295 (6597) 517-520
• 124 Jowett SL, Seal CJ, Pearce MS et al. Influence of dietary factors on the clinical course of ulcerative colitis: a prospective cohort study. Gut 2004; 53: 1479-1484
• 125 Hanai H, Iida T, Takeuchi K et al. Curcumin maintenance therapy for ulcerative colitis: randomized, multicenter, double-blind, placebo-controlled trial. Clin Gastroenterol Hepatol 2006; 13: 1576-1577
• 126 Yamamoto T, Nakahigashi M, Umegae S et al. Enteral nutrition for maintenance of remission in Crohn’s disease: a systematic review. Eur J Gastroenterol Hepatol 2010; 22: 1-8
• 127 Takagi S, Utsunomiya K, Kuriyama S et al. Effectiveness of an “half elemental diet” as maintenance therapy for Crohn’s disease: a randomized-controlled trial. Aliment Pharmacol Ther 2006; 24: 1333-1340
• 128 Akobeng AK, Thomas AG. Enteral nutrition for maintenance of remission in Crohn’s disease. Cochrane Database of Syst Rev 2007 Jul 18, (3): CD005984
• 129 Yamamoto T, Nakahigashi M, Umegae S et al. Impacts of long-term enteral nutrition on clinical and endoscopic disease activities and mucosal cytokines during remission in patients with Crohn’s disease: a prospective study. Inflamm Bowel Dis 2007; 13: 1493-1501
• 130 Tondeur M, Griffiths AM. Enteral nutritional therapy for induction of remission in Crohn’s disease. Cochrane Database Syst Rev 2007; 1 CD000542
• 131 Verma S, Kirkwood SB, Brown S et al Oral nutritional supplementation is effective in the maintenance of remission in Crohn’s disease. Dig Liver Dis 2000; 32: 769-774
• 132 Yamamoto T, Nakahigashi M, Umegae S et al. Prospective clinical trial: enteral nutrition during maintenance infliximab in Crohn’s disease. J Gastroenterol 2010; 45 (01) 24-29
• 133 Turner D, Shah PS, Steinhart AH et al. Maintenance of remission in inflammatory bowel disease using omega-3 fatty acids (fish oil): a systematic review and meta-analyses. Inflamm Bowel Dis 2011; 17: 336-345
• 134 Moise C, Rachel ML, Pierre D. Potential for amino acids supplementation during inflammatory bowel diseases. Inflamm Bowel Dis 2010; 16: 518-524
• 135 Butterworth AD, Thomas AG, Akobeng AK. Enteral nutrition for maintenance of remission in Crohn’s disease. Cochrane Database of Syst Rev 2007 Jul 18, (3): CD005984
• 136 Rolfe VE, Fortun PJ, Hawkey CJ et al. Probiotics for induction of remission in Crohn’s disease. Cochrane Database Syst Rev 2008 Jul 16, (3): CD006634
• 137 Rahimi R, Nikfar S, Rahimi F et al. A meta-analysis on the efficacy of probiotics for maintenance of remission and prevention of clinical and endoscopic relapse in Crohn’s disease. Dig Dis Sci 2008; 53 (09) 2524-2531
• 138 Rolfe VE, Fortun PJ, Hawkey CJ et al. Probiotics for maintenance of remission in Crohn’s disease. Cochrane Database Syst Rev 2006 Oct 18, (4): CD004826. Review
• 139 Doherty GA, Bennett GC, Cheifetz AS et al. Meta-analysis: targeting the intestinal microbiota in prophylaxis for post-operative Crohn’s disease. Aliment Pharmacol Ther 2010; 31 (08) 802-809
• 140 Shen J, Ran HZ, Yin MH et al. Meta-analysis: the effect and adverse events of Lactobacilli versus placebo in maintenance therapy for Crohn disease. Intern Med J 2009; 39 (02) 103-109
• 141 Plein K, Hotz J. Therapeutic effects of Saccharomyces boulardii on mild residual symptoms in a stable phase of Crohn’s disease with special respect to chronic diarrhea – a pilot study. Z Gastroenterol 1993; 31 (02) 129-134
• 142 Guslandi M, Mezzi G, Sorghi M et al. Saccharomyces boulardii in maintenance treatment of Crohn’s disease. Dig Dis Sci 2000; 45 (07) 1462-1464
• 143 Guslandi M, Giollo P, Testoni PA. A pilot trial of Saccharomyces boulardii in ulcerative colitis. Eur J Gastroenterol Hepatol 2003; 15 (06) 697-698
