Información del artículo
El manejo nutricional de la enfermedad inflamatoria intestinal (EII) incluye: 1) la vigilancia del estado nutricional, debido al elevado riesgo de desnutrición asociado a la colitis ulcerosa (CU) y, especialmente, a la enfermedad de Crohn (EC); 2) el tratamiento dietético y el nutricional, para mantener o restaurar el estado nutricional, y 3) el tratamiento primario de la EC activa mediante nutrición enteral (NE).
El tratamiento con glucocorticoides es más efectivo que la NE en la EC activa, pero en los niños y adolescentes puede estar justificado el uso de NE como tratamiento primario, especialmente en los que presentan retraso del crecimiento. El tratamiento con NE también está indicado en los casos de EC en los que existe contraindicación, ineficacia o intolerancia a los tratamientos farmacológicos.
La evidencia disponible sobre la eficacia de los prebióticos, ácidos grasos de cadena corta, probióticos, aceites de pescados, antioxidantes y TGF-β para el control de la inflamación intestinal es limitada y resulta insuficiente para recomendar su utilización para el tratamiento primario de la EII. El aporte reducido de micropartículas podría desempeñar un papel en el control de la actividad en la EC.
Palabras clave:
Enfermedad inflamatoria intestinal
Colitis ulcerosa
Enfermedad de Crohn
Desnutrición
Manejo nutricional
Tratamiento dietético y nutricional
The nutritional management of inflammatory bowel diseases (IBD) includes: 1) monitoring of the patient's nutritional status due to the high risk of developing malnutrition associated with ulcerative colitis (UC) and, especially, Crohn's disease (CD); 2) dietetic and nutritional therapies to maintain or restore nutritional status; and 3) primary therapy with enteral nutrition (EN) for active CD. Primary therapy with EN is not as effective as steroids in active CD, but may be justified in children and adolescents, especially in those with growth failure. EN is also indicated in CD when drug therapy is unsuccessful or contraindicated.
Currently available data on the effectiveness of prebiotics, short-chain fatty acids, probiotics, fish oils (omega-3-fatty acids), antioxidants, and transforming growth factor (TGF-β) are too limited to allow the use of these substances to be recommended as primary therapy to control inflammation in patients with IBD. Reducing microparticle intake could play a role in controlling active CD.
Key words:
Inflammatory bowel disease
Ulcerative colitis
Crohn's disease
Malnutrition
Nutritional management
Dietetic and nutritional therapies
El Texto completo está disponible en PDF
Bibliografía
[1.]
J. Riera.
Definiciones conceptuales de la enfermedad inflamatoria intestinal. Concepto de cronicidad.
Enfermedad inflamatoria intestinal, II edición, pp. 3-5
[2.]
D.K. Podolsky.
Inflammatory bowel disease.
N Engl J Med, 347 (2002), pp. 417-429
[3.]
S.B. Hanauer.
Inflammatory bowel disease: epidemiology, pathogenesis, and therapeutic opportunities.
Inflam Bowel Dis, 12 (2006), pp. S3-S9
[4.]
C. Saro, V. Ruiz.
Epidemiología y factores de riesgo de la enfermedad inflamatoria intestinal.
Enfermedad inflamatoria intestinal, II edición, pp. 7-19
[5.]
F. Shanahan.
Crohn's disease.
Lancet, 359 (2002), pp. 62-69
[6.]
A. Ekbom.
Epidemiology of inflammatory bowel disease.
Inflammatory bowel diseases, pp. 7-21
[7.]
S. Dionne, F.M. Ruemmele, E.G. Seidman.
Immunopathogenesis of inflammatory bowel disease: role of cytokines and immune cell-enterocyte interactions.
Inflammatory bowel diseases, pp. 41-61
[8.]
I.H. Rosenberg, J.B. Mason.
Inflammatory bowel disease.
Modern nutrition in health and disease, pp. 1043-1048
[9.]
L.A. Dieleman, W.D. Heizer.
Nutritional issues in inflammatory bowel disease.
Gastroenterol Clin North Am, 27 (1998), pp. 435-451
[10.]
A.M. Griffiths.
Inflammatory bowel disease.
Modern nutrition in helth and disease, 9th ed, pp. 1141-1149
[11.]
