Kinder- und Jugendmedizin 2011; 11(02): 77-81
DOI: 10.1055/s-0038-1630474
Ernährungsmedizin
Schattauer GmbH

Die Rolle der Ernährung in der Pathogenese und bei der Therapie entzündlicher Darmerkrankungen

The role of nutrition in pathogenesis and treatment of inflammatory bowel disease in children and adolescents
M. Claßen
1   Klinik für Kinder- und Jugendmedizin, Klinikum Links der Weser, Bremen
› Author Affiliations
Further Information

Publication History

received: 14 December 2010

Accepted after major revision 10 January 2011

Publication Date:
27 January 2018 (online)

Zusammenfassung

Angesichts einer chronischen, den Darm betreffenden entzündlichen Erkrankung stellen sowohl Laien als auch Ärzte die Frage nach der Rolle der Ernährung in der Entstehung von M. Crohn und Colitis ulcerosa. Die Daten hierzu sind kontrovers.

Hingegen gibt es gute Evidenz für die Wichtigkeit von Ernährungsinterventionen bei der Behandlung von Kindern und Jugendlichen mit chronisch-entzündlichen Darmerkrankungen (CED). Zunächst müssen Kalorien- und Nährstoffdefizite identifiziert und behandelt werden, vor allem bei den häufigen Problemen Untergewicht und Wachstumsretardierung. Daneben sollten Nahrungsunverträglichkeiten in der Planung der weiteren Ernährung berücksichtigt werden.

Bei limitierter Effektivität und relevantem Nebenwirkungspotenzial der Medikamente spielen Ernährungsinterventionen eine wichtige Rolle bei der Therapie von Kindern und Jugendlichen mit CED. Besonders beim M. Crohn bietet die enterale Ernährungstherapie mit flüssigen Formelnahrungen die Chance, ohne ein relevantes Nebenwirkungsrisiko mit hoher Wahrscheinlichkeit eine klinische Remission zu induzieren. Dabei spielt es nach neueren Daten keine Rolle, in welchem Darmabschnitt die Erkrankung sich manifestiert. Ernährung spielt eine wichtige Rolle bei Kindern und Jugendlichen mit CED. Der Artikel gibt eine Übersicht über den aktuellen Wissensstand zu diesem Thema.

Summary

Representing a chronic disease of the intestine, a role of nutrition in the origin of Crohns disease and ulcerative colitis is suspected by patients and physicians. Up to now, scientific proofs are scarce.

However, there is good evidence for the use of nutritional interventions in the treatment of patients with inflammatory bowel diseases (IBD). Deficiencies of total energy and micro-nutrients have to be identified and treated. This is especially important in frequently oc-curing problems as underweight and growth retardation. Food intolerances, which may accompany IBD, have to be taken into account. In the face of limited efficacy and relevant risk of side effects of pharmaceutical treatments, nutritional therapies play an important role in the treatment of children and adolescents with IBD. This is especially true for Crohns disease. Enteral nutrition treatment with liquid formula has the potential of inducing remission in a high percentage of cases without risk of side effects. The therapeutic effect seems to independent from the site of involvement.

Nutrition plays an important role for children and adolescents with IBD. This paper gives an overview of the current knowledge.

