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Welche Rolle spielt die Ernährung beim Morbus Crohn? Ein Beitrag zur Bedeutung der diätetischen Therapie der Enteritis regionalis

Influence of nutrition in Crohn's disease — a contribution on the importance of nutritional care in regional enteritis

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Summary

The clinical appearance of Crohn's disease (CD) is especially marked by nutritional deficits and insufficiencies. For a long time the goal of nutritional care was reduced to the readjustment of the nutritional status. The development and clinical use of controlled parenteral nutrition (TPN) and enteral nutritive solutions (EN) did not only emphasize this therapeutical issue, but furthermore showed positive effects on the conservative as well as on the surgical treatment concepts. Therefore today artifical nutritional support is a firm part of therapy in acute, active phases or in the contact of surgical management of CD. This is especially valid in children, where complications in general and growth failure in particular can be reduced. EN is the preferred feeding method in most of the cases, due to a lower complication rate and reduced cost when compared to TPN. The question regarding the importance of nutritional support as primary therapy has also been investigated. The results differ extensively, but point towards the conclusion that patients with solitary small bowel disease do profit from this therapeutical concept. Nevertheless it is unclear, how TPN or EN interfere in the pathophysiology or -biochemistry in this process. A question about reduction e.g. of allergic components of daily diet did stimulate new theories regarding the hypothesis of a possible causal relationship between diet and the pathogenesis of CD. Investigations on dietary habits and daily dietary therapy did not reveal an overall accepted dietary guideline. Nevertheless it seems obvious that dietary counselling has a positive effect on the disease process. It does appear, that today in the acute, active phase as well as in the long term management of Crohn's disease nutritional-care is an important therapeutical method.

Zusammenfassung

Das klinische Bild und der Krankheitsverlauf beim Morbus Crohn sind im besonderen durch generelle Ernährungsstörungen und Mangelzustände geprägt. Die Funktion der Ernährungstherapie wurde dabei lange Zeit fast ausschließlich in der Wiederherstellung der Ernährungsbilanz gesehen. Die Entwicklung und klinische Anwendung einer kontrollierten parenteralen Ernährung (TPN) und enteraler Nährstofflösungen (EN) hat diesem therapeutischen Ansatz Gewicht verliehen und zusätzlich positive Effekte für bestehende konservative wie chirurgische Behandlungsschemata gezeigt. So ist in der Behandlung des akuten Schubes der Erkrankung und im Rahmen des operativen Vorgehens heute die künstliche Ernährung ein fester Bestandteil der Therapie. Dies gilt insbesondere im Kindesalter, wo Komplikationsraten reduziert und Wachstumsstörungen effektiver behandelt werden können. Die EN hat dabei eine medrigere Komplikationsrate und ist kostengünstiger im Vergleich zur TPN. Auch die Frage nach der Bedeutung der künstlichen Ernährung als primäre Therapie ist gestellt worden. Umfangreiche Studien kommen zu unterschiedlichen Ergebnissen, die aber darauf hinweisen, daß insbesondere Patienten mit einem solitären Dünndarmbefall von diesen Behandlungsmethoden profitieren. Unklar bleibt, auf welche Weise die EN bzw. TPN die Pathophysiologie bzw. -biochemie des Krankheitsverlaufes beeinflussen. Dennoch haben Rückschlüsse auf eine mögliche Reduktion z. B. von Allergenen aus der täglichen Diät Theorien über einen möglichen Zusammenhang zwischen der Pathogenese des Morbus Crohn und der Ernährung neuen Antrieb gegeben. Untersuchungen zu Ernährungsgewohnheiten der Patienten und Therapiestudien haben aber zu keinen einheitlichen Ernährungsempfehlungen geführt. Dagegen scheint unbestritten, daß die Ernährungsberatung sich positiv auf den Krankheitsverlauf auswirkt. So ist festzustellen, daß sowohl im akuten Schub wie auch in der langfristigen Betreuung des Morbus Crohn die Ernährungstherapie heute eine wichtige Behandlungskomponente darstellt.

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  1. Klinik für Abdominal- und Transplantationschirurgie, Germany

    E. Nagel & R. Pichlmayr Dr. (Leiter: Prof.)

  2. Arbeitsbereich für klinische Diätetik und Ernährungsmedizin, Medizinische Hochschule, Konstanty-Gutschow-Straße 8, W-3000, Hannover 61, Germany

    H. Canzler (Leiter)

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Nagel, E., Canzler, H. & Pichlmayr, R. Welche Rolle spielt die Ernährung beim Morbus Crohn? Ein Beitrag zur Bedeutung der diätetischen Therapie der Enteritis regionalis. Langenbecks Arch Chir 376, 238–246 (1991). https://doi.org/10.1007/BF00186819

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