References

nogr

Экспериментальная и клиническая гастроэнтерология

Experimental and Clinical Gastroenterology

1682-8658

«Global Media Technologies»

10.31146/1682-8658-ecg-186-2-94-105

nogr-1568

Research Article

ОБЗОР

REVIEW

Патогенетическое обоснование диетотерапии болезни Крона у детей

Pathogenetic substantiation of diet therapy for Crohn’s disease in children

https://orcid.org/0000-0001-7308-7280

Хавкин

А. И.

Khavkin

A. I.

gastropedclin@gmail.com

https://orcid.org/0000-0001-5587-3560

Сорвачёва

Т. Н.

Sorvacheva

T. N.

noemail@neicon.ru

https://orcid.org/0000-0002-3993-1246

Рославцева

Е. А.

Roslavtseva

E. A.

noemail@neicon.ru

ФГБАУ ВПО «Российский национальный исследовательский медицинский университет им. Н. И. ПироговаРоссияFSBAI HPE “N. I. Pirogov Russian National Research Medical University” of the Ministry of Health of the Russian FederationRussian Federation

ФГБОУ ДПО «Российская Медицинская Академия непрерывного профессионального образования» МЗ РФРоссияFGBOU DPO “Russian Medical Academy of Continuing Professional Education” of the Ministry of Health of the Russian FederationRussian Federation

ФГАУ НМИЦ здоровья детей Минздрава РФРоссияFGAU National Medical Research Center of Children’s Health of the Ministry of Health of the Russian FederationRussian Federation

2021

07042021

0294105

2021

Хавкин А.И., Сорвачёва Т.Н., Рославцева Е.А.

Khavkin A.I., Sorvacheva T.N., Roslavtseva E.A.

Данная работа распространяется под лицензией Creative Commons Attribution 4.0.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://www.nogr.org/jour/article/view/1568

Болезнь Крона - хроническое воспалительное заболевание желудочно-кишечного тракта, при котором пациенты должны получать постоянную, пожизненную терапию. Особое внимание следует уделять их нутритивному статусу. Особенности рациона питания, традиционно рекомендуемого при болезни Крона, нередко приводят к снижению потребления пациентами основных пищевых веществ. Поэтому важная роль принадлежит нутритивной поддержке специализированными смесями, эффективность которых доказана, как для индукции ремиссии, так и для оптимизации параметров физического развития и полового созревания, минерализации костной ткани. Нутритивная поддержка должна осуществляться и при впервые выявленном заболевании в виде полного энтерального питания, и в последующем - при ремиссии, обострении, в пред- и постоперационные периоды, как дополнение к стандартному рациону. Особый интерес представляет программа “CDED ModuLife”, основанная на сочетании энтерального питания с питанием специально отобранными продуктами, направленная на снижение активности воспаления кишечника при БК.

Crohn’s disease is a chronic inflammatory disease of the gastrointestinal tract in which patients should receive continuous, lifelong therapy. Particular attention should be paid to their nutritional status. The characteristics of the diet traditionally recommended for Crohn’s disease often lead to a decrease in the consumption of essential nutrients by patients. Therefore, an important role belongs to nutritional support with specialized mixtures, the effectiveness of which has been proven, both for the induction of remission, and for optimizing the parameters of physical development and puberty, bone mineralization. Nutritional support should be carried out in the case of a newly diagnosed disease in the form of complete enteral nutrition, and subsequently - in remission, exacerbation, in the pre- and postoperative periods, as an addition to the standard diet. Of particular interest is the CDED ModuLife program, which is based on a combination of enteral nutrition with specially selected foods, aimed at reducing the activity of intestinal inflammation in CD.

