Atualização sobre o manejo nutricional da insuficiência pancreática exócrina: revisão da literatura
DOI:
https://doi.org/10.35454/rncm.v4n3.282Palavras-chave:
Insuficiência pancreática exócrina, Avaliação nutricional, Terapia de reposição enzimática pancreática, Terapia nutricionalResumo
A insuficiência pancreática exócrina (IPE) produz má digestão e má absorção de nutrientes, impactando negativamente no estado nutricional. Quando não è tratada adequadamente, leva à perda progressiva de peso e possíveis deficiências nutricionais, aumentando a morbimortalidade dos pacientes, as re-hospitalizações e os custos em saúde. A detecção e o tratamento precoce da IPE afetam positivamente o prognóstico da doença. O cuidado nutricional, que consiste num processo contínuo, deve fazer parte da atenção integral do paciente e, portanto, deve ser um componente inerente ao seu cuidado. A detecção precoce de pacientes em risco de desnutrição ou desnutridos, permite uma intervenção nutricional antecipada, com o objetivo de atenuar o impacto nutricional da IPE.
O objetivo desta revisão é proporcionar evidências científicas sobre a IPE e fornecer uma abordagem prática para o manejo nutricional e o tratamento clínico da doença, importante por seu impacto na morbimortalidade e na qualidade de vida.
Downloads
Referências
Othman MO, Harb D, Barkin JA. Introduction and practical approach to exocrine pancreatic insufficiency for the practicing clinician. Int J Clin Pract. 2018;72(2):e13066. doi: 10.1111/ijcp.13066.
Basso S, Canicoba M, Capitanich P, Carballido M, Crisci J, Giustina FD, et al. I Consenso argentino de diagnóstico y tratamiento de la insuficiencia pancreática exocrina. Acta Gastroentero Latinoam. 2018;48(3):213-25.
Dominguez-Muñoz JE. Management of pancreatic exocrine insufficiency. Curr Opin Gastroenterol. 2019;35(5):455-9. doi: 10.1097/MOG.0000000000000562.
Dominguez-Muñoz JE. Diagnosis and treatment of pancreatic exocrine insufficiency. Curr Opin Gastroenterol. 2018;34(5):349-54. doi: 10.1097/MOG.0000000000000459.
Löhr JM, Dominguez-Munoz E, Rosendahl J, Besselink M, Mayerle J, Lerch M, et al. United European Gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis (HaPanEU). United European Gastroenterol J. 2017;5(2):153-99. doi: 10.1177/2050640616684695.
Layer P, Kashirskaya N, Gubergrits N. Contribution of pancreatic enzyme replacement therapy to survival and quality of life in patients with pancreatic exocrine insufficiency. World J Gastroenterol. 2019;25(20):2430-41. doi: 10.3748/wjg.v25.i20.2430.
Gheorghe C, Seicean A, Saftoiu A, Tantau M, Dumitru E, Jinga M, et al. Romanian guidelines on the diagnosis and treatment of exocrine pancreatic insufficiency. J Gastrointestin Liver Dis. 2015;24(1):117-23. doi: 10.15403/jgld.2014.1121.app.
Working Party of the Australasian Pancreatic Club, Smith RC, Smith SF, Wilson J, Pearce C, Wray N, et al. Summary and recommendations from the Australasian guidelines for the management of pancreatic exocrine insufficiency. Pancreatology. 2016;16(2):164-80. doi: 10.1016/j.pan.2015.12.006.
Perbtani Y, Forsmark CE. Update on the diagnosis and management of exocrine pancreatic insufficiency. F1000Res. 2019;8:F1000. doi: 10.12688/f1000research.20779.1.
Lindkvist B, Phillips ME, Domínguez-Muñoz JE. Clinical, anthropometric and laboratory nutritional markers of pancreatic exocrine insufficiency: Prevalence and diagnostic use. Pancreatology. 2015;15(6):589-97. doi: 10.1016/j.pan.2015.07.001.
Arvanitakis M, Ockenga J, Bezmarevic M, Gianotti L, Krznarić Ž, Lobo DN, et al. ESPEN guideline on clinical nutrition in acute and chronic pancreatitis. Clin Nutr. 2020;39(3):612-31. doi: 10.1016/j.clnu.2020.01.004.
Duggan SN, Smyth ND, Murphy A, Macnaughton D, O’Keefe SJD, Conlon KC. High prevalence of osteoporosis in patients with chronic pancreatitis: A systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2014;12(2):219-28. doi: 10.1016/j.cgh.2013.06.016.
