Información del artículo
Las fístulas digestivas y el intestino corto son 2 procesos en los que el tratamiento nutricional es de gran importancia. Existen guías de actuación clínica basadas en la evidencia que ofrecen recomendaciones generales acerca del soporte nutricional en ambos casos.
En este trabajo se han revisado los metaanálisis y los estudios prospectivos aleatorizados (EPA) publicados entre 1990 y 2004 acerca del soporte nutricional en las fístulas digestivas y en el intestino corto.
No se han encontrado metaanálisis ni EPA que comparen nutrición enteral con la parenteral en ninguno de los 2 procesos estudiados, probablemente porque ya ha quedado establecido de tiempo atrás cómo realizar el tratamiento nutricional según las características clínicas concretas en cada caso de fístulas e intestino corto. Sí se han encontrado trabajos que estudian los efectos de la nutrición artificial asociada o no a nuevos fármacos o nutrientes, como somatostatina u octreótida en las fístulas digestivas, y la glutamina, la hormona de crecimiento y/o el glucagon-like peptide-2 en el intestino corto, que en algunos casos podrían ofrecer resultados prometedores en la mejoría de la evolución y pronóstico de estos 2 procesos.
Palabras clave:
Fístulas digestivas
Fístulas enterocutáneas
Intestino corto
Nutrición enteral
Nutrición parenteral
Somatostatina
Octreótido
Glutamina
Hormona de crecimiento
Glucagon-like peptide-2
Abstract
Gastrointestinal (GI) fistulae and short bowel syndrome are two processes in which nutritional treatment is highly important. There are evidence-based clinical practice guidelines that provide general recommendations on nutritional support in both processes.
The present article reviews meta-analyses and prospective randomized trials published between 1990 and 2004 on nutritional support in GI fistulae and short bowel syndrome. No meta-analyses or prospective randomized trials comparing enteral nutrition with parenteral nutrition were found in either of the two processes studied, probably because the most appropriate forms of nutritional treatment in both entities were established some time ago. In contrast, we did find studies on the effects of artificial nutrition alone or associated with new drugs or nutrients, such as somatostatin or octreotide in GI fistulae, and glutamine, growth hormone and/or glucagonlike peptide 2 in short bowel syndrome, which in some cases could offer promising results in improving the progression and outcome of these two processes.
Key words:
Gastrointestinal fistulae
Enterocutaneous fistulae
Short bowel
Enteral nutrition
Parenteral nutrition
Somatostatin
Octreotide
Glutamine
Growth hormone
Glucagon-like peptide 2
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Bibliografía
[1.]
Evidence Based Medicine Working Group.
La medicina basada en la evidencia: guías del usuario de la bibliografía médica.
JAMA (ed. esp), (1997),
[2.]
D. Del Olmo, M.A. Konning, T. López, V. Alcázar, P. Martínez de Icaya, C. Vázquez.
Utilización de las fórmulas especiales de Nutrición enteral: recomendaciones basadas en la evidencia.
Endocrinol Nutr, (2002), pp. 9-14
[3.]
Canadian Task Force on the Periodic Health Examination.
The periodic health examination.
J Can Med Assoc, 121 (1979), pp. 1193-1254
[4.]
S.M. Berry, J.E. Fischer.
Classification and pathophysiology of enterocutaneous fistulas.
Surg Clin North Am, 76 (1996), pp. 1009-1018
[5.]
M. Falconi, P. Pederzoli.
The relevance of gastrointestinal fistulae in clinical practice: a review.
Gut, 49 (2002), pp. 2-10
[6.]
S. Fukuchi, J. Seeburger, G. Parquet, R. Rolandelli.
Nutrition support of patients with enterocutaneous fistulas.
Nutr Clin Pract, 13 (1998), pp. 59-65
[7.]
C.E. Foster, A.T. Lefor.
General management or gastrointestinal fistulas.
Surg Clin North Am, 76 (1996), pp. 1019-1033
[8.]
ASPEN Board of Directors and the Clinical Guidelines Task Force.
Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. Gastrointestinal fistulae.
JPEN, 26 (2002), pp. 76SA-78SA
[9.]
J.A. Ryan, B.A. Adye, A.J. Weinstein.
Enteric fistulas.
Clinical nutrition. Vol II. Parenteral nutrition, pp. 419-436
[10.]
H.S. Himal, J.R. Allard, J.E. Nadea.
The importance of adequate nutrition in closure of small intestine fistulas.
Br J Surg, 61 (1974), pp. 724-730
[11.]
M. Deitel.
Nutritional management of external gastrointestinal fistulas.
Can J Surg, 19 (1976), pp. 505-509
[12.]
M.M. Meguid, A.C.L. Campos.
Nutritional management of patients with gastrointestinal fistulas.
Surg Clin North Am, 76 (1996), pp. 1035-1080
[13.]
