[Clinical efficacy of functional nutrition in patients with gastrointestinal disorders].

AIM: To identify micronutrient deficiencies in patients with functional bowel diseases (FBD) and to reveal their correction with functional foods and probiotics. SUBJECTS AND METHODS: The health status was evaluated in 90 patients aged 18 to 67 years with FBD. All the patients were randomized into 3 groups according to the treatment regimen. Group 1 took Amaltea goat's milk 200 ml/day during basic therapy; Group 2 received multispecies and multistrain RioFlora Balance probiotics in addition to the above components; Group 3 (a control group) had traditional basic dietary therapy. All the groups continued their treatment for 14 days. RESULTS: The performed examinations have demonstrated that diet-based treatment fortified with goat's milk and multispecies probiotics makes it possible to more promptly achieve remission and to level off clinical manifestations than in the control group. The patients using multispecies probiotics versus the control group showed a reduction in fat-soluble vitamin deficiencies and a considerable improvement in quality of life. CONCLUSION: FBD lacks a specific clinical picture and may be masked as lactase deficiency, which commonly leads to noticeable limitations in patients' diet and favors the development of vitamin deficiency. Of particular concern is the development of vitamin D deficiency in young patients, which may result in the early development of osteoporosis in the future. To specify the composition of enzymes in the patients gives grounds to refuse restricted diets, and the dietary addition of functional foods (goat's milk fortified with vitamins and minerals), particularly in combination with multistrain probiotics, produces a pronounced clinical effect and eliminates fat-soluble vitamin deficiencies.

[Solved and unsolved problems of nutritional support in surgical gastroenterology].

The article has revealed the relevance of nutriciology as a science, classification and types of nutritional support. Nutritional support--diagnostics and the metabolic correction of arising violations of various kinds of homeostasis, aimed at ensuring the functioning of the systems of protein-energy synthesis and intermediate exchange of nutrients, vitamins, macro--and microelements, or a temporary replacement therapy of their failure. The notions of "lack of food", "artificial" food, protein-energy insufficiency with the exception of the syndromes of malabsorption, alimentary anemia, the effects of protein-energy malnutrition, consumptive disease, starvation have been interpreted. It was noted that nutriciology has taken place as a science. The problems of prognostification of nutritional deficiency, assessment of nutritional risk, the organization of nutritional support in the hospital and at home have been presented. Some fundamental bases of enteral probe feeding have been described.

[Immunological criteria for evaluation of nutritional support in ulcerative colitis].

The article presents the data on the assessment of nutritional status, taking into account humoral immunologic criteria of patients with ulcerative colitis.

[Nutrition support of patients after extensive intestinal resections].

[Formula see text], their profile can be one of markers, characterizing activity of colon microflora at the consequences of the vast resections of bowels, and to determine setting of preparations of medicamental correction in the structure of nutritional therapy by siping compositions.

[Postgastrectomy syndromes in therapeutic practice ].

AIM: To specify policy of nutritive support late after radical gastric resection. MATERIAL AND METHODS: Patients with postgastroresectional dystrophy were examined using standard techniques and estimation of intestinal electric activity (registration of body surface biopotentials on Conan-M myngograph). RESULTS: Frequency-amplitude parameters of the intestine serve the basis for choice of mixtures for enteral correction. Nutritive support provided for on demand pharmaconutrients--microbiotic correctors. CONCLUSION: Myography gives additional information for decisions on the policy of nutritive support.

[Present status of clinical and fundamental threpsology].

A good nutrition status is one of the impotant prerequisites of good health. Malnutrition in hospital leads to increased complication, morbidity and mortality rates. Whenever the gastrointestinal tract cannot fulfil its function or must be rested (during intestinal desease), parenteral administration of nutrients (or simultative parenteral and enteral alimitation) is necessary. Nowday perspectives of nutrition support in patients whith intestinal deseases, methods of easily diagnosed of malnutrition are the problems of this article.

[Metabolic activity of intestinal microflora and its role in determination of nutritional support tactic after gastrectomy].

Nutrition recommendations in symptoms of postgastrectomy syndroms is very different. The calculation of regimen using the parenteral and enteral alimentation may be established in the control test of definition of fecal short-chain fatty acids and microflora in such patients. Probiotics attach to the intestinal wall and protect it from the attacks of pathologic microorganisms. Probiotics are especially useful in the complex treatment of postgastrectomy syndroms.

[Parenteral nutrition in treatment of patients with syndrome of short bowel].

If the gut is too short parenteral feeding becomes the only option. As clinicians interested in this field, we must continue to inform others about what standarts may be set in different patients. Nowadays the enteral nutrition is also used in the scheem of the treatment such patients. We discuss about haw, where and in what compositions and regimens it may be recommended the nutritional support.

[Enteral nutrition in the therapy of gastrointestinal diseases (according to materials of the European Association of Parenteral and Enteral Nutrition)].

The present article gives evidence-based recommendations for the indication, application and type of formula of enteral nutrition (EN) (oral nutrition supplements (ONS) or tube feeding (TF)) in patients with Crohn's disease (CD), ulcerative colitis (UC), short bowel syndrome (SBS), acute and chronic pancreatitis, alcoholic steatogepatitis and cirrosis. ONS and/or TF in addition to normal food is indicates in undernourished patients with CD or UC to improve nutritional status. In active CD EN is the first line therapy in children and should be used as sole therapy in adults mainly when treatment with corticosteroids is not feasible. No significant differences have been shown in the effects of free amino acid, peptide-based and hole protein formulae for TF. In remission ONS is recommended only in steroid dependent patients in CD. In patients with SBS TF should be introduced in the adaptation phase and should be changed with progressing adaptation to ONS in addition to normal food. Special nutrition support should not be used routinely in patients with mild or moderate acute pancreatitis. EN is the preffered route in patients with pancreatitis and should be attempted before initiating parenteral nutrition. Nutrition assessment in patients with liver disease should include screening for micronutrient deficiencies. Protein restriction should be implemented for the acute management of hepatic encephalopathy and should not be implemented chronically in patients with liver disease.

[Clinical efficacy of enteral nutrition in inflammatory bowel diseases].

Undernutrition with weight loss, protein deficiency and specific deficiencies in vitamins, and trace elements are common in the acute phase of IBD. Anorexia, increased intestinal losses and systemic inflammation are the main causes of undernutrition. The relevance and extent of these deficiencies vary according to the site and extent of diseased intestine as well as disease activity. Mechanisms of EN efficacy as a primary treatment of IBD are not revealed yet. However, most physicians start to be earnest about enteral feeding because this treatment method does not cause any serious or prolonged complications. There are no significant differences in the effect of free amino acid, peptide-based and whole protein formulae for EN in IBD. Nutritional support with normal food is considered the treatment of choice. This article gives recommendations for the indication, application and type of formula of EN (oral nutritional supplements (ONS) or tube feeding (TF)) in patients with IBD. These are based on all relevant publications since 1995 and own authors experience. ONS and/or TF in addition to normal food is indicated in undernourished patients with IBD to improve nutritional status and quality of life. In active IBD EN should be used as sole therapy in adults mainly when treatment with corticosteroids is not feasible, e.g. due to intolerance or refusal. Combined therapy (EN and drugs) is indicated in undernourished patients as well as in those with inflammatory stenosis of the intestine. With ONS, a supplementary intake of up to 600 kcal/day can be achieved in addition to normal food. If a higher intake is required, TF is necessary. TF can be safely delivered by the nasogastric tube (NGT). Continuous administration of TF rather than bolus delivery is preferred because of the lower complication. In remission of IBD ONS and/or TF are recommended.