De la Iglesia D, Vallejo-Senra N, López-López A, Iglesias-García J, Lariño-Noia J, Nieto-García L, et al . Pancreatic exocrine insufficiency and cardiovascular risk in patients with chronic pancreatitis: A prospective, longitudinal cohort study. J Gastroenterol Hepatol. 2019;34(1):277-83. doi: 10.1111/jgh.14460.
Shintakuya R, Uemura K, Murakami Y, Kondo N, Nakagawa N, Urabe K, et al. Sarcopenia is closely associated with pancreatic exocrine insufficiency in patients with pancreatic disease. Pancreatology. 2017;17(1):70-5. doi: 10.1016/j.pan.2016.10.005.
Domínguez-Muñoz JE, Phillips M. Nutritional therapy in chronic pancreatitis. Gastroenterol Clin North Am. 2018;47(1):95-106. doi: 10.1016/j.gtc.2017.09.004.
Machicado JD, Chari ST, Timmons L, Tang G, Yadav D. A population-based evaluation of the natural history of chronic pancreatitis. Pancreatology. 2018;18(1):39-45. doi: 10.1016/j.pan.2017.11.012.
Vujasinovic M, Valente R, Maier P, von Beckerath V, Haas SL, Arnelo U, et al. Diagnosis, treatment and long-term outcome of autoimmune pancreatitis in Sweden. Pancreatology. 2018;18(8):900-4. doi: 10.1016/j.pan.2018.09.003.
Mohapatra S, Majumder S, Smyrk TC, Zhang L, Matveyenko A, Kudva YC, et al. Diabetes mellitus is associated with an exocrine pancreatopathy: Conclusions from a review of literature. Pancreas. 2016;45(8):1104-10. doi: 10.1097/MPA.0000000000000609.
Lamarca A, McCallum L, Nuttall C, Barriuso J, Backen A, Frizziero M, et al. Somatostatin analogue-induced pancreatic exocrine insufficiency in patients with neuroendocrine tumors: Results of a prospective observational study. Expert Rev Gastroenterol Hepatol. 2018;12(7):723-31. doi: 10.1080/17474124.2018.1489232.
Goess R, Ceyhan GO, Friess H. Pancreatic exocrine insufficiency after pancreatic surgery. Panminerva Med. 2016;58(2):151-9.
Capurso G, Traini M, Piciucchi M, Signoretti M, Arcidiacono PG. Exocrine pancreatic insufficiency: Prevalence, diagnosis, and management. Clin Exp Gastroenterol. 2019;12:129-39. doi: 10.2147/CEG.S168266.
Okano K, Murakami Y, Nakagawa N, Uemura K, Sudo T, Hashimoto Y, et al. Remnant pancreatic parenchymal volume predicts postoperative pancreatic exocrine insufficiency after pancreatectomy. Surgery. 2016;159(3):885-92. doi: 10.1016/j.surg.2015.08.046.
Radlinger B, Ramoser G, Kaser S. Exocrine pancreatic insufficiency in type 1 and type 2 diabetes. Curr Diab Rep. 2020;20(6):18. doi: 10.1007/s11892-020-01304-0.
Yilmaz A, Hagberg L. Exocrine pancreatic insufficiency is common in people living with HIV on effective antiretroviral therapy. Infect Dis (Lond). 2018;50(3):193-9. doi: 10.1080/23744235.2017.1370126.
Raphael KL, Chawla S, Kim S, Keith CG, Propp DR, Chen ZN, et al. Pancreatic insufficiency secondary to tobacco exposure: A controlled cross-sectional evaluation. Pancreas. 2017;46(2):237-43. doi: 10.1097/MPA.0000000000000721.
Greer JB, Greer P, Sandhu BS, Alkaade S, Wilcox CM, Anderson MA, et al. Nutrition and inflammatory biomarkers in chronic pancreatitis patients. Nutr Clin Pract. 2019; 34(3):387-99. doi: 10.1002/ncp.10186.
Hollemans RA, Hallensleben NDL, Mager DJ, Kelder JC, Besselink MG, Bruno MJ, et al. Pancreatic exocrine insufficiency following acute pancreatitis: Systematic review and study level meta-analysis. Pancreatology. 2018;18(3):253-62. doi: 10.1016/j.pan.2018.02.009.
Huang W, De la Iglesia-García D, Baston-Rey I, Calviño-Suarez C, Lariño-Noia J, Iglesias-García J, et al. Exocrine pancreatic insufficiency following acute pancreatitis: Systematic review and meta-analysis. Dig Dis Sci. 2019;64(7):1985-2005. doi: 10.1007/s10620-019-05568-9.
