Patients suffering from Inflammatory Bowel Disease (IBD) as a group uniformly suffer from nutritional problems. Nevertheless the extent, severity and clinical significance of Protein Energy Malnutrition (PEM) in the various clinical presentations of these diseases remains unclear. In particular little is known of the nutritional status of the ambulatory patient with IBD. Confusion still exists over the long term nutritional changes following colectomy for colitis. Whether intravenous nutrition (IVN) should be prescribed in patients admitted to hospital for acute exacerbations of IBD still remains contentious. Recent work suggests that the significance of PEM relates to the associated impairments seen in various organ systems eg., impaired respiratory muscle function. Furthermore, there is other data to suggest that nutritional therapy may result in improvement in some of these physiological functions long before there is any measured change in the patient’s nutritional status. Through direct measurements of Body Composition (by neutron activation analysis in conjunction with tritium dilution) together with tests of physiological function (hepatosecretory proteins, skeletal muscle function, respiratory muscle function, wound healing and psychological function) work has been directed to clarify the following clinical questions:- 1. How extensive is the problem of protein depletion in the various clinical presentations of IBD? 2. What are the long term changes in body composition following surgery for colitis? and what is the nature of this restorative process. Is there a return to normal body composition? and if so, What is the duration of this recovery process? 3. What are the effects of a short course of IVN in patients suffering severe exacerbations of IBD? The results of these clinical studies have reaffirmed the high incidence of PEM in patients suffering from acute exacerbations of IBD, furthermore this work has established the existence of persisting protein deficits in the ambulatory patient with IBD who is in clinical remission. Contrary to previous reports, fully convalescent patients following surgery for colitis, were found to have normal body stores of protein and water. The timing of this restorative process was found however to take many months. A 2 week course of IVN was found not only to prevent further loss of body protein in a group of patients presenting with severe exacerbations of IBD, but also within a few days (4 days) lead to a significant improvement in hepatosecretory function, respiratory muscle function, skeletal muscle function, wound healing and psychological function. The magnitudes of these improvements although not complete was probably significant clinically. Following these early improvements, subsequent improvement was slow over many months and was dependent on an increase in body stores of protein.
| Identifer | oai:union.ndltd.org:ADTP/269277 |
| Date | January 1990 |
| Creators | Christie, Peter Michael |
| Publisher | ResearchSpace@Auckland |
| Source Sets | Australiasian Digital Theses Program |
| Detected Language | English |
| Rights | Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated., http://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htm, Copyright: the author |
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