ISSN:0884-5336    

DOI:10.1177/011542659200700251

出版商:Sage Publications    

年代:1992

数据来源: WILEY

摘要:

Many patients with the inflammatory bowel diseases, Crohn's disease, or ulcerative colitis have significant protein‐calorie malnutrition and micronutrient deficiencies. Factors that contribute to these nutritional deficits include inadequate nutrient intake, malabsorption, excessive nutrient secretion across the diseased gastrointestinal tract, drug‐nutrient interactions, and increased nutrient requirements. In this review, the use of enteral and parenteral nutrition support as primary therapy for active Crohn's disease and ulcerative colitis is discussed. Other roles for nutrition support in patients with inflammatory bowel disease, including preoperative nutrition support, nutritional treatment of intestinal fistulas and growth retardation, and home parenteral nutrition for gut failure, are also reviewed.

ISSN:0884-5336    

DOI:10.1177/011542659200700253

出版商:Sage Publications    

年代:1992

数据来源: WILEY

ISSN:0884-5336    

DOI:10.1177/011542659200700265

出版商:Sage Publications    

年代:1992

数据来源: WILEY

摘要:

Total parenteral nutrition (TPN) has become a useful tool in the management of patients with inflammatory bowel disease (IBD). In the past, it was felt that TPN would have a therapeutic role in IBD, but experience has shown that it functions more as an adjunct to other therapeutic interventions. The specific roles of TPN in IBD include: (1) nutritional maintenance in the short bowel syndrome, (2) TPN as adjunctive therapy in jejunoileitis of Crohn's disease, (3) home TPN (HTPN) in Crohn's colitis, and (4) preoperative repletion of significantly depleted patients going to surgery. The adaptation of hospital techniques to the home situation has allowed patients to carry out long‐term TPN therapy at home. Patients with IBD on HTPN are subject to the same mechanical and metabolic problems as are other patients on HTPN and, in addition, have a higher infection rate. When carried out appropriately, however, HTPN is a valuable technique in the management of patients with IBD and may provide an improved quality of life.

ISSN:0884-5336    

DOI:10.1177/011542659200700270

出版商:Sage Publications    

年代:1992

数据来源: WILEY

摘要:

We report a patient with regional enteritis and short bowel syndrome who has been treated with home parenteral nutrition for 19 years, during 10 of which he used a single Broviac central venous catheter. The catheter finally required replacement because of progressive lumen occlusion, which was presumed to be caused by thrombosis. At the time of replacement, the catheter was found to be friable and embedded in a hard sheath that made it adherent to the wall of the internal jugular vein and prevented complete removal. At some time during the ensuing 16 months, the retained fragment embolized asymptomatically to the pulmonary artery. During the first 2 months after the placement of a new Hickman catheter, progressive flow resistance developed, probably because of calcium phosphate precipitation, although no change had been made in the parenteral formulation. It resolved immediately upon the instillation of hydrochloric acid into the catheter.

ISSN:0884-5336    

DOI:10.1177/011542659200700274

出版商:Sage Publications    

年代:1992

数据来源: WILEY

摘要:

In two recent clinical trials in surgical patients, supplementation of total parenteral nutrition with daily doses of 12 or 20 g of glutamine resulted in a diminished loss of free glutamine in skeletal muscle tissue. Studies in animals exploring the use of both enteral and parenteral glutamine supplementation suggest that glutamine may be an essential nutrient in the maintenance of gut structure and function during critical illness. These findings have led to heightened interest in the glutamine content of enteral formulas. This article describes a method for estimating the glutamine content of whole‐protein enteral formulas. The average amount of glutamine in selected, whole‐protein formulas ranges from a minimum of 3.55 g/4200 kJ to a maximum of 5.15 g/4200 kJ. Although it is still too early to define the safest and most effective dose of glutamine, there are two points regarding glutamine supplementation that clearly merit further investigation: no clinical trials have been conducted to assess the potential benefits of glutamine supplementation of an enteral diet or to assess the effects of using diets containing protein‐bound glutamine rather than free glutamine.

ISSN:0884-5336    

DOI:10.1177/011542659200700277

出版商:Sage Publications    

年代:1992

数据来源: WILEY

摘要:

The use of somatostatin to manage diarrhea associated with the short gut syndrome is impractical because of its need to be given by continuous infusion and a rebound effect on stool output with cessation of therapy. Octreotide has been used more successfully to control stool and electrolyte losses in patients with shortened gastrointestinal tracts. In published series and studies, all subjects appear to decrease stool losses, but clinical benefit for longterm use is not achieved for all patients. In the patients who do respond, the need for parenteral nutrition and intravenous hydration has been decreased or eliminated. The optimal dose is unclear, but many patients respond to 50‐μg injections twice daily. Several investigations noted no additional beneficial effects with escalating dosages. Adverse effects include impairment of fat absorption, which may offset the therapeutic benefits of octreotide. The patients with the greatest response appear to have the least fat malabsorption. Other adverse effects noted when using octreotide for control of the short gut syndrome include pain associated with subcutaneous injection and abdominal complaints. Other potential concerns include the effect on gallstone formation in this high‐risk population and intestinal adaptation.

ISSN:0884-5336    

DOI:10.1177/011542659200700281

出版商:Sage Publications    

年代:1992

数据来源: WILEY

ISSN:0884-5336    

DOI:10.1177/088453369200700208

出版商:Sage Publications    

年代:1992

数据来源: WILEY

ISSN:0884-5336    

DOI:10.1177/088453369200700211

出版商:Sage Publications    

年代:1992

数据来源: WILEY

ISSN:0884-5336    

DOI:10.1177/088453369200700212

出版商:Sage Publications    

年代:1992

数据来源: WILEY