S3-Leitlinie Klinische Ernährung bei chronisch-entzündlichen Darmerkrankungen

Zusammenfassung

Chronisch-entzündliche Darmerkrankungen (CED) sind nicht nur mit einem erhöhten Risiko für Mangelernährung assoziiert, neuerdings kommt auch Adipositas vor, was die ernährungsmedizinische Begleitbehandlung von Patienten mit CED verkompliziert. Adipositas bei CED erhöht das Komplikationsrisiko, insbesondere bei chirurgischen Eingriffen, und reduziert möglicherweise das Ansprechen auf immunsuppressive Behandlung. Darüber hinaus spielt die Ernährung wahrscheinlich auch bei der Entstehung von CED eine Rolle, insbesondere hochverarbeitete Lebensmittel könnten hier von Bedeutung sein. Diese und andere Aspekte werden in der gründlich überarbeiteten Leitlinie „Klinische Ernährung bei chronisch-entzündlichen Darmerkrankungen“ in 62 evidenz- bzw. expertenbasierten Empfehlungen adressiert.

Die Leitlinie basiert auf der früheren DGEM-Leitlinie zum Thema sowie v. a. auf der aktuellen europäischen Leitlinie „ESPEN guideline on Clinical Nutrition in inflammatory bowel disease“ von 2023. Die Leitlinie wurde nach der „SIGN-Methodik“ erstellt, basierend auf einer aktualisierten Literaturrecherche von Dez. 2021 bis Nov. 2023. Erstmals kommt neben oraler Trinknahrung sowie enteraler und parenteraler Ernährung auch die neue „Crohn’s disease exclusion diet“ zur Sprache.

Die Leitlinie macht deutlich, dass eine fachgerechte ernährungsmedizinische Diagnostik, Ernährungstherapie und Gewichtskontrolle sowie orale Trinknahrung und oral/enterale Formulanahrung eine wichtige Rolle in der Behandlung von CED spielen. Dadurch können der Krankheitsverlauf sowie die Lebensqualität verbessert werden.

Abstract

Inflammatory bowel disease (IBD) is not only associated with an increased risk of malnutrition, but obesity has also recently emerged, complicating the nutritional management of patients with IBD. Obesity in IBD increases the risk of complications, especially in surgical procedures, and may reduce the response to immunosuppressive treatment. In addition, diet is also likely to play a role in the development of IBD, and highly processed foods in particular may be important. These and other aspects are addressed in the thoroughly revised guideline “Clinical nutrition in inflammatory bowel disease” in 62 evidence- and expert-based recommendations.

The guideline is based on the previous DGEM guideline from 2014 and in particular on the current European guideline “ESPEN guideline on Clinical Nutrition in inflammatory bowel disease” from 2023. The guideline was prepared according to the “SIGN methodology”, based on an updated literature search from Dec. 2021 to Nov. 2023. For the first time, the new “Crohn's disease exclusion diet” is also discussed in addition to oral nutrition and enteral and parenteral nutrition.

The guideline makes clear that professional nutritional diagnostics, nutritional counseling and weight control as well as oral nutrition supplements and oral/enteral formulas play an important role in the treatment of IBD. This can improve the course of the disease and quality of life in IBD patients.

Schlüsselwörter

Morbus Crohn - Colitis ulcerosa - orale Trinknahrung - Malnutrition - Adipositas

Keywords

Crohn’s disease - ulcerative colitis - oral nutrition - malnutrition - obesity

Publication History

Article published online:
16 April 2025

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