H. Arenas-Márquez, R. Anaya-Prado, H. Hurtado, J. Fernández, L. Galindo-Mendoza, F. Terrazas-Espitia, et al.
Conference review: Mexican consensus on the integral management of digestive tract fistulas.
Nutrition, 15 (1999), pp. 235-238
[14.]
Z.A. Makhdoom, M.J. Komar, C.D. Still.
Nutrition and enterocutaneous fistulas.
J Clin Gastroenterol, 31 (2000), pp. 195-204
[15.]
U. Hesse, D. Ysebaert, B. De Hemptinne.
Role of somatostatin-14 and its analogues in the management of gastrointestinal fistulae: clinical data.
Gut, (2002), pp. 11-20
[16.]
A.J. Torres, J.I. Landa, M. Moreno-Azcoitia, J.M. Argüello, G. Silecchia, J. Castro, et al.
Somatostatin in the management of gastrointestinal fistulas. A multicenter trial.
Arch Surg, 127 (1992), pp. 97-99
[17.]
J.J. Sancho, J. Di Constanzo, P. Nubiola, A. Beguiristain, F. Roqueta, G. Franch, et al.
Randomized double-blind placebo-controlled trial of early octreotide in patients with postoperative enterocutaneous fistula.
Br J Surg, 85 (1995), pp. 638-641
[18.]
J.C. Hernández-Aranda, B. Gallo-Chico, L.A. Flores-Ramírez, R. Avalos-Huante, F.J. Magos-Vázquez, E.J. Ramírez-Barba.
Tratamiento de las fístulas enterocutáneas con o sin octreótida y nutrición parenteral.
Nutr Hosp, 11 (1996), pp. 226-229
[19.]
M. Jamil, U. Ahmed, H. Sobia.
Role of somatostatin analogues in the management of enterocutanoeous fistulae.
J Coll Physicians Surg Pak, 14 (2004), pp. 237-240
[20.]
ASPEN Board of Directors and the Clinical Guidelines Task Force.
Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. Short-bowel syndrome.
J Parenteral Enteral Nutr, 26 (2002), pp. 70-73
[21.]
J.S. Scolapio.
Current update of short-bowel syndrome.
Curr Opin Gastroenterol, 20 (2004), pp. 143-145
[22.]
P.B. Jeppesen, P.B. Mortensen.
Experimental approaches: dietary and hormone therapy.
Best Pract Res Clin Gastroenterol, 17 (2003), pp. 1041-1054
[23.]
A.B.R. Thomson, M. Keelan, A. Thiesen, M.T. Clandinin, M. Ropeleski, G.E. Wild.
Small bowel review. Normal physiology part 1.
Dig Dis Sci, 46 (2001), pp. 2567-2587
[24.]
A.B.R. Thomson, M. Keelan, A. Thiesen, M.T. Clandinin, M. Ropeleski, G.E. Wild.
Small bowel review. Normal physiology, (II).
Dig Dis Sci, 46 (2001), pp. 2588-2607
[25.]
J.M. Nightingale, M.A. Kamm, J.R. Van der Sijp, M.A. Ghatei, S.R. Bloom, J.E. Lennard-Jones.
Gastrointestinal hormones in short bowel syndrome. Peptide YY may be the “colonic brake” to gastric emptying.
Gut, 39 (1996), pp. 267-272
[26.]
J.M. Nightingale, E.R. Walker, M.J. Farthing, J.E. Lennard-Jones.
Effect of omeprazole on intestinal output in the short bowel syndrome.
Aliment Pharmacol Therap, 5 (1991), pp. 405-412
[27.]
A. Cortot, C.R. Fleming, J.R. Malagelada.
Improved nutrient absorption after cimetidine in short bowel syndrome with gastric hypersecretion.
N Engl J Med, 300 (1979), pp. 79-80
[28.]
J.M.D. Nightingale, J.E. Lennard-Jones.
The short bowel syndrome. What's new and old?.
Dig Dis, 11 (1993), pp. 12-31
[29.]
J.S. Scolapio.
Treatment of short-bowel syndrome.
Curr Opin Clin Nutr Metab Care, 4 (2001), pp. 557-560
[30.]
D.W. Wilmore.
Indications for specific therapy in the rehabilitation of patients with the short-bowel syndrome.
Best Pract Res Clin Gastroenterol, 17 (2003), pp. 895-906
[31.]
J. Ksiazyk, M. Piena, J. Kierkus, M. Lyszkowska.
Hydrolyzed versus nonhydrolyzed protein diet in short bowel syndrome in children.
J Pediatr Gastroenterol Nutr, 35 (2002), pp. 615-618
[33.]
A. Gardemann, Y. Watanabe, V. Grosse, S. Hesse, K. Jungermann.
Increase in intestinal glucose absorption and hepatic glucose uptake elicited by luminal but not vascular glutamine in the jointly perfused small intestine and liver in the rat.