K.N. Jeejeeboy.
Nutrition versus drug therapy.
Inflammatory bowel diseases, pp. 139-154
[12.]
F. Fernández Bañares, M.A. Gassull.
Revisión y consenso en terapia nutricional: nutrición en enfermedad inflamatoria intestinal.
Nutr Hosp, 14 (1999), pp. 71S-80S
[13.]
F. Fernández-Bañares, E. Cabré.
Nutrición en la enfermedad inflamatoria intestinal.
Enfermedad inflamatoria intestinal, 2a ed, pp. 351-358
[14.]
E. Cabré, M.A. Gassull.
Nutrición en la enfermedad inflamatoria intestinal.
Tratado de Nutrición, tomo IV, pp. 880-906
[15.]
B.R. Bistrian.
Role of the sistemic inflammatory response in the development of protein-energy malnutrition in inflammatory bowel disease.
Inflammatory bowel diseases, pp. 1-6
[16.]
B.J. Geerling, A. Badart-Smook, R.W. Stockbrügger, R.J.M. Brummer.
Comprehensive nutritional status in patients with long-standing Crohn disease currently in remission.
Am J Clin Nutr, 67 (1998), pp. 919-926
[17.]
D.A. Kastin, A.L. Buchman.
Malnutrition and gastrointestinal disease.
Curr Opin Nutr Metab Care, 5 (2002), pp. 699-706
[18.]
D.G. Weir, J.M. Scott.
Vitamin B12 “Cobalamin”.
Modern nutrition in helth and disease, 9th ed, pp. 447-458
[19.]
B. Oldenburg, R. Fijnheer, R. Van der Griend, G.P. Van Berge-Henegouwen, J.C. Koningsberger.
Homocysteine in inflammatory bowel disease: a risk factor for thromboembolic complications?.
Am J Gastroenterol, 95 (2000), pp. 2825-2830
[20.]
A.M. Griffiths.
Enfermedad inflamatoria intestinal pediátrica: peculiaridades y objetivos específicos.
Enfermedad inflamatoria intestinal, II edición, pp. 359-371
[21.]
J.C. Escher, J.A.J.M. Taminiau, E.E.S. Nieuwenhuis, H.A. Buller, R.J. Grand.
Treatment of inflammatory bowel disease in childhood: best available evidence.
Inflamm Bowel Dis, 9 (2003), pp. 34-58
[22.]
R.E. Kleinman, R.N. Baldassano, A. Caplan, A.M. Griffiths, M.B. Heyman, R.M. Issenman, et al.
Nutrition support for pediatric patients with inflammatory bowel disease: a clinical report of North American Society for Pediatric Gastroenterology, Hepatology and Nutrition.
J Pediatr Gastroenterol Nutr, 39 (2004), pp. 15-27
[23.]
Newby EA, Sawczenko A, Thomas AG, Wilson D. Intervenciones frente al retraso del crecimiento en niños con enfermedad de Crohn (Revisión Cochrane traducida). En: La Biblioteca Cochrane Plus, 2005 Número 4. Oxford: Update Software Ltd. Disponible en: http://www.update-software.com (Traducida de The Cochrane Library, 2005 Issue 4. Chichester, UK: John Wiley & Sons, Ltd.).
[24.]
American Society for Parenteral and Enteral Nutrition, (A.S.P.E.N.).
Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients.
J Parenter Enteral Nutr, 26 (2002), pp. 73SA-74SA
[25.]
N. Virgili, P. Leyes, A.M. Pita.
Nutrición en enfermedades digestivas.
Tratado de nutrición artificial, pp. 385-399
[26.]
M.J. Carter, A.J. Lobo, S.P.L. Travis.
Guidelines for the management of inflammatory bowel disease in adults.
Gut, 53 (2004), pp. v1-v16
[27.]
Cuerda MC, Bretón I, Camblor M, García Peris P. Soporte nutricional basado en la evidencia en la enfermedad inflamatoria intestinal. En: Bellido D, Ballesteros MD, Álvarez J, Del Olmo D, editores. Nutrición basada en la evidencia. Endocrinol Nutr. 2005;52 Supl 2:70-7.
[28.]