воспалительные заболевания кишечникаболезнь Кронаболезнь Крона у детейполное энтеральное питаниечастичное энтеральное питаниесмеси для энтерального питания

inflammatory bowel diseaseCrohn’s diseaseCrohn’s disease in childrencomplete enteral nutritionpartial enteral nutritionenteral nutritional formula

References1

Levine Arie, Wine E, Assa A, Sigall Boneh R1 Shaoul R, Kori M. Crohn’s Disease Exclusion Diet Plus Partial Enteral Nutrition Induces Sustained Remission in a Randomized Controlled Trial. Gastroenterology. 2019;157:440-450. DOI: 10.1053/j.gastro.2019.04.021

Kornienko E.A., Khavkin A. I., Fedulova E. N., et al. Crohn’s disease in children: diagnosis and treatment. Collection: Selected Works of the Society of Pediatric Gastroenterologists, Hepatologists and Nutritionists “Pediatric Gastroenterology 2019”. Moscow-Saint Petersburg, 2019;77-131. (In Russ.)@@ Корниенко ЕА, Хавкин АИ, Федулова ЕН, Волынец ГВ, Габрусская ТВ, Скворцова ТА, и др. Болезнь Крона у детей: диагностика и лечение. Сборник: Избранные труды Общества детских гастроэнтерологов, гепатологов и нутрициологов «Детская гастроэнтерология 2019». Под ред. Хавкина АИ, Новиковой ВП, Волынец ГВ. М.-СПб., 2019;77-131.

Kornienko E. A. Inflammatory bowel disease in children. Moscow, Prima Print, 2014, 208 p. (In Russ.)@@ Корниенко Е. А. Воспалительные заболевания кишечника у детей - М., Прима Принт, 2014-208с.

Kornienko E.A., Krupina A. N., Gabruskaya T. V., Kalinina N. M. Inflammatory bowel disease with very early onset. Almanac of Clinical Medicine. 2016; 44 (6): 719-733. (In Russ.)@@ Корниенко Е. А., Крупина А. Н., Габрусская Т. В., Калинина Н. М. Воспалительные заболевания кишечника с очень ранним началом. Альманах клинической медицины. 2016;44(6):719-733.

Kelsen JR, Sullivan KE, Rabizadeh SR, Singh N, Snapper S, Elkadri A, Grossman AB. North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Position Paper on the Evaluation and Management for Patients With Very Early-onset Inflammatory Bowel Disease. J Pediatr Gastroenterol Nutr. 2020 Mar;70(3):389-403.

Uhlig HH, Charbit-Henrion F, Kotlarz D, Shouval DS, et al. Paediatric IBD Porto group of ESPGHAN. Clinical Genomics for the Diagnosis of Monogenic forms of Inflammatory Bowel Disease: A Position Paper from The Paediatric IBD Porto Group of ESPGHAN. J Pediatr Gastroenterol Nutr. 2020 Dec 16; Publish Ahead of Print

Levine A., Koletzko S., Turner D. ESPGHAN revised Porto criteria for the diagnosis of inflammatory bowel disease in children and adolescents. J. Pediatric Gasroenterol Nutr. 2014, v.58 (6), p.795-806.

Bel’mer S.V., Razumovskii A. Yu., Khavkin A. I., et al. Bolezni kishechnika u detei. Vol. 1. Moscow. “MEDPRAKTIKA-M” Publ., 2018. (In Russ.)@@ Бельмер СВ, Разумовский АЮ, Хавкин АИ, Алхасов А. Б., Бехтерева МК, Волынец ГВ, и др. Болезни кишечника у детей. Том 1. М.: МЕДПРАКТИКА-М, 2018.

Rachkova N.S., Khavkin A. I. Inflammatory bowel disease. Differential diagnosis and treatment problems. RMZh. 2006;14(3):154. (In Russ.)@@ Рачкова НС, Хавкин АИ. Воспалительные заболевания кишечника. Проблемы дифференциальной диагностики и лечения. РМЖ. 2006;14(3):154.

Khavkin A.I., Rachkova N. S. Bolezn’ Krona. RMZh. 2005;18(13):1202. (In Russ.)@@ Хавкин АИ., Рачкова НС, Болезнь Крона. РМЖ. 2005;18(13):1202.

