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Ernährungstherapie bei akuter Pankreatitis

Nutritional therapy in acute pancreatitis

Zusammenfassung

Die akute Pankreatitis ist ein häufiges Krankheitsbild. Etwa 80% der Patienten erleiden eine interstitielle ödematöse Pankreatitis, die in der Regel innerhalb von einigen Tagen ausheilt, etwa 20% entwickeln 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 eine initiale gastrale enterale Sondenernährung mit hochmolekularer Standardnahrung. Nur wenn diese aufgrund eines erhöhten gastralen Residualvolumens nicht möglich ist, sollte eine jejunale Sondenernährung erfolgen. Bei einer relevanten Maldigestion kann auf eine niedermolekulare Sondenkost gewechselt werden. Ist auch darüber innerhalb von 5–7 Tagen keine ausreichende Kalorienzufuhr möglich, ist eine parenterale (Zusatz-)Ernährung notwendig. Eine individualisierte frühe – möglichst enterale Ernährung – ist ein essenzieller Bestandteil der multimodalen Therapie der akuten Pankreatitis und verbessert das Outcome.

Abstract

Acute pancreatitis is a frequent clinical entity in the West. About 80% of patients with acute pancreatitis develop edematous pancreatitis, while 20% develop necrotizing pancreatitis: The latter is a potentially life-threatening disease. In this case, early enteral nutrition has been shown to improve the course of the disease. Usually, gastric enteral nutrition with a polymeric formula via a nasogastric tube is possible; only in a minority of patients is jejunal feeding necessary owing to the high gastric residual volume. An elemental formula is useful for patients with significant intestinal maldigestion. If enteral feeding is not feasible within 5–7 days, (additional) parenteral nutrition has to be considered. Individualized—primary enteral—nutritional support is an essential part of a multimodal therapy in severe acute pancreatitis and it improves clinical outcome.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehung/en hin: Prof. Dr. J. Ockenga ist bzw. war als Referent und/oder Berater für die Firma B. Braun Melsungen AG, Fresenius-Kabi Deutschland GmbH, Pfrimmer-Nutricia GmbH, Baxter Deutschland GmbH tätig.

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Correspondence to J. Ockenga.

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Ockenga, J. Ernährungstherapie bei akuter Pankreatitis. Med Klin Intensivmed Notfmed 108, 401–407 (2013). https://doi.org/10.1007/s00063-012-0202-2

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  • DOI: https://doi.org/10.1007/s00063-012-0202-2

Schlüsselwörter

  • Feinnadelkatheterjejunostomie
  • Antioxidanzien
  • Nekrotisierende Pankreatitis
  • Intensivtherapie
  • Aminosäurenmetabolismus

Keywords

  • Fine-needle catheter jejunostomy
  • Antioxidants
  • Necrotizing pancreatitis
  • Intensive therapy
  • Amino acid metabolism