Ernährung bei chronisch entzündlichen Darmerkrankungen (CED)

Zusammenfassung

Die Pathogenese der chronisch entzündlichen Darmerkrankungen (CED) wie Morbus Crohn (MC) und Colitis ulcerosa (CU) ist im Detail noch nicht bekannt. Genetische, Ernährungs- und Umgebungsfaktoren sowie die Zusammensetzung der intestinalen Bakterien spielen jedoch eine wichtige Rolle.

Ernährungsdefizite sind oft vorhanden, jedoch häufiger bei Patienten mit einem MC als bei Patienten mit einer CU. Diese müssen rechtzeitig erkannt werden, da sie einen negativen Einfluss auf den Verlauf der Erkrankung haben. Ziele der Ernährungstherapie sind die Verbesserung von Ernährungsdefiziten und die Beeinflussung der entzündlichen Prozesse im Darm. Während eines akuten Schubs sollte außerdem verhindert werden, dass eine Mangelernährung entsteht. Die Ernährungstherapie muss individuell an die zugrunde liegenden Probleme angepasst werden.

Eine Optimierung der normalen Ernährung, die Gabe von Supplementen oder eine gezielte enterale oder parenterale Ernährung können je nach klinischem Verlauf hilfreich sein. Die enterale Ernährung ist jedoch gegenüber der parenteralen Ernährung wegen der spezifischen Effekte im Darm und dem darmassoziierten Immunsystem vorteilhafter. Bei einer enteralen Ernährung sind die nährstoffdefinierten Diäten ebenso wirksam wie die chemisch definierten Diäten.

Der Einsatz spezifischer Nährlösungen (z. B. unterschiedliche Fettzusammensetzungen) oder immunmodulierende Substrate sind interessant, da sie die Immunantwort und die entzündliche Aktivität beeinflussen könnten. Weitere klinische Studien müssen das jedoch noch beweisen. Prä- und Probiotika sind interessante zusätzliche Optionen. Der Verlauf bei Patienten mit einer CU wurde positiv beeinflusst. Ebenfalls sind die Resultate zur Verhinderung einer Pouchitis und von Rezidiven Erfolg versprechend, jedoch noch nicht überzeugend klinisch belegt.

Bei Patienten mit CED kann die Zuhilfenahme einer Ernährungsberatung sehr hilfreich sein.

Abstract

The pathogenesis of the inflammatory bowel diseases (IBD) as Crohn’s disease (CD) and ulcerative colitis (UC) is still not fully understood. Genetic, nutritional and environmental factors as well as the intestinal microbiota are discussed.

Nutritional deficiencies and malnutrition are often seen in IBD; they are more frequent in CD than in UC. Nutritional deficiencies must be treated, because they have a negative effect on the outcome.

The aim of nutritional support in IBD patients is to prevent or treat malnutrition and to influence specific inflammatory pathways in the intestine. The nutritional treatment is individual according the underlying problems.

Optimizing the diet, oral supplements, enteral and parenteral nutrition are used. In this respect enteral nutrition is more beneficial than parenteral nutrition because of its direct effects on the gut and its associated lymphatic tissue. Polymeric diets are as useful as oligomeric diets and are used first.

The use of specific formulae (e. g. different lipids) or specific nutrients may be of value since there is some evidence that these can influence the immune and inflammatory response. Further studies are still needed to clarify this in the future. Pre- and probiotics to modify the disease show considerable promise, particularly in maintaining remission in ulcerative colitis and preventing pouchitis.

The involvement of a trained dietician can be highly recommended.

Schlüsselwörter

Morbus Crohn - Colitis ulcerosa - Mangelernährung - orale Supplemente - enterale Ernährung - parenterale Ernährung - Probiotika

Keywords

Crohn’s disease - ulcerative colitis - malnutrition - oral supplements - enteral nutrition - parenteral nutrition - probiotics

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