De la Iglesia D, Avci B, Kiriukova M, Panic N, Bozhychko M, Sandru V, et al. Pancreatic exocrine insufficiency and pancreatic enzyme replacement therapy in patients with advanced pancreatic cancer: A systematic review and meta-analysis. United European Gastroenterol J. 2020;8(9):1115-25. doi: 10.1177/2050640620938987.
Roeyen G, Jansen M, Ruyssinck L, Chapelle T, Vanlander A, Bracke B, et al. Pancreatic exocrine insufficiency after pancreaticoduodenectomy is more prevalent with pancreaticogastrostomy than with pancreatic jejunostomy. A retrospective multicentre observational cohort study. HPB (Oxford). 2016;18(12):1017-22. doi: 10.1016/j.hpb.2016.09.002.
Struyvenberg MR, Martin CR, Freedman SD. Practical guide to exocrine pancreatic insufficiency - Breaking the myths. BMC Med. 2017;15(1):29. doi: 10.1186/s12916-017-0783-y.
Diéguez-Castillo C, Jiménez-Luna C, Prados J, Martín-Ruiz JL, Caba O. State of the art in exocrine pancreatic insufficiency. Medicina (Kaunas). 2020;56(10):523. doi: 10.3390/medicina56100523.
Rodrigues-Pinto E, Caldeira A, Soares JB, Antunes T, Carvalho JR, Costa- Maia J,et al. Clube português do pâncreas recommendations for chronic pancreatitis: medical, endoscopic, and surgical treatment (Part II). GE Port J Gastroenterol. 2019; 26(6):404-13. doi: 10.1159/000497389.
Canicoba ME, Mauricio S. Valoración del estado nutricional en diversas situaciones clínicas. Los Olivos, Lima: Universidad Privada del Norte. 2017.
Cortes R, Bennasar-Veny M, Castro-Sanchez E, Fresneda S, de Pedro-Gomez J, Yañez A. Nutrition screening tools for risk of malnutrition among hospitalized patients: A protocol for systematic review and meta-analysis. Medicine (Baltimore). 2020;99(43):e22601. doi: 10.1097/MD.0000000000022601.
Di Sibio M, Jastreblansky Z, Magnífico LP, Fischberg M, Ramírez SE, Jereb S, et al. Revisión de diferentes herramientas de tamizaje nutricional para pacientes hospitalizados. Diaeta. 2018; 36(164):30-38.
Moro, M, Kohan G, Pasqua A, Volpacchio M, Marcaccio, F, Kujaruk M, et al. Recomendaciones para el diagnóstico y tratamiento del adenocarcinoma ductal de páncreas. Acta Gastroenterol Latinoam. 2020;50(S2):1-43.
Lobo DN, Gianotti L, Adiamah A, Barazzoni R, Deutz NEP, Dhatariya K, et al. Perioperative nutrition: Recommendations from the ESPEN expert group. Clin Nutr. 2020;39(11):3211-27. doi: 10.1016/j.clnu.2020.03.038.
Dominguez-Munoz JE, Drewes AM, Lindkvist B, Ewald N, Czakó L, Rosendahl J, et al. Recommendations from the United European Gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis. Pancreatology. 2018;18(8):847-54. doi: 10.1016/j.pan.2018.09.016.
Duggan S, O’Sullivan M, Feehan S, Ridgway P, Conlon K. Nutrition treatment of deficiency and malnutrition in chronic pancreatitis: A review. Nutr Clin Pract. 2010;25(4):362-70. doi: 10.1177/0884533610373772.
Dutta SK, Hlasko J. Dietary fiber in pancreatic disease: Effect of high fiber diet on fat malabsorption in pancreatic insufficiency and in vitro study of the interaction of dietary fiber with pancreatic enzymes. Am J Clin Nutr. 1985;41(3):517-25. doi: 10.1093/ajcn/41.3.517.
Ribichini E, Stigliano S, Rossi S, Zaccari P, Sacchi MC, Bruno G, et al. Role of fibre in nutritional management of pancreatic diseases. Nutrients. 2019;11(9):2219. doi: 10.3390/nu11092219.
Singh S, Midha S, Singh N, Joshi YK, Garg PK. Dietary counseling versus dietary supplements for malnutrition in chronic pancreatitis: A randomized controlled trial. Clin Gastroenterol Hepatol. 2008;6(3):353-9. doi: 10.1016/j.cgh.2007.12.040.
Freedman SD. Options for addressing exocrine pancreatic insufficiency in patients receiving enteral nutrition supplementation. Am J Manag Care. 2017;23(12):S220-8.
Publicado
Como Citar
Edição
Seção
Licença
Copyright (c) 2021 Marisa Ester Canicoba
Este trabalho está licenciado sob uma licença Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