• 144 Sang LX, Chang B, Zhang WL et al. Remission induction and maintenance effect of probiotics on ulcerative colitis: a meta-analysis. World J Gastroenterol 2010; 16 (15) 1908-1915
• 145 Fujimori S, Gudis K, Mitsui K et al. A randomized controlled trial on the efficacy of synbiotic versus probiotic or prebiotic treatment to improve the quality of life in patients with ulcerative colitis. Nutrition 2009; 25 (05) 520-525
• 146 Do VT, Baird BG, Kockler DR. Probiotics for maintaining remission of ulcerative colitis in adults. Ann Pharmacother 2010; 44 (03) 565-571
• 147 Dignass A, Lindsay JO, Sturm A et al. Second European evidence-based consensus on the diagnosis and management of ulcerative colitis part 2: current management. J Crohns Colitis 2012; 6 (10) 991-1030
• 148 Chermesh I, Tamir A, Reshef R et al. Failure of Synbiotic 2000 to prevent postoperative recurrence of Crohn’s disease. Dig Dis Sci 2007; 52 (02) 385-389
• 149 Van Gossum A, Cabre E, Hébuterne X et al. ESPEN Guidelines in Parenteral Nutrition:Gastroenterology. Clinical Nutrition 2009; 28: 415-427
• 150 AGA. Technical Review on Perianal Crohn’s Disease. Gastroenterology 2003; 125: 1508-1530
• 151 Lorenz-Meyer H, Bauer P, Nicolay C et al. Omega-3 fatty acids and low carbohydrate diet for maintenance of remission in Crohn’s disease. Study Group Members (German Crohn’s Disease Study Group). A randomized controlled multicenter trial. Scand J Gastroenterol 1996; 31 (8) 778-785
• 152 Belluzi A, Brignola C, Campieri M et al. Effect of an enteric-coated fish-oil preparation on relapses in crohn’s disease. N Engl J Med 1996; 334: 1557-1560
• 153 Feagan BG, Sandborn WJ, Mittmann U et al. Omega 3-free fatty acids for the maintenance of remission in Crohn’s disease. The EPIC randomized Controlled Trials. JAMA 2008; 299: 1690-1697
• 154 Turner D, Zlotkin SH, Shah PS et al. Omega 3 fatty acids (fish oil) for maintenance of remission in Crohn’s disease. Cochrane Database Sys Rev 2009; 1 CD006320
• 155 Thompson JS et al. Inflammatory disease and outcome of short bowel syndrome. Am J Surg 2000; 180 (06) 551-554
• 156 Nightingale J, Woodward JM. Guidelines for management of patients with a short bowel. Gut 2006; 55 (Suppl. IV): iv 1–12
• 157 Leiss O. Diätetische und medikamentöse Therapie des Kurzdarmsyndroms. Z Gastroenterol 2005; 43: 661-675
• 158 Norman K, Kirchner H, Lochs H et al. Malnutrition affects quality of life in gastroenterology patients. World J Gastroenterol 2006; 12 (21) 3380-3385
• 159 Soncini M, Triossi O, Leo P et al. Inflammatory bowel disease and hospital treatment in Italy: the RING multi-centre study. Aliment Pharmacol Therapeutics 2004; 19: 63-68
• 160 Löser C. Malnutrition in hospital: the clinical and economic implications. Dtsch Arztebl Int 2010; 107 (51) 911-917
• 161 Chandra RK. Nutrition, immunity and infection: from basic knowledge of dietary manipulation of immune responses to practical application of ameliorating suffering and improving survival. Proc Natl Acad Sci USA 1996; 93: 14304-14307
• 162 Gershwin ME, Borchers AT, Keen CL. Phenotypic and functional considerations in the evaluation of immunity in nutritionally compromised hosts. J Infect Dis 2000; 182 (Suppl. 01) S108-S114
• 163 Rahier JF, Ben-Horin S, Chowers Y et al. European evidence-based Consensus on the prevention, diagnosis and management of opportunistic infections in inflammatory bowel disease. J Crohns Colitis 2009; 3 (02) 47-91
• 164 Harpavat M, Keljo DJ, Regueiro MD. Metabolic bone disease in inflammatory bowel disease. J Clin Gastroenterol 2004; 38 (03) 218-224
• 165 Razack R, Seidner DL. Nutrition in inflammatory bowel disease. Curr Opin Gastroenterol 2007; 23: 400-405
• 166 Nguyen G, Munsell M, Harris ML. Nationwide Prevalence and Prognostic Significance of Clinically Diagnosable Protein-Calorie Malnutrition in Hospitalized Inflammatory Bowel Disease Patients. Inflamm Bowel Dis 2008; 14: 1105-1111
