Parenterale Ernährung in der Behandlung des Minderwuchses bei Adoleszenten mit Morbus Crohn

Abstract

Growth retardation and delayed puberty occur in 20-35% of children and adolescents with Crohn's disease. Alternate day corticosteroid treatment, use of azathioprine, enteral or parenteral hyperalimentation and surgery have been advocated to reverse growth failure. Because of nonacceptance of elemental diet 7 patients with Crohn's disease and growth retardation received parenteral nutrition for 2-3 months (maximal for more than 30 months in one patient). All of them exhibited a mean weight gain of 10 kg and a mean increase of their height velocity from 2.4 to 7.1 cm/year. Main problems were bacterial infections and dislocations of the central lines. Surgery was performed in 3 adolescents immediately after parenteral nutrition. One patient showed a catch-up growth during a 30-months nocturnal home parenteral nutrition at a biological age of 21 years. Parenteral nutrition is an effective regimen to manage growth failure in children with Crohn's disease, but has to be performed for larger periods in individual cases.

Gastroenterology – Guidelines on Parenteral Nutrition, Chapter 15

“…PN is indicated in cases of toxic megacolon, malabsorption syndrome, particularly short bowel syndrome, insufficient growth and disturbance of growth in children as well as when enteral nutrition is not tolerated [2], [3], [4], [5], [6], [7], [8], [9], [10]. …”

“…There are extensive differences in the parameters for malnutrition between Crohn’s disease and ulcerative colitis. Malnutrition is diagnosed in 80% of Crohn's disease patients [5], [9], [10], [11]. The severity of malnutrition depends on the duration of the illness, activity of the inflammation, the function of the small intestine and extent of the diseased sections in the small intestine, and results in a higher incidence of protein energy malnutrition as well as specific substrate deficiency.…”