Biochem J, 283 (1992), pp. 759-765
[34.]
L. Beaugerie, F. Carbonnel, B. Hecketsweiler, P. Dechelotte, J.P. Gendre, J. Cosnes.
Effects of an isotonic oral rehydratation solution, enriched with glutamine, on fluid and sodium absorption in patients with a shortbowel.
Aliment Pharmacol Ther, 11 (1997), pp. 741-746
[35.]
J.S. Scolapio, K. McGreevy, G.S. Tennyson, O.L. Burnett.
Effect of glutamine in short-bowel syndrome.
Clin Nutr, 20 (2001), pp. 319-323
[36.]
P.H. Benhamou, J.P. Canarelli, S. Richard, C. Cordonier, J.P. Postel, E. Grenier, et al.
Human recombinant growth hormone increases small bowel lengthening after massive small bowel resection in piglets.
J Pediatr Surg, 32 (1997), pp. 1332-1336
[37.]
L. Ellegard, I. Bosaeus, S. Nordgren, B.A. Bengtsson.
Low-dose recombinant human growth hormone increases body weight and lean body mass in patients with short bowel syndrome.
Ann Surg, 225 (1997), pp. 88-96
[38.]
E. Ellegard, L. Ellegard.
Nasal airflow in growth hormone treatment.
Rhinology, 36 (1998), pp. 66-68
[39.]
D. Seguy, K. Vahedi, N. Kapel, J.C. Souberbielle, B. Messing.
Low-dose growth hormone in adult home parenteral nutrition-dependent short bowel syndrome patients. A positive study.
Gastroenterology, 124 (2003), pp. 293-302
[40.]
T.A. Byrne, T.B. Morrissey, T.V. Nattakom, T.R. Ziegler, D.W. Wilmore.
Growth hormone, glutamine, and a modified diet enhance nutrient absorption in patients with severe short bowel syndrome.
J Parenteral Enteral Nutr, 19 (1995), pp. 296-302
[41.]
T.A. Byrne, R.L. Persinger, L.S. Young, T.R. Ziegler, D.W. Wilmore.
A new treatment for patients with short-bowel syndrome. Growth hormone, glutamine, and a modified diet.
Ann Surgery, 222 (1995), pp. 243-254
[42.]
J.S. Scolapio, M. Camilleri, C.R. Fleming, L.V. Oenning, D.D. Burton, T.J. Sebo, et al.
Effect of growth hormone, glutamine, and diet on adaptation in short-bowel syndrome: a randomised, controlled study.
Gastroenterology, 113 (1997), pp. 1074-1081
[43.]
J.S. Scolapio.
Effect of growth hormone, glutamine, and diet on body composition in short bowel syndrome: a randomised, controlled study.
J Parenteral Enteral Nutr, 23 (1999), pp. 309-313
[44.]
J. Szkudlarek, P.B. Jeppesen, P.B. Mortensen.
Effect of high dose growth hormone with glutamine and no change in diet on intestinal absorption in short bowel patients: a randomised, double blind, crossover, placebo controlled study.
Gut, 47 (2000), pp. 199-205
[45.]
P.B. Jeppesen, J. Szkudlarek, P.B. Mortensen.
Effect of high-dose growth hormone and glutamine on body composition, urine creatinine excretion, fatty acid absorption, and essential fatty acids status in short bowel patients: a randomised, double-bind, crossover, placebo-controlled study.
Scand J Gastroenterol, 36 (2001), pp. 48-54
[46.]
D.W. Wilmore, J.M. Lacey, R.P. Soultanakis, R.L. Bosch, T.A. Byrne.
Factors predicting a successful outcome after pharmacologic bowel compensation.
Ann Surg, 226 (1997), pp. 288-293
[47.]
G.H. Wu, Z.H. Wu, Z.G. Wu.
Effects of bowel rehabilitation and combined trophic therapy on intestinal adaptation in short bowel patients.
World J Gastroenterol, 9 (2003), pp. 2601-2604
[48.]
P.B. Jeppesen, B. Hartmann, J. Thulesen, J. Graff, J. Lohmann, B.S. Hansen, et al.
Glucagon-like peptide 2 improves nutrient absorption and nutritional status in short-bowel patients with no colon.
Gastroenterology, 120 (2001), pp. 1041-1043
[49.]
K.V. Haderslev, P.B. Jeppesen, B. Hartmann, J. Thulesen, H.A. Sorensen, J. Graff, et al.
Short-term administration of glucagons-like peptide-2. Effects on bone mineral density and markers of bone turnover in shortbowel patients with no colon.
Scand J Gastroenterol, 37 (2002), pp. 392-398
[50.]
L.E. Matarese, D.L. Seidner, E. Steiger.
Growth hormone, glutamine, and modified diet for intestinal adaptation: a systematic review of the literature.
J Am Diet Assoc, 104 (2004), pp. 1265-1272
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