Pechkurov D.V., Tyazheva A. A., Polkanova V. A., Romanova A. A. A rare cause of abdominal pain in a 9-year-old child. Vopr. dietol. (Nutrition). 2020; 10(2): 27-30 (In Russ.) DOI: 10.20953/2224-5448-2020-2-27-30@@ Печкуров Д. В., Тяжева А. А., Полканова В. А., Романова А. А. Редкая причина абдоминальной боли у ребенка 9 лет. Вопросы диетологии. 2020; 10(2): 27-30 DOI: 10.20953/2224-5448-2020-2-27-30

Whitten K.E., Rogers P., Ooi C. Y., Day A. S. International survey ofenteral nutrition protocols used in children with Crohn’s disease. J Dig Dis. 2012; 13 (2):107-12.

Kornienko E.A., Khavkin A. I., Fedulova E. N., et al. Draft recommendations of the Russian Society of Pediatric Gastroenterologists, Hepatologists and Nutritionists for the diagnosis and treatment of Crohn’s disease in children. Experimental and Clinical Gastroenterology. 2019;11(171):100-34. (In Russ.) DOI: 10.31146/1682-8658-ecg-171-11-100-134@@ Корниенко ЕА, Хавкин АИ, Федулова ЕН, Волынец Г. В., Габрусская ТВ, Скворцова ТА, и др. Проект рекомендаций Российского общества детских гастроэнтерологов, гепатологов и нутрициологов по диагностике и лечению болезни Крона у детей. Экспериментальная и клиническая гастроэнтерология. 2019;11(171):100-34. DOI: 10.31146/1682-8658-ecg-171-11-100-134

Eckert D., Mensing S., Sharma S. et al. Pharmacokinetics of Adalimumab in Paediatric Patients with Moderate to Severe Crohn’s Disease. ECCO. 2013 P411.

Matsumoto T., Motoya S., Watanabe K., et al. Adalimumab Monotherapy and a Combination with Azathioprine for Crohn’s Disease: A Prospective, Randomized Trial. J CrohnsColitis. 2016 Nov;10(11):1259-1266

Rubio A., Pigneur B., Garnier-Lengline H., et al. The efficacy of exclusive nutritional therapy in paediatric Crohn’s disease, comparing fractionated oral vs. continuous enteral feeding. Aliment Pharmacol Ther. 2011;33(12):1332-1339

Miele E., Shamir R., Aloi M., et al. Nutrition in Pediatric Inflammatory Bowel Disease: A Position Paper on Behalf of the Porto Inflammatory Bowel Disease Group of the European Society of Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr. 2018;66(4):687-708.

Grover Z., Muir R., Lewindon P. Exclusive enteral nutrition induces early clinical, mucosal and transmural remission in paediatric Crohn’s disease. J Gastroenterol. 2014;49(4):638-645.

Van Limbergen J., Haskett J., Griffiths A. M., et al. Toward enteral nutrition for the treatment of pediatric Crohn disease in Canada: a workshop to identify barriers and enablers. Can J Gastroenterol Hepatol. 2015;29:351-356.

Lawley M., Wu J. W., Navas-Lopez V.M., et al. Global variation in use of enteral nutrition for pediatric Crohn disease. J Pediatr Gastroenterol Nutr. 2018;67: e22-e29.

Kaganov B. S. Nutritional therapy for chronic diseases. Organization of medical nutrition for children in hospitals: Moscow, 2001. 240 p. (In Russ.)@@ Каганов Б. С. Лечебное питание при хронических заболеваниях. в кн. Организация лечебного питания детей в стационарах: Пособие для врачей. Под ред. А. А. Баранова, К. С. Ладодо. М., 2001. 240 с.

Kanshina O.A., Kanshin N. N. Ulcerative colitis in children. Moscow. Medicine Publ., 1974. 144 p. (In Russ.)@@ Каншина О. А., Каншин Н. Н. Неспецифический язвенный колит у детей. М: Медицина, 1974. 144 с. /

Luft V.M., Luft A. V., Nazarov V. E., Lapitsky A. V., et al. Enteral nutrition. In the book. Clinical Nutrition Guide. SPb “Art-Express” 2016. 217 P. (In Russ.)@@ Луфт В. М., Луфт А. В., Назаров В. Е., Лапицкий А. В. и др. Энтеральное питание. В кн. Руководство по клиническому питанию. Под ред. проф. Луфта В. М. СПб «Арт-Экспресс» 2016. - С. 217

Ruemmele F.M., Veres G., Kolhoe K. L., et al. Consensus guidelines of ECCO/ESPGHAN on the medical management of pediatric Crohn’s disease. Journal of Crohn’s and Colitis. 2014: 8: 1179-1207

Haskey N., Gibson D. L. An examination of diet for the maintenance of remission in IBD. Nutrients. 2017; 9: 259.