J.K. Nelson, K.E. Moxness, M.D. Jensen, C.F. Gastineau.
Dietética y Nutrición: Manual de la Clínica Mayo.
Mosby-Doyma, (1996),
[29.]
F.L. Suárez, J. Adshead, J.K. Furne, M.D. Levitt.
Lactose maldigestion is not an impediment to the intake of 1,500 mg calcium daily as dairy products.
Am J Clin Nutr, 68 (1998), pp. 1118-1122
[30.]
J.C. Kolars, M.D. Levitt, A. Mostafa, D.A. Savaiano.
Yogurt: an autodigesting source of lactose.
N Engl J Med, 310 (1984), pp. 1-3
[31.]
M. Rosinach, A. Maurer-Pons, E. Domènech, A. Deselaers, E. García-Planella, I. Bernal, et al.
¿Es necesario suprimir los lácteos de la dieta en los brotes de actividad de la enfermedad inflamatoria intestinal? [resumen].
Gastroenterol Hepatol, 25 (2002), pp. 198-199
[32.]
J.K. Nelson, K.E. Moxness, M.D. Jensen, C.F. Gastineau.
Dietética y Nutrición: Manual de la Clínica Mayo.
Mosby-Doyma, (1996),
[33.]
A.M. Riordan, J.O. Hunter, R.E. Cowan, J.R. Crampton, A.R. Davidson, R.J. Dickinson, et al.
Treatment of active Crohn's disease by exclusion diet: East Anglian multicentre controlled trial.
Lancet, 342 (1993), pp. 1131-1134
[34.]
M. Pearson, K. Teahon, A. Jonathan Levi, I. Bjarnason.
Food intolerance and Crohn's disease.
Gut, 34 (1993), pp. 783-787
[35.]
S.L. Jowett, C.J. Seal, E. Phillips, W. Gregory, J.R. Barton, M.R. Welfare.
Dietary beliefs of people with ulcerative colitis and their effect on relapse and nutrient intake.
Cin Nutr, 23 (2004), pp. 61-70
[36.]
S.L. Jowett, C.J. Seal, M.S. Pearce, E. Phillips, W. Gregory, J.R. Barton, et al.
Influence of dietary factors on the clinical course of ulcerative colitis: a prospective cohort study.
Gut, 53 (2004), pp. 1479-1484
[37.]
M.E. Kupferman, J.L. Rombeau.
Parenteral nutrition in inflammatory bowel disease.
Parenteral nutrition, pp. 208-229
[38.]
M. Esteve.
Tratamiento general del brote de enfermedad del Crohn.
Enfermedad inflamatoria intestinal, 2a ed, pp. 233-240
[39.]
Zachos M, Tondeur M, Griffiths AM. Nutrición enteral para la inducción de remisión en la enfermedad de Crohn (Revisión Cochrane traducida). En: La Biblioteca Cochrane Plus, 2005 Número 4. Oxford: Update Software Ltd. Disponible en: http://www.update-software.com (Traducida de The Cochrane Library, 2005 Issue 4. Chichester, UK: John Wiley & Sons, Ltd.).
[40.]
A.M. Griffiths, A. Ohlsson, P.M. Sherman, R.L. Sutherland.
Meta-analysis of enteral nutrition as a primary tratment of active Crohn's disease.
Gastroenterology, 108 (1995), pp. 1056-1067
[41.]
F. Fernández-Bañares, E. Cabré, M. Esteve-Comas, M.A. Gassull.
How effective is enteral nutrition in inducing clinical remission in active Crohn's disease?. A meta-analysis of the randomized clinicals trials.
J Parenter Enteral Nutr, 19 (1995), pp. 356-364
[42.]
A. Messori, G. Trallori, G. D’Albasio, M. Milla, G. Vannozzi, F. Pacini.
Defined-formula diets versus steroids in the treatment of active Crohn's disease. A meta-analysis.
Scand J Gastroenterol, 31 (1996), pp. 267-272
[43.]
E. Seidman.
Nutritional therapy for Crohn's disease: lessons from the Ste-Justine Hospital experience.
Inflam Bowel Dis, 3 (1997), pp. S43-S45
[44.]
F.M. Ruemmele, C.C. Roy, E. Levy, E.G. Seidman.
