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Gastroenterologie up2date 2013; 09(03): 157-170
DOI: 10.1055/s-0033-1344508
Darm/Anorektum
© Georg Thieme Verlag KG Stuttgart · New York

Kurzdarmsyndrom

Georg Lamprecht
,
Alfred Königsrainer
Further Information

Publication History

Publication Date:
01 September 2013 (online)

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Definition

  • Unter einem Kurzdarmsyndrom versteht man die Unfähigkeit, mittels einer konventionellen Diät die Protein-Energie-, Flüssigkeits- und Mikronährstoffbalance aufrechtzuerhalten.

  • Bei Erwachsenen sind die häufigsten Ursachen die intestinale Ischämie, der Morbus Crohn, Traumata, postoperative Komplikationen einschließlich Ileus, die intestinalen Motilitätsstörungen und gelegentlich abdominelle Tumoren.

Parenterale Therapie

  • Die Indikation zur parenteralen Therapie des Kurzdarmsyndroms ergibt sich postoperativ aus der Notwendigkeit, die im Rahmen der Hypersekretion auftretenden Flüssigkeitsverluste zu kompensieren.

  • Die parenterale Substitution umfasst Flüssigkeit, Elektrolyte und Basenäquivalente, Aminosäuren, Kohlenhydrate und Fette sowie Vitamine und Spurenelemente.

  • Für die parenterale Ernährung ist ein zentraler Zugang erforderlich. Katheterinfekte sollten – wenn immer möglich – konservativ therapiert werden, um den Verlust der zentralvenösen Zugangsgefäße zu vermeiden.

  • Unter einer langfristigen parenteralen Ernährung kann es zur Entwicklung einer IFALD kommen, die u. U. eine Indikation zur Darmtransplantation bzw. multiviszeralen Transplantation ist.

Rekonstruktive Chirurgie und Darmtransplantation

  • Ziele der rekonstruktiven Chirurgie sind die Verlangsamung des Transits des Speisebreies und die Erhöhung der Resorptionsfläche.

  • Die Darmtransplantation ist insbesondere bei Kindern und jungen Erwachsenen mit langer Lebenserwartung eine lebensrettende Behandlung, die in den meisten Fällen auch eine völlige orale Autonomie gewährleistet.

  • Probleme sind nach wie vor die chronische Abstoßung und die daher lebenslang erforderliche Immunsuppression.

 

