欧洲肠外肠内营养学会指南：炎性肠病临床营养
2016年12月31日，欧洲肠外肠内营养学会（ESPEN）官方期刊《临床营养》在线发表英国东英吉利大学诺维奇医学院、荷兰鹿特丹伊拉斯姆斯大学医疗中心索菲亚儿童医院、法国尼斯大学中心医院、波兰斯坦利·达德里克纪念医院、克罗地亚萨格勒布大学临床中心医院、以色列特拉维夫大学施奈德儿童医学中心、马其顿圣基里尔麦托迪大学德蕾莎修女纪念医院、荷兰阿姆斯特丹自由大学医学中心、英国布里斯托尔皇家儿童医院、德国霍恩海姆大学营养医学研究所起草的《ESPEN指南：炎性肠病临床营养》，全文共27页，参考文献达326篇。
该指南针对炎性肠病（克罗恩病和溃疡性结肠炎）临床营养，根据对文献进行广泛的系统回顾（当客观数据缺乏或不确定时，根据专家意见）得出若干结论，并且经过全面的同行评审，采用德尔菲法（以邮件方式，通过调查问卷征询专家意见，经过反复征询和反馈，使专家意见逐步趋于集中）获得共识（赞成或非常赞成），总结出64项多学科推荐意见，简要概括如下：
由于炎性肠病越来越常见，故该指南对其可能存在的饮食因素进行简要回顾。营养不良在炎性肠病中非常普遍，尤其是在克罗恩病中。在一些患者中，可见能量和蛋白质需求量增加。营养不良患者支持原则被认为适用于炎性肠病营养不良处理。强烈建议治疗缺铁（如有必要时肠外补铁）。并无证据支持在炎性肠病中常规提供特殊饮食。肠外营养仅在肠内营养失败或不可能时才有指征。炎性肠病手术患者围手术期的处理建议，与ESPEN指南关于腹部手术患者的建议通用。益生菌可能有助于溃疡性结肠炎，但是无助于克罗恩病。采用营养基础疗法治疗炎性肠病，对于溃疡性结肠炎证据不足，但是对于克罗恩病证据尚可，尤其对于类固醇疗法后果不良比例较大的儿童。当制订营养方案时，几乎没有证据支持任何特定配方食品，通常也不推荐脱敏饮食。
因此，根据现有客观数据，指导炎性肠病营养支持和基础营养疗法的推荐意见共有64项，其中9项非常强烈推荐（A级）、22项强烈推荐（B级）、12项证据欠佳（0级）、21项指南专家组临床经验（GPP）。
注意：该指南仅供中国专家参考和英语爱好者学习，普通医生请参考中国专家共识或上级医生指示，患者和家属请遵正规医院专科医生医嘱，具体病情具体分析，不可一概而论。
Clin Nutr. 2016 Dec 31. [Epub ahead of print]
ESPEN guideline: Clinical nutrition in inflammatory bowel disease.
Forbes A, Escher J, Hébuterne X, Klek S, Krznaric Z, Schneider S, Shamir R, Stardelova K, Wierdsma N, Wiskin AE, Bischoff SC.
Norwich Medical School, University of East Anglia, Norwich, United Kingdom; Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands; CHU de Nice, Université Cote d'Azur, Nice, France; Stanley Dudrick's Memorial Hospital, Skawina, Krakau, Poland; Clinical Hospital Centre Zagreb, University of Zagreb, Zagreb, Croatia; Tel-Aviv University, Schneider Children's Medical Center of Israel, Petach-Tikva, Israel; University Clinic for Gastroenterohepatology, Clinical Centre "Mother Therese", Skopje, Republic of Macedonia; VU University Medical Center, Amsterdam, The Netherlands; Bristol Royal Hospital for Children, Bristol, United Kingdom; Institut für Ernahrungsmedizin, Universitat Hohenheim, Stuttgart, Germany.
INTRODUCTION: The ESPEN guideline presents a multidisciplinary focus on clinical nutrition in inflammatory bowel disease (IBD).
METHODOLOGY: The guideline is based on extensive systematic review of the literature, but relies on expert opinion when objective data were lacking or inconclusive. The conclusions and 64 recommendations have been subject to full peer review and a Delphi process in which uniformly positive responses (agree or strongly agree) were required.
RESULTS: IBD is increasingly common and potential dietary factors in its aetiology are briefly reviewed. Malnutrition is highly prevalent in IBD - especially in Crohn's disease. Increased energy and protein requirements are observed in some patients. The management of malnutrition in IBD is considered within the general context of support for malnourished patients. Treatment of iron deficiency (parenterally if necessary) is strongly recommended. Routine provision of a special diet in IBD is not however supported. Parenteral nutrition is indicated only when enteral nutrition has failed or is impossible. The recommended perioperative management of patients with IBD undergoing surgery accords with general ESPEN guidance for patients having abdominal surgery. Probiotics may be helpful in UC but not Crohn's disease. Primary therapy using nutrition to treat IBD is not supported in ulcerative colitis, but is moderately well supported in Crohn's disease, especially in children where the adverse consequences of steroid therapy are proportionally greater. However, exclusion diets are generally not recommended and there is little evidence to support any particular formula feed when nutritional regimens are constructed.
CONCLUSIONS: Available objective data to guide nutritional support and primary nutritional therapy in IBD are presented as 64 recommendations, of which 9 are very strong recommendations (grade A), 22 are strong recommendations (grade B) and 12 are based only on sparse evidence (grade 0); 21 recommendations are good practice points (GPP).
KEYWORDS: Crohn's disease; Enteral nutrition; Inflammatory bowel disease; Nutritional therapy; Parenteral nutrition; Ulcerative colitis
PMID: 28131521
PII: S0261-5614(16)31368-1
DOI: 10.1016/j.clnu.2016.12.027