Nutrition as primary therapy in pediatric Crohn's disease: Fact or fantasy?.
J Pediatr, 136 (2000), pp. 285-291
[45.]
R. Heuschkel, C.C. Menache, J.T. Megerian, A.E. Baird.
Enteral nutrition and corticosteroids in the treatment of acute Crohn's disease in children.
J Pediatr Gastroenterol Nutr, 31 (2000), pp. 8-15
[46.]
A.M. Griffiths.
Enteral nutrition in the management of Crohn's disease.
J Parenter Enteral Nutr, 29 (2005), pp. S108-S117
[47.]
X. Dray, P. Marteau.
The use of enteral nutrition in te management of Crohn's disease in adults.
J Parenter Enteral Nutr, 29 (2005), pp. S166-S172
[48.]
Proceedings from de wokshop “Use of nutrition in the management and treatment of inflammatory bowel disease” [Concluding Remarks]. J Parenter Enteral Nutr. 2005;29(Suppl):184S-8S
[49.]
M.A. Gassull.
New insights in nutritional therapy in inflammatory bowel disease.
Clin Nutr, 20 (2001), pp. 113-121
[50.]
M.A. Gassull, E. Cabré.
Nutrition in inflammatory bowel disease.
Curr Opin Clin Nutr Metab Care, 4 (2001), pp. 561-569
[51.]
M.A. Gassull, J. Mañé, E. Pedrosa, E. Cabré.
Macronutrients and bioactive molecules: is there a specific role in the management of inflammatory bowel disease?.
J Parenter Enteral Nutr, 29 (2005), pp. S179-S183
[52.]
K. Mitsuyama, T. Saiki, O. Kanauchi, T. Iwanaga, N. Tomiyasu, T. Nishiyama, et al.
Treatment of ulcerative colitis with germinated barley foodstuff feeding: a pilot study.
Aliment Pharmacol Ther, 12 (1998), pp. 1225-1230
[53.]
R.N. Fedorak, K.L. Masden.
Probiotics and the management of inflammatory bowel disease.
Inflamm Bowel Dis, 10 (2004), pp. 286-299
[54.]
S.J. Middleton, J.T. Rucker, G.A. Kirby, A.M. Riordan, J.O. Hunter.
Long-chain triglycerides reduce the efficacy of enteral feeds in patients with active Crohn's disease.
Clin Nutr, 14 (1995), pp. 229-236
[55.]
T. Sakurai, T. Matsui, T. Yao, Y. Takagi, F. Hirai, K. Aoyagi, et al.
Short-term efficacy of enteral nutrition in the treatment of active Crohn's disease: a randomized, controlled trial comparing nutrient formulas.
J Parenter Enteral Nutr, 26 (2002), pp. 98-103
[56.]
M.A. Gassull, F. Fernández-Bañares, E. Cabré, M. Papo, M.H. Giaffer, J.L. Sánchez-Lombraña.
Fat composition may be a clue to explain the primary therapeutic effect of enteral nutrition in Crohn's disease: results of a double blind randomised multicentre European trial.
Gut, 51 (2002), pp. 164-168
[57.]
A. Belluzzi, S. Boschi, C. Brignola, A. Munarini, G. Cariani, F. Miglio.
Polyunsaturated fatty acids and inflammatory bowel disease.
Am J Clin Nutr, 71 (2000), pp. 339S-342S
[58.]
A.K. Akobeng, V. Miller, J. Stanton, A.M. Elbadri, A.G. Thomas.
Double-blind randomized controlled trial of glutamine-enriched polymeric diet in the treatment of active Crohn's disease.
J Pediatr Gastroenterol Nutr, 30 (2000), pp. 78-84
[59.]
J.M.E. Fell.
Control of sistemic and local inflammation with transforming growth factor contaning formulas.
J Parenter Enteral Nutr, 29 (2005), pp. S126-S133
[60.]
M.C.E. Lomer, R.P.H. Thompson, J.J. Powell.
Fine and ultrafine particles of the diet: influence on the mucosal immune response and association with Crohn's disease.
Proc Nutr Soc, 61 (2002), pp. 123-130
Copyright © 2007. Sociedad Española de Endocrinología y Nutrición