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Aktuelle Ernährungsmedizin 2023; 48(03): 183-194
DOI: 10.1055/a-2062-9552
Übersicht

Enterale Ernährungstherapien beim pädiatrischen M. Crohn Anwendungen und Wirkweise

Enteral Nutrition Therapies in Children with Crohn’s Disease – Current Strategies and Possible Modes of Action
André Hörning
1   Pädiatrische Gastroenterologie, Hepatologie und Endoskopie, Klinik für Kinder- und Jugendmedizin, Universitätsklinik Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg
,
Anjona Schmidt-Choudhury
2   Pädiatrische Gastroenterologie und Hepatologie, Klinik für Kinder- und Jugendmedizin, Katholisches Klinikum Bochum, Universitätsklinikum der Ruhr-Universität Bochum
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Erratum: Enterale Ernährungstherapien beim pädiatrischen M. Crohn Anwendungen und WirkweiseAktuelle Ernährungsmedizin 2023; 48(03): e29-e29
DOI: 10.1055/a-2185-9745

Zusammenfassung

Die Inzidenz chronisch-entzündlicher Darmerkrankungen (CED), insbesondere des Morbus Crohn, nimmt weltweit deutlich zu. Externe Umweltfaktoren, einschließlich der alltäglichen westlich-industrialisierten Ernährung, welche sich u. a. durch einen hohen Anteil prozessierter industriell hergestellter Lebensmittel auszeichnet, spielen eine Schlüsselrolle im Pathomechanismus der Krankheit.

Ernährungsspezifische Maßnahmen nehmen seit jeher eine zentrale Rolle bei der Behandlung der CED ein. Der erfolgreiche Einsatz der exklusiven enteralen Ernährung (EET), die als Induktionstherapie der ersten Wahl bei pädiatrischem Morbus Crohn (MC) gilt, spricht deutlich für einen Zusammenhang zwischen Ernährung und CED. Die EET wird alleinig oder im Verlauf der Erkrankung und auch beim hochaktiven MC in Kombination mit Immunmodulatoren eingesetzt. Einziger Nachteil dieser hocheffizienten Ernährungstherapie ist die Geschmacksmonotonie, die eine reduzierte Therapieadhärenz mit sich bringt. Die intestinale Mikrobiota und deren Stoffwechselaktivität (Mikrobiom) scheinen ebenso eine wichtige Rolle für die Pathogenese zu spielen, da Kinder und Jugendliche mit Morbus Crohn oder Colitis ulcerosa diesbezüglich häufig ausgeprägte Veränderungen aufweisen. Es ist bekannt, dass die Zusammensetzung der intestinalen Mikrobiota stark von der Ernährung beeinflusst wird. Auch die EET kann durch Ausschluss potenziell schädlicher Nahrungsbestandteile die Darmmikrobiota modifizieren und zur mukosalen Heilung führen.

Diätetische Interventionen könnten demnach eine sehr nebenwirkungsarme Möglichkeit darstellen, den MC zu behandeln und der Manifestation bei genetisch prädisponierten Individuen möglicherweise sogar vorzubeugen. Auf der Grundlage der Nährstoffzusammensetzung der EET hat daher die Suche nach einer geschmacklich verbesserten und gleichzeitig wirksamen Diät begonnen, die Ergebnisse dieser alternativen Ernährungsstrategien erscheinen vielversprechend.

Dieser Übersichtsartikel soll den Wirkmechanismus der exklusiven enteralen Eliminationsdiät und moderner ernährungsmedizinischer Therapiestrategien aufzeigen sowie den aktuellen Stand der wissenschaftlichen Erkenntnisse, die deren Wirksamkeit bei der Behandlung des pädiatrischen MC belegen, zusammenfassen. Insbesondere sollen dabei die möglichen pathophysiologischen Mechanismen, die der Remissionsinduktion und -erhaltung zugrunde liegen, auch im Hinblick auf Veränderungen des Darmmikrobioms beleuchtet werden.

Abstract

Nutrition has an essential effect on the occurence and course of disease in inflammatory bowel disease.

Several factors as for example breast feeding, fiber intake from fruit as well as the so called „mediterranian diet“ have been identified as being protective with regard to developing IBD. On the other hand, intake of high levels of sugar, raw meat or ultraprocessed food is associated with a higher risk for a manifestation of IBD in genetically predisposed children. Nevertheless, the underlying mechanisms how exclusion diets alone or in combination with medication modulate intestinal microbiota lead to mucosal healing still have to be elucidated. Since there already exists knowledge on the influence of nutrition on treating or preventing IBD this should be implicated in therapeutic and prevention strategies.

Schlüsselwörter

Chronisch-entzündliche Darmerkrankungen - EET - CDED - Mikrobiota

Key words

IBD - nutrition - EET - CDED - microbiota


Publication History

Article published online:
26 May 2023

© 2023. Thieme. All rights reserved.

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Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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