Kısa Bağırsak Sendromunda Malnutrisyonun Önlenmesi ve Tedavisinde Beslenmenin Rolü: Geleneksel Derleme

Öz

Kısa bağırsak sendromu toplumda yaygın görülmemekle birlikte son kırk yılda prevalansında 2 kat artış olduğu düşünülen bir hastalıktır. Konjenital anomalinin türü veya uygulanan cerrahi rezeksiyona bağlı olarak farklı patofizyolojik mekanizmaların eşlik ettiği bu hastalıkta, hastaların en büyük problemlerinden biri malabsorpsiyondur. Malabsorpsiyon ve buna bağlı stoma kayıpları hastada ciddi malnütrisyon gelişme riskini doğurmaktadır. Bu durum oral beslenmenin yetersiz olduğu durumlarda ek olarak hastanın uzun dönem enteral ve/veya parenteral beslenme ile tedavi edilmesini gerektirmektedir. Hastaların metabolik ve fizyolojik koşullarına uygun beslenme gereksinimleri saptandıktan sonra yeterli enerji, protein ve mikrobesin ögelerinden zengin bir diyet içeriğinin olması tedavide elzemdir. Günlük enerji ve protein gereksinimlerini karşılamak adına 20-35 kkal/kg enerji ve 0.8-1.4 g/kg protein içeren bir diyet, konu ile ilgili uzman bir diyetisyen tarafından planlanmalıdır. Son dönemde yapılan bazı araştırmalar, probiyotik, omega-3 ve sitrulin gibi takviyelerin kısa bağırsak sendromuna ilişkin metabolik süreçlerde olumlu etkileri olduğunu ortaya koymuştur. Probiyotik çalışmalarında özellikle Lactobacillus ve Bifidobacterium gibi bakteri cinsleri ön plana çıkmıştır. Omega-3 yağ asitlerinin parenteral beslenmeye bağlı kolestaz tedavisinde etkili olabileceği ve parenteral beslenme durumunda karaciğerin yeni bir koruyucu ajanı olabileceği ortaya koyulmuştur. Sitrulin takviyesinin 0.1-3.0 mg/kg/gün doz aralığında uygulandığında bağırsak sağlığı üzerinde potansiyel etkiler geliştirebileceği saptanmıştır. Bununla beraber bu takviyelerin klinikte kullanımına ilişkin hala kanıt düzeyi yüksek klinik araştırmalara ihtiyaç vardır. Kısa bağırsak sendromu hastaları, medikal tedavi ve tıbbi beslenme tedavisi açısından multidisipliner bir ekiple takip edilmelidir.

Anahtar Kelimeler

• Kısa bağırsak sendromu
• malnütrisyon
• beslenme tedavisi

The Role of Nutrition in the Prevention and Treatment of Malnutrition in Short Bowel Syndrome: A Traditional Review

Öz

Short bowel syndrome is not common in the general population, but it is thought to have a 2-fold increase in prevalence in the last four decades. In this disease, which is accompanied by different pathophysiologic mechanisms depending on the type of congenital anomaly or surgical resection, one of the biggest problems of patients is malabsorption. Malabsorption and associated stoma loss lead to the risk of severe malnutrition. In cases where oral nutrition is inadequate, this situation requires the patient to be treated with long-term enteral and/or parenteral nutrition. After determining the nutritional requirements of the patients in accordance with their metabolic and physiologic conditions, a diet rich in sufficient energy, protein and micronutrients is essential in treatment. A diet containing 20-35 kcal/kg energy and 0.8-1.4 g/kg protein to meet daily energy and protein requirements should be planned by a specialized dietician. Some recent studies have shown that supplements such as probiotics, omega-3 and citrulline have positive effects on metabolic processes related to short bowel syndrome. Bacterial genera such as Lactobacillus and Bifidobacterium have come to the fore in probiotic studies. Omega-3 fatty acids may be effective in the treatment of cholestasis due to parenteral nutrition and may be a new protective agent of the liver in case of parenteral nutrition. However, clinical trials with a high level of evidence for the use of these supplements in the clinic are still needed. Patients with short bowel syndrome should be followed by a multidisciplinary team for medical and nutritional therapy.

Anahtar Kelimeler

• short bowel syndrome
• malnutrition
• diet therapy

Kaynakça

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