Ernährung während/ nach akuter Pankreatitis: Was hat wirklich Einfluss auf die Erkrankung?

Dtsch. Med. Wschr. 0120472 001; 126: S90–S95 © Georg Thieme Verlag Stuttgart · New York Ü b e r s i c h t e n Die akute Pankreatitis ist ein Krankheitsbild, das in verschiedenen Schweregraden verlaufen kann: von der milden, spontan rückläufigen Erscheinungsform der ödematösen Pankreatitis bis zu dem schweren Krankheitsbild der hämorrhagisch nekrotisierenden Form kann sich die akute Pankreatitis sehr variabel manifestieren. Während die milde Form der akuten Pankreatitis, die etwa 70–80% der Fälle ausmacht, initial auf einer Überwachungsstation und dann auf einer Normalstation zu therapieren ist, sollten Patienten mit einer nekrotisierenden Pankreatitis unverzüglich intensivmedizinisch überwacht und behandelt werden. Dabei ist eine konsequente intensivmedizinische Therapie die einzige Möglichkeit, die in der frühen Phase der Erkrankung auftretenden kardiorespiratorischen Komplikationen und damit die Mortalität maßgeblich zu beeinflussen (25). Dennoch stellen die Infektion von Pankreasnekrosen und die daraus resultierenden septischen Komplikationen bei der schweren Pankreatitis den Hauptfaktor für die hohe Morbidität und Mortalität des Krankheitsbildes dar (5). In verschiedenen experimentellen Studien wurde die Bedeutung der Translokation von Bakterien aus dem Gastrointestinaltrakt als Ursache der infizierten Pankreasnekrose untersucht (14, 46).

[1]  C. Löser,et al.  Akute nekrotisierende Pankreatitis , 1999, Der Internist.

[2]  Lamers,et al.  Does jejunal feeding activate exocrine pancreatic secretion? , 1999, European journal of clinical investigation.

[3]  H. Simms,et al.  Prognostic usefulness of scoring systems in critically ill patients with severe acute pancreatitis. , 1999, Critical care medicine.

[4]  M. Usami,et al.  Enteral nutrition prevents bacterial translocation but does not improve survival during acute pancreatitis. , 1999, Archives of surgery.

[5]  R. Griffiths,et al.  Randomized clinical outcome study of critically ill patients given glutamine-supplemented enteral nutrition. , 1999, Nutrition.

[6]  M. Reynaert,et al.  Is Early Enteral Nutrition in Acute Pancreatitis Dangerous? About 20 Patients Fed by an Endoscopically Placed Nasogastrojejunal Tube , 1998, Pancreas.

[7]  K. Fearon,et al.  Glutamine-supplemented total parenteral nutrition reduces blood mononuclear cell interleukin-8 release in severe acute pancreatitis. , 1998, Nutrition.

[8]  J. Reynolds,et al.  Compared with parenteral nutrition, enteral feeding attenuates the acute phase response and improves disease severity in acute pancreatitis , 1998, Gut.

[9]  M. Olszewski,et al.  Cerulein‐Induced Acute Pancreatitis in Rats—Does Bacterial Translocation Occur via a Transperitoneal Pathway? , 1997, Pancreas.

[10]  R. Andersson,et al.  Alterations in intestinal function in acute pancreatitis in an experimental model , 1996, The British journal of surgery.

[11]  W. Simpson,et al.  Enteral nutritional support in acute alcoholic pancreatitis. , 1995, Journal of the American College of Nutrition.

[12]  H. Reber,et al.  Routes of spread of pathogens into the pancreas in a feline model of acute pancreatitis. , 1994, Gut.

[13]  J. Alexander,et al.  Bacterial Translocation: A Potential Source for Infection in Acute Pancreatitis , 1993, Pancreas.

[14]  D. Rattner,et al.  Gut macromolecular permeability in pancreatitis correlates with severity of disease in rats. , 1993, Gastroenterology.

