Diätetische und medikamentöse Therapie des Kurzdarmsyndroms

Zusammenfassung

Durchfälle, Malabsorption und Mangelernährung sind die Hauptsymptome des Kurzdarmsyndroms. Die zugrunde liegenden gastrointestinalen Erkrankungen, die typischerweise durchgeführten Darmresektionen und die daraus folgenden pathophysiologischen Konsequenzen werden zusammenfassend dargestellt. Die therapeutischen Maßnahmen in der postoperativen Phase und in der Langzeitrehabilitation von Patienten mit Kurzdarmsyndrom werden ausführlich erörtert. Die initiale parenterale Ernährung soll frühzeitig durch eine enterale Ernährung ergänzt werden, um die intestinale Adaptation zu begünstigen, den Flüssigkeitsverlust zu reduzieren und die Nährstoffresorption zu verbessern. Die langfristigen diätetischen Maßnahmen hängen von der Art der durchgeführten Operation und vom Vorhandensein eines Dickdarms ab. Die Bedeutung des Dickdarms als Verdauungsorgan und Energielieferant und die Notwendigkeit einer oxalatarmen Ernährung werden herausgestellt. Der mögliche Nutzen neuerer Therapieoptionen (Glutamin, Wachstumshormon, Glukagon-like Peptid 2) wird erörtert. Typische Krankheitskomplikationen des Kurzdarmsyndroms und Möglichkeiten ihrer Behandlung werden dargestellt.

Abstract

Diarrhoea, malabsorption and malnutrition characterise the short bowel syndrome. The underlying gastrointestinal disorders, the types of intestinal resections performed and the subsequent pathophysiological situations are reviewed. Recommended therapeutic measures in the postoperative period as well as in the rehabilitation of patients with short bowel syndrome are discussed in more detail. In the postoperative period, parenteral nutrition is essential followed by an enteral diet to stimulate bowel adaptation, reduce fluid loss and increase nutrient absorption. The final diet should be based on the anatomy of the retained bowel (presence or absence of a colon and ileum). The importance of the colon as a digestive organ in patients with short bowel and the need of a low-oxalate diet are underlined. The possible benefit of new treatment options (glutamine, growth hormone and glucagon-like peptide 2) is discussed. Both typical complications of the short bowel syndrome and management of these complications are presented.

Schlüsselwörter

Kurzdarmsyndrom - Jejunostomie - jejunokolische Anastomose - diätetische Therapie - parenterale Ernährung - Glutamin - Wachstumshormon

Key words

Short bowel syndrome - jejunostomy - jejunocolonic anastomosis - diet therapy - parenteral nutrition - glutamine - growth hormone

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