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CC BY-NC-ND 4.0 · Journal of Coloproctology 2021; 41(03): 295-300
DOI: 10.1055/s-0041-1730369
Review Article

Perioperative Nutritional Optimization in Inflammatory Bowel Diseases: When and How?

Isadora Sayuri Macedo da Silva 
1   Colorectal Surgery Unit, IBD Outpatient Clinics, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, PR, Brazil
,
Maria Paula Carlini Cambi 
1   Colorectal Surgery Unit, IBD Outpatient Clinics, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, PR, Brazil
,
Daniéla Oliveira Magro 
2   Department of Surgery, Faculdade de Ciências Médicas, Universidade Estadual de Campinas UNICAMP-SP, Campinas, São Paulo, SP, Brazil
,
Paulo Gustavo Kotze 
1   Colorectal Surgery Unit, IBD Outpatient Clinics, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, PR, Brazil
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Abstract

Inflammatory bowel diseases (IBDs), including ulcerative colitis (UC) and Crohn's disease (CD), are commonly associated with important changes in nutritional status (NS). Both malnutrition and obesity have a negative impact on the course of both diseases, with greater risks of postoperative complications, such as anastomotic dehiscences, reoperations, prolonged hospitalizations, and increased mortality. The diagnostic criteria for identifying individuals at nutritional risk, with clear indication for preoperative nutritional therapy, involves several factors. Oral nutrition should be the first choice of nutritional support. If the patient has difficulty in consuming food, the enteral route is the second option, through elementary (amino acids), semi-elementary (oligopeptides), or polymeric (whole proteins) formulas. When oral or enteral routes are not indicated (in the presence of intestinal obstruction or ischemia, fistula, or bleeding), total parenteral nutrition can meet the daily nutritional needs of the critically ill patient. Nutritional support can be performed exclusively or in an associated way, which will depend on the nutritional severity of the patient with IBD. Nutritional screening should be performed at all stages of the disease, always individually and with professionals with experience in IBD. The reduction of complications in the perioperative period is not only associated with adequate surgical technique, but also with adequate nutritional support and clinical preparation before surgery. Therefore, the dietitian with a focus in IBD has an important role in the multidisciplinary team, collaborating with all stages of treatment and with the optimization of the nutritional status of the surgical patient.