  • Literatur

  • 1 O’Keefe SJ, Buchman AL, Fishbein TM et al. Short bowel syndrome and intestinal failure: consensus definitions and overview. Clin Gastroenterol Hepatol 2006; 4: 6-10
    CrossrefPubMedGoogle Scholar
  • 2 Fishbein TM. Intestinal transplantation. N Engl J Med 2009; 361: 998-1008
    CrossrefPubMedGoogle Scholar
  • 3 Wilmore DW. Indications for specific therapy in the rehabilitation of patients with the short-bowel syndrome. Best Pract Res Clin Gastroenterol 2003; 17: 895-906
    CrossrefPubMedGoogle Scholar
  • 4 Messing B, Crenn P, Beau P et al. Long-term survival and parenteral nutrition dependence in adult patients with the short bowel syndrome. Gastroenterology 1999; 117: 1043-1050
    CrossrefPubMedGoogle Scholar
  • 5 Wilmore DW, Lacey JM, Soultanakis RP et al. Factors predicting a successful outcome after pharmacologic bowel compensation. Ann Surg 1997; 226: 288-292
    CrossrefPubMedGoogle Scholar
  • 6 Drozdowski L, Thomson AB. Intestinal mucosal adaptation. World J Gastroenterol 2006; 12: 4614-4627
    PubMedGoogle Scholar
  • 7 Jeppesen PB. Clinical significance of GLP-2 in short-bowel syndrome. J Nutr 2003; 133: 3721-3724
    PubMedGoogle Scholar
  • 8 Lal S, Teubner A, Shaffer JL. Review article: intestinal failure. Aliment Pharmacol Ther 2006; 24: 19-31
    PubMedGoogle Scholar
  • 9 Van Gossum A, Cabre E, Hebuterne X et al. ESPEN Guidelines on Parenteral Nutrition: gastroenterology. Clin Nutr 2009; 28: 415-427
    CrossrefPubMedGoogle Scholar
  • 10 Staun M, Pironi L, Bozzetti F et al. ESPEN Guidelines on Parenteral Nutrition: home parenteral nutrition (HPN) in adult patients. Clin Nutr 2009; 28: 467-479
    CrossrefPubMedGoogle Scholar
  • 11 Buchman AL. Use of percutaneous endoscopic gastrostomy or percutaneous endoscopic jejunostomy in short bowel syndrome. Gastrointest Endosc Clin N Am 2007; 17: 787-794
    CrossrefPubMedGoogle Scholar
  • 12 Nightingale JM, Lennard-Jones JE, Walker ER et al. Jejunal efflux in short bowel syndrome. Lancet 1990; 336: 765-768
    CrossrefPubMedGoogle Scholar
  • 13 Zander R. Acetat. In: Flüssigkeitstherapie. Melsungen: Bibliomed; 2006: 17-21
    Google Scholar
  • 14 Cash RA, Toha KM, Nalin DR et al. Acetate in the correction of acidosis secondary to diarrhoea. Lancet 1969; 2: 302-303
    PubMedGoogle Scholar
  • 15 Tsai IC, Huang JW, Chu TS et al. Factors associated with metabolic acidosis in patients receiving parenteral nutrition. Nephrology (Carlton) 2007; 12: 3-7
    CrossrefPubMedGoogle Scholar
  • 16 Berkelhammer CH, Wood RJ, Sitrin MD. Acetate and hypercalciuria during total parenteral nutrition. Am J Clin Nutr 1988; 48: 1482-1489
    PubMedGoogle Scholar
  • 17 Jeejeebhoy K. Zinc: an essential trace element for parenteral nutrition. Gastroenterology 2009; 137: 7-12
    CrossrefPubMedGoogle Scholar
  • 18 Cavicchi M, Beau P, Crenn P et al. Prevalence of liver disease and contributing factors in patients receiving home parenteral nutrition for permanent intestinal failure. Ann Intern Med 2000; 132: 525-532
    PubMedGoogle Scholar
  • 19 Dreesen M, Foulon V, Spriet I et al. Epidemiology of catheter-related infections in adult patients receiving home parenteral nutrition: A systematic review. Clin Nutr 2013; 32: 16-26
    CrossrefPubMedGoogle Scholar
  • 20 Howard L, Ashley C. Management of complications in patients receiving home parenteral nutrition. Gastroenterology 2003; 124: 1651-1661
    CrossrefPubMedGoogle Scholar
  • 21 Bisseling TM, Willems MC, Versleijen MW et al. Taurolidine lock is highly effective in preventing catheter-related bloodstream infections in patients on home parenteral nutrition: A heparin-controlled prospective trial. Clinical Nutrition 2010; 29: 464-468
    CrossrefPubMedGoogle Scholar
  • 22 Toure A, Lauverjat M, Peraldi C et al. Taurolidine lock solution in the secondary prevention of central venous catheter-associated bloodstream infection in home parenteral nutrition patients. Clin Nutr 2012; 31: 567-570
    CrossrefPubMedGoogle Scholar
  • 23 Staun M, Hebuterne X, Shaffer J et al. Management of intestinal failure in Europe. A questionnaire based study on the incidence and management. Dyn Med 2007; 6: 7
    CrossrefPubMedGoogle Scholar
  • 24 Baskin JL, Pui CH, Reiss U et al. Management of occlusion and thrombosis associated with long-term indwelling central venous catheters. The Lancet 2009; 374: 159-169
    CrossrefPubMedGoogle Scholar
  • 25 Goulet O, Joly F, Corriol O et al. Some new insights in intestinal failure-associated liver disease. Curr Opin Organ Transplant 2009; 14: 256-261
    CrossrefPubMedGoogle Scholar
  • 26 Jeppesen PB, Staun M, Tjellesen L et al. Effect of intravenous ranitidine and omeprazole on intestinal absorption of water, sodium, and macronutrients in patients with intestinal resection. Gut 1998; 43: 763-769
    CrossrefPubMedGoogle Scholar
  • 27 Ladefoged K, Christensen KC, Hegnhøj J et al. Effect of a long acting somatostatin analogue SMS 201-995 on jejunostomy effluents in patients with severe short bowel syndrome. Gut 1989; 30: 943-949
    CrossrefPubMedGoogle Scholar
  • 28 Nightingale JM, Walker ER, Burnham WR et al. Octreotide (a somatostatin analogue) improves the quality of life in some patients with a short intestine. Aliment Pharmacol Ther 1989; 3: 367-373
    PubMedGoogle Scholar
  • 29 Jeppesen PB, Gilroy R, Pertkiewicz M et al. Randomised placebo-controlled trial of teduglutide in reducing parenteral nutrition and/or intravenous fluid requirements in patients with short bowel syndrome. Gut 2011; 60: 902-914
    CrossrefPubMedGoogle Scholar
  • 30 Jeppesen PB, Pertkiewicz M, Messing B et al. Teduglutide reduces need for parenteral support among patients with short bowel syndrome with intestinal failure. Gastroenterology 2012; 143: 1473-1481
    CrossrefPubMedGoogle Scholar
  • 31 Atia AN, Buchman AL. Oral rehydration solutions in non-cholera diarrhea: a review. Am J Gastroenterol 2009; 104: 2596-2604
    CrossrefPubMedGoogle Scholar
  • 32 King B, Carlson G, Khalil BA et al. Intestinal bowel lengthening in children with short bowel syndrome: systematic review of the Bianchi and STEP Procedures. World J Surg 2013; 37: 694-704
    CrossrefPubMedGoogle Scholar
  • 33 Intestinal Transplant Registry Data. http://www.intestinaltransplant.org/
    PubMedGoogle Scholar
  • 34 Pironi L, Forbes A, Joly F et al. Survival of patients identified as candidates for intestinal transplantation: a 3-year prospective follow-up. Gastroenterology 2008; 135: 61-71
    CrossrefPubMedGoogle Scholar
  • 35 Pascher A. Intestinales Versagen und Dünndarmtransplantation. Allgemein- und Viszeralchirurgie up2date 2010; 4: 109-123
    PubMedGoogle Scholar
  • 36 Sudan DL, Iyer KR, Deroover A et al. A new technique for combined liver/small intestinal transplantation. Transplantation 2001; 72: 1846-1848
    CrossrefPubMedGoogle Scholar