Gibson, PR; Shepherd, SJ. Personal view: food for thought-western lifestyle and susceptibility to Crohn’s disease. The FODMAP hypothesis. Aliment Pharmacol Ther. 2005;21(12): 1399-1409

Braly K, Williamson N, Shaffer ML, et al. Nutritional adequacy of the Specific Carbohydrate Diet. JPGN. Nov 2017, Vol. 65 N 5, P. 533-8

Navas-Lopes VM et al. Prescription of enteral nutrition in pedatric Crohn’s disease in Spain. Nutr. Hosp. 2014; (29) 537-46.

Chen Sarbagili-Shabat, Rotem Sigall-Boneh. Arie Levine Curr Opin. Gastroenterol. 2015;31(4):303-308.

Martinez-Medina M, Denizot J, Dreux N, Robin F, Billard E, Bonnet R, Darfeuille-Michaud A, Barnich N. Western diet induces dysbiosis with increased E coli in CEABAC10 mice, alters host barrier function favouring AIEC colonization. Gut. 2014 Jan;63(1):116-24.

Agus A, Denizot J, Thévenot J, et al. Western diet induces a shift in microbiota composition enhancing susceptibility to Adherent-Invasive E. coli infection and intestinal inflammation. Sci Rep. 2016 Jan 8;6:19032. doi: 10.1038/srep19032.

Julie Tomas, Céline Mulet, Azadeh Saffarian, et al. High-fat diet modifies the PPAR-γ pathway leading to disruption of microbial and physiological ecosystem in murine small intestine. PNAS. October 4, 2016 113 (40) E5934-E5943

Stefan J Wagner 1, Annemarie Schmidt, Manuel J P Effenberger, Lisa Gruber, Jürgen Danier, Dirk Haller Semisynthetic diet ameliorates Crohn’s disease-like ileitis in TNFΔARE/WT mice through antigen-independent mechanisms of gluten. Inflamm Bowel Dis. 2013 May;19(6):1285-94

Chassaing B, Van de Wiele T, De Bodt J, Marzorati M, Gewirtz AT Dietary emulsifiers directly alter human microbiota composition and gene expression ex vivo potentiating intestinal inflammation. Gut. 2017 Aug;66(8):1414-1427.

Kourtney P. Nickerson, Craig R. Homer, Sean P. Kessler, et al. The Dietary Polysaccharide Maltodextrin Promotes Salmonella Survival and Mucosal Colonization in Mice. PLoS ONE. 9(7): e101789.

Kourtney P Nickerson, Rachael Chanin, Christine McDonald Deregulation of intestinal anti-microbial defense by the dietary additive, maltodextrin. Gut Microbes. 2015; 6(1): 78-83

Lulu Fahoum, Alice Moscovici, Shlomit David, Ron Shaoul, Geila Rozen, Esther G Meyron-Holtz, Uri Lesmes.Digestive fate of dietary carrageenan: Evidence of interference with digestive proteolysis and disruption of gut epithelial function. Mol Nutr Food Res. 2017 Mar;61(3)

Mehta R.S., Nishihara R., Cao Y., et al. Association of Dietary Patterns With Risk of Colorectal Cancer Subtypes Classified by Fusobacterium nucleatum in Tumor Tissue. JAMA Oncol. 2017 Jul 1;3(7):921-927.

Devkota S., Wang Y., Musch M., et al. Dietary-fat-induced taurocholic acid promotes pathobiont expansion and colitis in Il10-/- mice. Nature 2012; 487:104-108.

