GUIDELINES FOR CLINICAL NUTRITION IN INFLAMMATORY BOWEL DISEASE
Autori:
Željko Krznarić, Darija Vranešić Bender, Dina Ljubas Kelečić, Ante Tonkić, Silvija Čuković-Čavka, Brankica Mijandrušić-Sinčić, Viktor Domislović, Tajana Pavić, Ana Barišić, Marko Banić, Boris Vucelić
Sažetak
Dijetoterapija i klinička prehrana zauzimaju važno mjesto u liječenju bolesnika s upalnim bolestima crijeva (UBC). Nutritivna potpora važna je komponenta liječenja pacijenata s UBC-om, a uključuje prevenciju i liječe-nje svih oblika malnutricije. Potvrđenu malnutriciju u bolesnika s upalnim bolestima crijeva treba adekvatno zbrinjavati jer pogoršava prognozu, stupanj komplikacija, mortalitet i kvalitetu života bolesnika. Enteralna je prehrana izuzetno važan dio nutritivnog liječenja u upalnim bolestima crijeva, a u pojedinim situacijama ima značenje primarne terapije. Parenteralna prehrana ima mjesto u liječenju upalnih bolesti crijeva, i u akutnim situacijama i u kroničnom liječenju bolesnika sa sindromom kratkog crijeva. U izradi ovih smjernica sudjelo-vali su predstavnici Hrvatskog društva za kliničku prehranu Hrvatskoga liječničkog zbora, Hrvatskog društva za imunologiju sluznice Hrvatskoga liječničkog zbora, Hrvatskoga gastroenterološkog društva i Hrvatskog društva nutricionista i dijetetičara. Utemeljene su na dokazima, prema sustavu GRADE (engl. Grading of Re-commendations, Assessment, Development and Evaluation), koji uz snagu dokaza opisuje i razinu preporuke. Temeljni zaključci ovih smjernica odnose se na prepoznavanje malnutricije u ovoj skupini bolesnika, određi-vanje nutritivnih potreba, nadoknadu ključnih nutrijenata i farmakonutrijenata, primjenu različitih modaliteta artificijalne prehrane te specifičnosti perioperativne prehrane.
Summary
Diet therapy and clinical nutrition have a significant place in the treatment of patients with inflammatory bowel disease (IBD). Nutritional support is an important component of medical therapy in patients with IBD, and includes the prevention and treatment of all forms of malnutrition. Confirmed malnutrition in patients with inflammatory bowel disease should be treated adequately as it exacerbates prognosis, degree of complications, mortality and quality of life of a patient. Enteral nutrition is an extremely important part of nutritional therapy in inflammatory bowel diseases, and in some situations it has the meaning of primary therapy. Parenteral nutrition has its place in nutrition therapy of inflammatory bowel disease, both in acute and chronic treatment of patients with short bowel syndrome. Representatives of the Croatian Society of Clinical Nutrition Croatian Medical Association, Croatian Society of Mucosal Immunology Croatian Medical Association, Croatian Society of Gastroenterology and Croatian Society of Nutritionists and Dietitians participated in the development of these guidelines. They are evidence-based, according to the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) system which, with the strength of evidence, also describes the level of recommendation. The basic conclusions of these guidelines relate to the assessment of malnutrition in this group of patients, the determination of nutritional needs, the replacement of key nutrients and pharmaconutrients, the application of various artificial nutrition modalities and the specificities of perioperative nutrition.