[15]  J. Ranson,et al.  Nutritional support for acute pancreatitis. , 1992, Surgery, gynecology & obstetrics.

[16]  M. Yaqoob,et al.  Prevention of bacterial infection and sepsis in acute severe pancreatitis. , 1992, Annals of the Royal College of Surgeons of England.

[17]  R. Dickerson,et al.  Resting energy expenditure in patients with pancreatitis , 1991, Critical care medicine.

[18]  K. Kudsk,et al.  Postoperative jejunal feedings following complicated pancreatitis. , 1990, Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition.

[19]  R. P. Thompson,et al.  Small-intestinal function during enteral feeding and starvation in man. , 1989, Clinical science.

[20]  Achord Jl.  1987 Henry Baker lecture. Nutrition, alcohol, and the liver. , 1988 .

[21]  J. H. Shaw,et al.  Glucose, fatty acid, and urea kinetics in patients with severe pancreatitis. The response to substrate infusion and total parenteral nutrition. , 1986, Annals of surgery.

[22]  M. Büchler,et al.  Bacterial contamination of pancreatic necrosis. A prospective clinical study. , 1986, Gastroenterology.

[23]  W. Mauritz,et al.  Amino acid concentrations in plasma and skeletal muscle of patients with acute hemorrhagic necrotizing pancreatitis. , 1985, Clinical chemistry.

[24]  J. Grant,et al.  Total Parenteral Nutrition in Pancreatic Disease , 1984, Annals of surgery.

[25]  H. Debas,et al.  Intravenous mixed amino acids and fats do not stimulate exocrine pancreatic secretion. , 1984, The American journal of physiology.

[26]  J. Konturek,et al.  Intravenous amino acids and fat stimulate pancreatic secretion. , 1979, The American journal of physiology.

[27]  J. Fischer,et al.  Parenteral Nutrition inthe Treatment of Acute Pancr3eatitis: Effect on Complications and Mortality , 1977, Annals of surgery.

[28]  J. Ranson,et al.  Prevention, diagnosis, and treatment of pancreatic abscess. , 1977, Surgery.

[29]  R. Brown,et al.  Changing methods in the treatment of severe pancreatitis. , 1974, American journal of surgery.

[30]  E. Seifter,et al.  Intrajejunal administration of an elemental diet at neutral pH avoids pancreatic stimulation. Studies in dog and man. , 1973, American journal of surgery.

[31]  J. Ostrow,et al.  Effect of jejunal amino acid perfusion and exogenous cholecystokinin on the exocrine pancreatic and biliary secretions in man. , 1971, Gastroenterology.

[32]  N. Everitt.  Enteral nutrition is superior to parenteral nutrition in severe acute pancreatitis: results of a randomized prospective trial. , 1998, The British journal of surgery.

[33]  S. McClave,et al.  Comparison of the safety of early enteral vs parenteral nutrition in mild acute pancreatitis. , 1997, JPEN. Journal of parenteral and enteral nutrition.

[34]  G. Bodoky,et al.  Effect of enteral nutrition on exocrine pancreatic function. , 1991, American journal of surgery.

[35]  B. Delafosse,et al.  Energy expenditure during severe acute pancreatitis. , 1989, JPEN. Journal of parenteral and enteral nutrition.

[36]  R J Smith,et al.  The gut: a central organ after surgical stress. , 1988, Surgery.

[37]  M. Talamini,et al.  Early total parenteral nutrition in acute pancreatitis: lack of beneficial effects. , 1987, American journal of surgery.

[38]  G. Blackburn,et al.  New approaches to the management of severe acute pancreatitis. , 1976, American journal of surgery.

[39]  D. Nahrwold,et al.  Pancreatic secretion in response to an elemental diet and intravenous hyperalimentation. , 1976, Surgery, gynecology & obstetrics.

[40]  E. Dimagno,et al.  Intraluminal and postabsorptive effects of amino acids on pancreatic enzyme secretion. , 1973, The Journal of laboratory and clinical medicine.