• 167 Travis SP, Stange EF, Lémann M et al. European evidence based consensus on the diagnosis and management of Crohn’s disease: current management. Gut 2006; 55 (Suppl. 01) i16-i35
• 168 Bischoff SC, Fleig W. Diagnostik und Therapie der Colitis Ulcerosa: Ergebnisse einer evidenzbasierten Konsensuskonferenz der Deutschen Gesellschaft für Verdauungs- und Stoffwechselerkrankungen zusammen mit dem Kompetenznetz chronisch entzündliche Darm-erkrankungen: Ernährung. Z Gastroenterol 2004; 42: 1002-1006
• 169 Yakut M, Ustün Y, Kabaçam G et al. Serum vitamin B12 and folate status in patients with inflammatory bowel diseases. Eur J Intern Med 2010; 21 (04) 320-323
• 170 Duerksen DR, Fallows G, Bernstein CN. Vitamin B12 malabsorption in patients with limited ileal resection. Nutrition 2006; 22 (11) 1210-1213
• 171 Jayaprakash A, Creed T, Stewart L et al. Should we monitor vitamin B12 levels in patients who have had end-ileostomy for inflammatory bowel disease?. Int J Colorectal Dis 2004; 19 (04) 316-318
• 172 Lucendo AJ, de Rezende LC. Importance of nutrition in inflammatory bowel disease. World J gastroenterol 2009; 15 (17) 2081-2088
• 173 Lashner BA, Provencher KS, Seidner DL et al. The effect of folic acid supplementation on the risk for cancer or dysplasia in ulcerative colitis. Gastroenterology 1997; 112 (01) 29-32
• 174 Oussalah A, Guéant JL, Peyrin-Biroulet L. Meta-analysis: hyperhomocysteinaemia in inflammatory bowel diseases. Aliment Pharmacol Ther 2011; 34 (10) 1173-1184
• 175 Gasche C, Evstatiev R, Haas T et al. Diagnosis and treatment of iron deficiency and anaemia in inflammatory bowel diseases. Consensus of the Austrian IBD Working Party. Z Gastroenterol 2011; 49 (05) 627-623
• 176 Saper RB, Rash R. Zinc: an essential micronutrient. Am Fam Physician 2009; 79 (09) 768-772
• 177 Vagianos K, Bector S, McConnell J et al. Nutrition assessment of patients with inflammatory bowel disease. JPEN J Parenter Enteral Nutr 2007; 31 (04) 311-319
• 178 Geerling BJ, Badart-Smook A, Stockbrügger RW et al. Comprehensive nutritional status in recently diagnosed patients with inflammatory bowel disease compared with population controls. Eur J Clin Nutr 2000; 54 (06) 514-521
• 179 Filippi J, Al-Jaouni R, Wiroth JP et al. Nutritional deficiencies in patients with Crohn’s disease in remission. Inflamm Bowel Dis 2006; 12: 185-191
• 180 Kruis W, Rindfleisch GE, Weinzierl M. Zinc deficiency as a problem in patients with Crohn’s disease and fistula formation. Hepatogastroenterology 1985; 32 (03) 133-134
• 181 Sun J. Vitamin D and mucosal immune function. Curr Opin Gastroenterol 2010; 26 (06) 591-595
• 182 Pappa HM, Grand RJ, Gordon CM. Report on the vitamin D status of adult and pediatric patients with inflammatory bowel disease and its significance for bone health and disease. Inflamm Bowel Dis 2006; 12 (12) 1162-1174
• 183 Farraye FA, Nimitphong H, Stucchi A et al. Use of a novel vitamin D bioavailability test demonstrates that vitamin D absorption is decreased in patients with quiescent Crohn’s disease. Inflamm Bowel Dis 2011; 17 (10) 2116-2121
• 184 de la Hunty A, Wallace AM, Gibson S et al. UK Food Standards Agency Workshop Consensus Report: the choice of method for measuring 25-hydroxyvitamin D to estimate vitamin D status for the UK National Diet and Nutrition Survey. Br J Nutr 2010; 104 (04) 612-619
• 185 Pramyothin P, Holick MF. Vitamin D supplementation: guidelines and evidence for subclinical deficiency. Curr Opin Gastroenterol 2012; 28 (02) 139-150
• 186 Jørgensen SP, Agnholt J, Glerup H et al. Clinical trial: vitamin D3 treatment in Crohn’s disease – a randomized double-blind placebo-controlled study. Aliment Pharma-colTher 2010; 32 (03) 377-383