 
  • Literatur

  • 1 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 Nutr 2000; 30: 78-84.
  • 2 Akobeng AK, Thomas AG. Enteral nutrition for maintenance of remission in Crohn’s disease. Cochrane Database Syst Rev. 2007: CD005984.
  • 3 Amre DK, D’Souza S, Mack D. et al. Imbalances in dietary consumption of fatty acids, vegetables and fruits are associated with risk for Crohn’s disease in children. Am J Gastroenterol 2007; 102: 2016-2025.
  • 4 Bannerjee K, Camacho-Hubner C, Babinska K. et al. Anti-inflammatory and growth-stimulating effects precede nutritional restitution during enteral feeding in Crohn disease. J Pediatr Gastroenterol Nutr 2004; 38: 270-275.
  • 5 Bernstein CN, Rawsthorne P, Cheang M, Blanchard JF. A population-based case control study of potential risk factors for IBD. Am J Gastroenterol 2006; 101: 993-1002.
  • 6 Bernstein CN, Shanahan F. Disorders of a modern lifestyle: reconciling the epidemiology of inflammatory bowel diseases. Gut 2009; 57: 1185-1191.
  • 7 Buchanan E, Gaunt WW, Cardigan T. et al. The use of exclusive enteral nutrition for induction of remission in children with Crohn’s disease demonstrates that disease phenotype does not influence clinical remission. Aliment Pharmacol Ther 2009; 30: 501-507.
  • 8 Chapman-Kiddell CA, Davies PSW, Gillen L. et al. Role of diet in the development of inflammatory bowel disease. Inflamm Bowel Dis 2010; 16: 137-151.
  • 9 Corrao G, Tragnone A, Caprilli R. et al. Risk of inflammatory bowel disease attributable to smoking, oral contraception and breastfeeding in Italy: a nationwide case-control study. Cooperative Investigators of the Italian Group for the Study of the Colon and the Rectum (GISC). Int J Epidemiol 1998; 27: 397-404.
  • 10 D’Souza S, Levy E, Mack D. et al. Dietary patterns and risk for Crohn’s disease in children. Inflamm Bowel Dis 2008; 14: 367-373.
  • 11 Day AS, Whitten KE, Sidler M. et al. Systematic review: nutritional therapy in paediatric Crohn’s disease. Aliment Pharmacol Ther 2008; 27: 293-307.
  • 12 De Ley M, de Vos R, Hommes DW. et al. Fish oil for induction of remission in ulcerative colitis. Cochrane Database Syst Rev. 2007 (4): CD005986.
  • 13 Dignass A, Van Assche G, Lindsay GO. et al. The second European evidence-based Consensus on the diagnosis and management of Crohn’s disease: Current management. Journal of Crohn’s and Colitis 2010; 4: 28-62.
  • 14 Dziechciarz P, Horvath A, Shamir R. et al. Metaanalysis: enteral nutrition in active Crohn’s disease in children. Aliment Pharmacol Ther 2007; 26: 795-806
  • 15 Evans JP, Steinhart AH, Cohen Z. et al. Home total parenteral nutrition: an alternative to early surgery for complicated inflammatory bowel disease. J Gastrointest Surg 2003; 7: 562-566.
  • 16 Fell JM, Paintin M, Arnaud-Battandier F. et al. Mucosal healing and a fall in mucosal pro-inflammatory cytokine mRNA induced by a specific oral polymeric diet in paediatric Crohn’s disease. Aliment Pharmacol Ther 2002; 14: 281-290.
  • 17 Fernández-Bañares F, Hinojosa J, Sánchez-Lombraña JL. et al. Randomized clinical trial of Plantago ovata seeds (dietary fiber) as compared with mesalamine in maintaining remission in ulcerative colitis. Spanish Group for the Study of Crohn’s Disease and Ulcerative Colitis (GETECCU). Am J Gastroenterol 1999; 94: 427-433.
  • 18 Gavin J, Anderson CE, Bremner AR. et al. Energy intakes of children with Crohn’s disease treated with enteral nutrition as primary therapy. J Hum Nutr Diet 2005; 18: 337-342.
  • 19 Gerhardt H, Seifert F, Buvari P. et al. Therapy of active Crohn disease with Boswellia serrata extract H 15. Z Gastroenterol 2001; 39: 11-17.
  • 20 Hanai H, Sugimoto K. Curcumin has bright prospects for the treatment of inflammatory bowel disease. Curr Pharm Des 2009; 15: 2087-2094.
  • 21 Hart AR, Luben R, Olsen A. et al. Diet in the aetiology of ulcerative colitis: a European prospective cohort study. Digestion 2008; 77: 57-64.
  • 22 Hartman C, Berkowitz D, Weiss B. et al. Nutritional supplementation with polymeric diet enriched with transforming growth factor-beta 2 for children with Crohn’s disease. Isr Med Assoc J 2008; 10: 503-507.
  • 23 Heuschkel R, Salvestrini C, Beattie RM. et al. Guidelines for the management of growth failure in childhood inflammatory bowel disease. Inflamm Bowel Dis 2008; 14: 839-849.