Keywords

inflammatory bowel diseases - nutritional optimization - perioperarive nutrition


Publication History

Received: 27 January 2021

Accepted: 22 March 2021

Article published online:
03 June 2021

© 2021. Sociedade Brasileira de Coloproctologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Brennan GT, Ha I, Hogan C. et al. Does preoperative enteral or parenteral nutrition reduce postoperative complications in Crohn's disease patients: a meta-analysis. Eur J Gastroenterol Hepatol 2018; 30 (09) 997-1002
    CrossrefPubMedGoogle Scholar
  • 2 Balestrieri P, Ribolsi M, Guarino MPL, Emerenziani S, Altomare A, Cicala M. Nutritional aspects of inflammatory bowel disease. Nutrients 2020; 12 (02) 1-11
    CrossrefPubMedGoogle Scholar
  • 3 Damas OM, Garces L, Abreu MT. Diet as Adjunctive Treatment for Inflammatory Bowel Disease: Review and Update of the Latest Literature. Curr Treat Options Gastroenterol 2019; 17 (02) 313-325
    CrossrefPubMedGoogle Scholar
  • 4 Lamb CA, Kennedy NA, Raine T. et al; IBD guidelines eDelphi consensus group. British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults. Gut 2019; 68 (03, Suppl 3): s1-s106
    CrossrefPubMedGoogle Scholar
  • 5 Grass F, Pache B, Martin D, Hahnloser D, Demartines N, Hübner M. Preoperative Nutritional Conditioning of Crohn's Patients-Systematic Review of Current Evidence and Practice. Nutrients 2017; 9 (06) 2-14
    CrossrefPubMedGoogle Scholar
  • 6 Adamina M, Gerasimidis K, Sigall-Boneh R. et al. Perioperative Dietary Therapy in Inflammatory Bowel Disease. J Crohn's Colitis 2020; 14 (04) 431-444
    CrossrefPubMedGoogle Scholar
  • 7 Yamamoto T, Shimoyama T, Umegae S, Kotze PG. Impact of preoperative nutritional status on the incidence rate of surgical complications in patients with inflammatory bowel disease with vs without preoperative biologic therapy: A case-control study. Clin Transl Gastroenterol 2019; 10 (06) e00050
    CrossrefPubMedGoogle Scholar
  • 8 Bn L, Parian A, Le M. et al. Dietary interventions for induction and maintenance of remission in inflammatory bowel disease. . (Review) Cochrane Libr 2019; 2 (02) 1-83
    Google Scholar
  • 9 Grass F, Hübner M, Schäfer M. et al. Preoperative nutritional screening by the specialist instead of the nutritional risk score might prevent excess nutrition: a multivariate analysis of nutritional risk factors. Nutr J 2015; 14 (01) 37
    CrossrefPubMedGoogle Scholar
  • 10 Weimann A, Braga M, Carli F. et al. ESPEN guideline: Clinical nutrition in surgery. Clin Nutr 2017; 36 (03) 623-650
    CrossrefPubMedGoogle Scholar
  • 11 Bischoff SC, Escher J, Hébuterne X. et al. ESPEN practical guideline: Clinical Nutrition in inflammatory bowel disease. Clin Nutr 2020; 39 (03) 632-653
    CrossrefPubMedGoogle Scholar
  • 12 Wischmeyer PE, Carli F, Evans DC. et al; Perioperative Quality Initiative (POQI) 2 Workgroup. American Society for Enhanced recovery and perioperative quality initiative joint consensus statement on nutrition screening and therapy within a surgical enhanced recovery pathway. Anesth Analg 2018; 126 (06) 1883-1895
    CrossrefPubMedGoogle Scholar
  • 13 Araújo MAR, Lima LDS, Ornelas GC, Logrado MHG. Análise comparativa de diferentes métodos de triagem. Com Ciências Saúde. 2010; 21 (04) 331-342
    Google Scholar
  • 14 Nunes PP, Marshall NG. Nutritional Risk Screening (NRS 2002) como instrumento preditor de desfechos pós-operatórios em pacientes submetidos a cirurgias gastrointestinais. Rev Bras Nutr Clínica. 2015; 30 (02) 120-125
    Google Scholar
  • 15 Junior Jde S, Castro T, Lima L, Batista F. Comparison of subjective global assessment and the new nutritional diagnosis proposed by ASPEN in surgical patients. BRASPEN J 2016; 31 (04) 305-310
    Google Scholar
  • 16 Stoner PL, Kamel A, Ayoub F. et al. Perioperative care of patients with inflammatory bowel disease: Focus on nutritional support. Gastroenterol Res Pract 2018; 2018 (7890161): 7890161
    CrossrefPubMedGoogle Scholar
  • 17 Lakananurak N, Gramlich L. The role of preoperative parenteral nutrition. Nutrients 2020; 12 (05) 1-13
    CrossrefPubMedGoogle Scholar
  • 18 Connors J, Basseri S, Grant A. et al. Exclusive enteral nutrition therapy in paediatric Crohn's disease results in long-term avoidance of corticosteroids: Results of a propensity-score matched cohort analysis. J Crohn's Colitis 2017; 11 (09) 1063-1070
    CrossrefPubMedGoogle Scholar
  • 19 Sigall-Boneh R, Pfeffer-Gik T, Segal I, Zangen T, Boaz M, Levine A. Partial enteral nutrition with a Crohn's disease exclusion diet is effective for induction of remission in children and young adults with Crohn's disease. Inflamm Bowel Dis 2014; 20 (08) 1353-1360
    CrossrefPubMedGoogle Scholar
  • 20 Cerantola Y, Grass F, Cristaudi A, Demartines N, Schäfer M, Hübner M. Perioperative nutrition in abdominal surgery: recommendations and reality. Gastroenterol Res Pract 2011; 2011 (739347): 739347
    CrossrefPubMedGoogle Scholar
  • 21 Vasudevan A, Gibson PR, van Langenberg DR. Time to clinical response and remission for therapeutics in inflammatory bowel diseases: What should the clinician expect, what should patients be told?. World J Gastroenterol 2017; 23 (35) 6385-6402
    CrossrefPubMedGoogle Scholar
  • 22 Heyland DK, Montalvo M, MacDonald S, Keefe L, Su XY, Drover JW. Total parenteral nutrition in the surgical patient: a meta-analysis. Can J Surg 2001; 44 (02) 102-111
    PubMedGoogle Scholar
  • 23 Jacobson S. Early postoperative complications in patients with Crohn's disease given and not given preoperative total parenteral nutrition. Scand J Gastroenterol 2012; 47 (02) 170-177
    CrossrefPubMedGoogle Scholar
  • 24 Harvey SE, Parrott F, Harrison DA. et al; CALORIES Trial Investigators. Trial of the route of early nutritional support in critically ill adults. N Engl J Med 2014; 371 (18) 1673-1684
    CrossrefPubMedGoogle Scholar
  • 25 Jankowski M, Las-Jankowska M, Sousak M, Zegarski W. Contemporary enteral and parenteral nutrition before surgery for gastrointestinal cancers: a literature review. World J Surg Oncol 2018; 16 (01) 1-5
    CrossrefPubMedGoogle Scholar
  • 26 Fiorindi C, Cuffaro F, Piemonte G. et al. Effect of long-lasting nutritional prehabilitation on postoperative outcome in elective surgery for IBD. Clin Nutr 2021; 40 (03) 928-935
    CrossrefPubMedGoogle Scholar
  • 27 Lassen K, Soop M, Nygren J. et al; Enhanced Recovery After Surgery (ERAS) Group. Consensus review of optimal perioperative care in colorectal surgery: Enhanced Recovery After Surgery (ERAS) Group recommendations. Arch Surg 2009; 144 (10) 961-969
    CrossrefPubMedGoogle Scholar
  • 28 El Nakeeb A, Fikry A, El Metwally T. et al. Early oral feeding in patients undergoing elective colonic anastomosis. Int J Surg 2009; 7 (03) 206-209
    CrossrefPubMedGoogle Scholar