Vazeille E., Chassaing B., Buisson A., et al. GipA Factor Supports Colonization of Peyer’s Patches by Crohn’s Disease-associated Escherichia Coli. Inflamm Bowel Dis. 2016 Jan;22(1):68-81. doi: 10.1097/MIB.0000000000000609

Viennois E, Bretin A, Dubé PE, Maue AC, Dauriat CJG, Barnich N, Gewirtz AT, Chassaing B. Dietary Emulsifiers Directly Impact Adherent-Invasive E. coli Gene Expression to Drive Chronic Intestinal Inflammation. Cell Reports. 2020 Volume 33, Issue 1, 108229.

Gérard, P. Metabolism of Cholesterol and Bile Acids by the Gut Microbiota. Pathogens. 2014; 3: 14-24

Desai MS, Seekatz AM, Koropatkin NM, et al. A Dietary Fiber-Deprived Gut Microbiota Degrades the Colonic Mucus Barrier and Enhances Pathogen Susceptibility. Cell. 2016 Nov 17;167(5):1339-1353.

Brotherton CS, Taylor AG, Bourguignon C, Anderson JG. A High-Fiber Diet May Improve Bowel Function and Health-Related Quality of Life in Patients With Crohn Disease. Gastroenterology Nursing. 2014; 37:206-16

Levine A, Sigall Boneh R, Wine E. Evolving role of diet in the pathogenesis and treatment of inflammatory bowel diseases. Gut. 2018;67:1726-1738.

Johnson T, Macdonald S, Hill SM, et al. Treatment of active Crohn’s disease in children using partial enteral nutrition with liquid formula: a randomised controlled trial. Gut. 2006;55:356-361.

Svolos V, Hansen R, Nichols B, et al. Treatment of active Crohn’s disease with an ordinary food-based diet that replicates exclusive enteral nutrition. Gastroenterology. 2019;156:1354-1367.

Gevers D, Kugathasan S, Denson LA, et al. The treatment-naive microbiome in new-onset Crohn’s disease. Cell Host Microbe. 2014;15:382-392.

Sigall-Boneh R, Pfeffer-Gik T, Segal I, et al. Partial enteral nutrition with a Crohn’s Disease exclusion diet is effective for induction of remission in children and young adults with Crohn’s disease. Inflamm Bowel Dis. 2014; 20:1353-1360. doi: 10.1053/j.gastro.2019.04.021.

Sigall Boneh R, Sarbagili Shabat C, Yanai H, et al. Dietary therapy with the Crohn’s Disease exclusion diet is a successful strategy for induction of remission in children and adults failing biological therapy. J Crohns Colitis. 2017;11:1205-1212. doi: 10.1053/j.gastro.2019.04.021.

Lee D, Baldassano RN, Otley AR, et al. Comparative effectiveness of nutritional and biological therapy in North American children with active Crohn’s disease. Inflamm Bowel Dis. 2015;21:1786-1793.

Cohen-Dolev N, Sladek M, Hussey S, et al. Differences in outcomes over time with exclusive enteral nutrition compared with steroids in children with mild to moderate Crohn’s disease: results from the GROWTH CD study. J Crohns Colitis. 2018;12:306-312.

Grover Z, Burgess C, Muir R, et al. Early mucosal healing with exclusive enteral nutrition is associated with improved outcomes in newly diagnosed children with luminal Crohn’s disease. J Crohns Colitis. 2016;10:1159-1164.

Connors J, Basseri S, Grant A, et al. Exclusive enteral nutrition therapy in paediatric Crohn’s disease results in long-term avoidance of corticosteroids: results of a propensity-score matched cohort analysis. J Crohns Colitis. 2017;11:1063-1070.

Lewis JD, Chen EZ, Baldassano RN, et al. Inflammation, antibiotics, and diet as environmental stressors of the gut microbiome in pediatric Crohn’s disease. Cell Host Microbe. 2015;18:489-500.

Cameron FL, Gerasimidis K, Papangelou A, et al. Clinical progress in the two years following a course of exclusive enteral nutrition in 109 paediatric patients with Crohn’s disease. Aliment Pharmacol Ther. 2013;37:622-629.

Frivolt K, Schwerd T, Werkstetter KJ, et al. Repeated exclusive enteral nutrition in the treatment of paediatric Crohn’s disease: predictors of efficacy and outcome. Aliment Pharmacol Ther. 2014;39:1398-1407.

The authors declare that there are no conflicts of interest present.