  • 24 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.
  • 25 Hill R, Lewindon P, Muir R. et al. Quality of Life in Children with Crohn Disease. J Pediatr Gastroenterol Nutr 2010 Apr 19. [Epub ahead of print].
  • 26 Huber R, Ditfurth AV, Amann F. et al. Tormentil for active ulcerative colitis: an open-label, dose-escalating study. J Clin Gastroenterol 2007; 41: 834-838.
  • 27 Järnerot G, Järnmark I, Nilsson K. Consumption of refined sugar by patients with Crohn’s disease, ulcerative colitis, or irritable bowel syndrome. Scand J Gastroenterol 1983; 18: 999-1002.
  • 28 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.
  • 29 Koletzko S, Sherman P, Corey M. et al. Role of infant feeding practices in development of Crohn’s disease in childhood. BMJ 1989; 298: 1617-1618.
  • 30 Koletzko S, Siegert T. Ernährungstherapie der chronisch-entzündlichen Darmerkrankungen. Monatsschr Kinderheilk 2004; 152: 145-152.
  • 31 Kugathasan S, Judd RH, Hoffman RG. et al. Epidemiologic and clinical characteristics of children with newly diagnosed inflammatory bowel disease in Wisconsin: a statewide population-based study. J Pediatr 2003; 143: 525-531.
  • 32 Mahid SS, Minor KS, Stevens PL, Galandiuk S. The role of smoking in Crohn’s disease as defined by clinical variables. Dig Dis Sci 2007; 52: 2897-2903.
  • 33 Mayberry JF, Rhodes J, Newcombe RG. Increased sugar consumption in Crohn’s disease. Digestion 1980; 20: 323-326.
  • 34 Newby EA, Sawczenko A, Thomas AG. et al. Interventions for growth failure in childhood Crohn’s disease. Cochrane Database Syst Rev. 2005 (3): CD003873.
  • 35 Persson PG, Ahlbom A, Hellers G. Diet and inflammatory bowel disease: a case-control study. Epidemiology 1992; 3: 47-52.
  • 36 Pfefferkorn MD, Fitzgerald JF, Croffie JM. et al. Lactase deficiency: not more common in pediatric patients with inflammatory bowel disease than in patients with chronic abdominal pain. J Pediatr Gastroenterol Nutr 35: 339-343.
  • 37 Rajendran N, Kumar D. Role of diet in the management of inflammatory bowel disease. World J Gastroenterol 2010; 16 (12) 1442-1448.
  • 38 Sandhu BK, Fell JM, Beattie RM. et al. Guidelines for the Management of Inflammatory Bowel Disease in Children in the United Kingdom. J Pediatr Gastroenterol Nutr 2010 Jan 13. [Epub ahead of print].
  • 39 Shamir R, Phillip M, Levine A. Growth retardation in pediatric Crohn’s disease: pathogenesis and interventions. Inflamm Bowel Dis 2007; 13: 620-628.
  • 40 Stremmel W, Ehehalt R, Autschbach F. Phosphatidylcholine for steroid-refractory chronic ulcerative colitis: a randomized trial. Ann Intern Med 2007; 147: 603-610.
  • 41 Tragnone A, Valpiani D, Miglio F. et al. Dietary habits as risk factors for inflammatory bowel disease. Eur J Gastroenterol Hepatol 1995; 7: 47-51.
  • 42 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.
  • 43 Turner D, Steinhart AH, Griffiths AM. Omega 3 fatty acids (fish oil) for maintenance of remission in ulcerative colitis. Cochrane Database Syst Rev. 2007 (3): CD006443.
  • 44 Turner D, Zlotkin SH, Shah PS. et al. Omega 3 fatty acids (fish oil) for maintenance of remission in Crohn’s disease. Cochrane Database Syst Rev. 2009 (1): CD006320.
  • 45 Vagianos K, Bector S, McConnell J, Bernstein CN. Nutrition assessment of patients with inflammatory bowel disease. JPEN J Parenter Enteral Nutr 2007; 31: 311-319.
  • 46 Van Assche G, Dignass A, Reinisch W. et al. The second European evidence-based Consensus on the diagnosis and management of Crohn’s disease: Special situations. Journal of Crohn’s and Colitis 2010; 4: 63-101.
  • 47 Wilschanski M, Sherman P, Pencharz P. et al. Supplementary enteral nutrition maintains remission in paediatric Crohn’s disease. Gut 1996; 38: 543-548.
  • 48 Wilson D, Thomas A, Croft N. et al. Systematic Review of the Evidence Base for the Medical Treatment of Paediatric Inflammatory Bowel Disease. J Pediatr Gastroenterol Nutr 2010. [Epub ahead of print].
  • 49 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.
  • 50 Zachos M, Tondeur M, Griffiths AM. Enteral nutritional therapy for induction of remission in Crohn’s disease. Cochrane Database Syst Rev. 2007 (1): CD000542.