Customised nutrition therapy in the treatment of Crohn's disease-related malignant bowel diseases

Introduction: Sarcopenia accompanying a malignant disease and exacerbated by chemotherapy intensifies the side effects and decreases the efficiency of treatment, thereby reducing life expectancy. Case description: We present the nutrition therapy of two young female patients (A and B) receiving chemotherapy for malignant tumours with different localisations (A: small intestine, B: large intestine) developed in connection with Crohn's disease (A: poorly differentiated small intestine neuroendocrine malignoma pT3(m)NxMO; B: colon adenocarcinoma pT3pN3M2, Dukes C2). Beyond chemotherapy, nutrition was complicated by the primary disease and the special conditions caused by preventive resective surgery (A: Type II Short Bowel Syndrome with 70 cm jejunum, with missing coecum and rectosigmoid colon; B: subtotal colectomy with a 16 – 18 cm rectum stub and a perianal fistula). Using the body mass index, skin-fold thickness measurement, lab results and also bioelectrical impedance analysis a more complex image of the patients' nutrition levels was gained. Enteral diet was optimised. Assessment of body composition enabled us to set up customised and effective enteral and parenteral diets. Results: The undernutrition (BMI A: 15.6 – 18.9 kg/sq. m.; B: 17.7 – 18.9 kg/sq. m.), body fat loss (A: 17 – 21.8 per cent; B: 27.2 – 21.7 per cent) and sarcopenia (skeletal muscle mass A: 16.9 – 15.8 – 19.3 kg; B: 23.8 – 24.8 kg) observed at the beginning of the nutrition therapy took a turn for the better in both cases despite chemotherapy. To achieve this, in case A supplemental parenteral nutrition in the patient's home was required. For patient B cancer cachexia could be avoided by a repeated adjustment of enteral nutrition. Patient A was freed of tumour as a result of oncological treatment, while with patient B the hope could be maintained for making the liver metastases operable. Conclusion: By designing and administering a customised nutrition therapy the assessment of body composition is of vital importance. Intestinal failure can be diagnosed and parenteral nutrition commenced only after the failure of the optimised enteral diet. If parenteral nutrition therapy is required it can effectively reduce the sarcopenia caused by the primary disease and chemotherapy. Thereby, apart from the patients' quality of life also their life expectancy can be improved.