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Las fístulas digestivas y el intestino corto son 2 procesos en los que el tratamiento nutricional es de gran importancia. Existen guías de actuación clínica basadas en la evidencia que ofrecen recomendaciones generales acerca del soporte nutricional en ambos casos.
En este trabajo se han revisado los metaanálisis y los estudios prospectivos aleatorizados (EPA) publicados entre 1990 y 2004 acerca del soporte nutricional en las fístulas digestivas y en el intestino corto.
No se han encontrado metaanálisis ni EPA que comparen nutrición enteral con la parenteral en ninguno de los 2 procesos estudiados, probablemente porque ya ha quedado establecido de tiempo atrás cómo realizar el tratamiento nutricional según las características clínicas concretas en cada caso de fístulas e intestino corto. Sí se han encontrado trabajos que estudian los efectos de la nutrición artificial asociada o no a nuevos fármacos o nutrientes, como somatostatina u octreótida en las fístulas digestivas, y la glutamina, la hormona de crecimiento y/o el glucagon-like peptide-2 en el intestino corto, que en algunos casos podrían ofrecer resultados prometedores en la mejoría de la evolución y pronóstico de estos 2 procesos.
Palabras clave:
Fístulas digestivas
Fístulas enterocutáneas
Intestino corto
Nutrición enteral
Nutrición parenteral
Somatostatina
Octreótido
Glutamina
Hormona de crecimiento
Glucagon-like peptide-2
Abstract
Gastrointestinal (GI) fistulae and short bowel syndrome are two processes in which nutritional treatment is highly important. There are evidence-based clinical practice guidelines that provide general recommendations on nutritional support in both processes.
The present article reviews meta-analyses and prospective randomized trials published between 1990 and 2004 on nutritional support in GI fistulae and short bowel syndrome. No meta-analyses or prospective randomized trials comparing enteral nutrition with parenteral nutrition were found in either of the two processes studied, probably because the most appropriate forms of nutritional treatment in both entities were established some time ago. In contrast, we did find studies on the effects of artificial nutrition alone or associated with new drugs or nutrients, such as somatostatin or octreotide in GI fistulae, and glutamine, growth hormone and/or glucagonlike peptide 2 in short bowel syndrome, which in some cases could offer promising results in improving the progression and outcome of these two processes.
Key words:
Gastrointestinal fistulae
Enterocutaneous fistulae
Short bowel
Enteral nutrition
Parenteral nutrition
Somatostatin
Octreotide
Glutamine
Growth hormone
Glucagon-like peptide 2
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