Pharmacological nutrition in inflammatory bowel diseases.
Inflammatory Bowel Diseases--ulcerative colitis and Crohn's disease--are chronic gastrointestinal inflammatory diseases of unknown etiology. Decreased oral intake, malabsorption, accelerated nutrient losses, increased requirements, and drug-nutrient interactions cause nutritional and functional deficiencies that require proper correction by nutritional therapy. The goals of the different forms of nutritional therapy are to correct nutritional disturbances and to modulate inflammatory response, thus influencing disease activity. Nutritional intervention may improve outcome in certain individuals; however, because of the costs and complications of such therapy, careful selection is warranted. Total parenteral nutrition has been used to correct and prevent nutritional disturbances and to promote bowel rest during active disease, mainly in cases of digestive fistulae with a high output. Its use should be reserved for patients who cannot tolerate enteral nutrition. Enteral nutrition is effective in inducing clinical remission of disease in adults and promoting growth in children. Recent research has focused on the use of specific nutrients as primary treatment agents. Although some reports have indicated that glutamine, short-chain fatty acids, antioxidants and immunonutrition with omega-3 fatty acids are an important therapeutic alternative in the management of inflammatory bowel diseases, the beneficial reported effects have yet to be translated into the clinical practice. The real efficacy of these nutrients still need further evaluation through prospective and randomized trials.
Department of Gastroenterology, Colorectal Surgery Unit, Hospital das Clinicas, University of São Paulo Medical School, Sao Paulo, Brasil. fgcampos@osite.com.br
F G
FG
Campos
D L
DL
Waitzberg
M G
MG
Teixeira
D R
DR
Mucerino
D R
DR
Kiss
A
A
Habr-Gama
D003093:Colitis, Ulcerative / Q000150:complications / Q000628:therapy; D003424:Crohn Disease / Q000150:complications / Q000628:therapy; D003677:Deficiency Diseases / Q000175:diagnosis / Q000209:etiology; D004750:Enteral Nutrition / Q000379:methods; D005227:Fatty Acids / Q000627:therapeutic use; D015525:Fatty Acids, Omega-3 / Q000627:therapeutic use; D005973:Glutamine / Q000627:therapeutic use; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications / Q000188:drug therapy / Q000628:therapy*; D008286:Malabsorption Syndromes / Q000175:diagnosis / Q000209:etiology; D015596:Nutrition Assessment; D009748:Nutrition Disorders / Q000175:diagnosis / Q000209:etiology; D010289:Parenteral Nutrition, Total / Q000379:methods
D005227:Fatty Acids; D015525:Fatty Acids, Omega-3; D005973:Glutamine