Klinička prehrana i kolorektalni karcinom

Cachexia-anorexia syndrome, characterized by anorexia and loss of adipose tissue and skeletal muscle mass, is common feature in majority of patients with cancer, especially in cancer localized in gastrointestinal tract. Malnutrition is recognized as a negative prognostic factor in patients with colorectal cancer. Malnutrition in cancer patients reduces response to specific oncological therapy, slows down recovery after surgical treatment, leads to impairement of quality of life and decreases survival. It is considered that developement of cancer cachexia is a multifactorial process, however inflammation plays a major role. Therefore, targeting inflammation may represent an effective strategy to prevent/treat cachexia. Treatment should be patient-tailored and based on a multimodal approach.Kaheksija-anoreksija sindrom je karakteriziran anoreksijom i gubitkom masnog tkiva i skeletne mišićne mase. Sindrom je prisutan u većine onkoloških bolesnika, osobito u bolesnika s tumorima probavnog sustava. Odavno je prepoznato kako malnutricija predstavlja negativni prognostički faktor kod bolesnika s kolorektalnim karcinomom. Malnutricija u onkoloških bolesnika dovodi do slabijeg odgovora na specifičnu onkološku terapiju, sporijeg oporavka nakon kirurških zahvata, do smanjenja kvalitete života, ali i sveukupnog preživljenja. Istraživanja su pokazala kako je tumorska kaheksija multifaktorijalan proces. Međutim, smatra se kako glavnu ulogu u patogenezi tumorske kaheksije ima upala. Stoga je upravo djelovanje na upalni proces potencijalni terapijski cilj u liječenju, odnosno prevenciji kaheksije. Liječenje tumorske kaheksije trebalo bi biti individualizirano i temeljeno na multimodalnom pristupu

Assessment of nutritional status of gastroenterology patients in Croatia [Procjena nutritivnog statusa gastroenteroloških bolesnika u Republici Hrvatskoj]

Malnutrition is a common feature of gastroenterological diseases. In this study, nutritional status of the patients admitted to Department of Gastroenterology at University Hospital Center Zagreb was assessed. Anthropometric, dietetic, biochemical methods and method of Subjective Global Assessment (SGA) was used. The study group included 284 patients admitted to the Hospital. Malnutrition, as defined by SGA, was found in 61.1% of the patients, of whom 75% were moderately and 25% severely malnourished. Those patients classified as moderately and extremely malnourished by SGA were found to have statistically lower values of BMI, albumin, total proteins, calcium, iron, triglycerides, cholesterol, vitamin A and lymphocytes as compared to those who were adequately nourished. The prevalence of malnutrition in hospitalized patients treated at the Department of Gastroenterology is high. The use of nutritional screening with multiple measures would be important in the early identification and treatment of these patients and would help decrease this high prevalence

Klinička prehrana i kolorektalni karcinom

Cachexia-anorexia syndrome, characterized by anorexia and loss of adipose tissue and skeletal muscle mass, is common feature in majority of patients with cancer, especially in cancer localized in gastrointestinal tract. Malnutrition is recognized as a negative prognostic factor in patients with colorectal cancer. Malnutrition in cancer patients reduces response to specific oncological therapy, slows down recovery after surgical treatment, leads to impairement of quality of life and decreases survival. It is considered that developement of cancer cachexia is a multifactorial process, however inflammation plays a major role. Therefore, targeting inflammation may represent an effective strategy to prevent/treat cachexia. Treatment should be patient-tailored and based on a multimodal approach.Kaheksija-anoreksija sindrom je karakteriziran anoreksijom i gubitkom masnog tkiva i skeletne mišićne mase. Sindrom je prisutan u većine onkoloških bolesnika, osobito u bolesnika s tumorima probavnog sustava. Odavno je prepoznato kako malnutricija predstavlja negativni prognostički faktor kod bolesnika s kolorektalnim karcinomom. Malnutricija u onkoloških bolesnika dovodi do slabijeg odgovora na specifičnu onkološku terapiju, sporijeg oporavka nakon kirurških zahvata, do smanjenja kvalitete života, ali i sveukupnog preživljenja. Istraživanja su pokazala kako je tumorska kaheksija multifaktorijalan proces. Međutim, smatra se kako glavnu ulogu u patogenezi tumorske kaheksije ima upala. Stoga je upravo djelovanje na upalni proces potencijalni terapijski cilj u liječenju, odnosno prevenciji kaheksije. Liječenje tumorske kaheksije trebalo bi biti individualizirano i temeljeno na multimodalnom pristupu

Drugs in Gastroenterology

U strukturi vodećih uzroka hospitalizacije i mortaliteta bolesti probavnog sustava nalaze se na četvrtome, odnosno trećem mjestu. Uočava se porast potrošnje lijekova koje rabimo u liječenju bolesti probavnog sustava, i u ambulantnim i polikliničkim uvjetima, a i u bolnicama. Osobito raste propisivanje i potrošnja inhibitora sekrecije želučane kiseline, ali i antiemetika, laksativa i antidijaroika. Spektar antiulkusnih lijekova dostupnih na tržištu kreće se od antacida, antagonista H2-receptora, inhibitora protonske pumpe (IPP) do lijekova kao što su sukralfat i ranitidin-bizmut-citrat. Iako se radi o dobro poznatim skupinama lijekova koji se godinama propisuju vrlo široko i koji su dobro poznati i liječnicima i bolesnicima, brojne dileme vezane za indikacije i način primjene i dalje ostaju otvorene.Diseases of the gastrointestinal tract are on the third or fourth place in the structure of mortality and main causes of hospitalisation. There is a marked increase of drug consumption used in treatment of digestive tract diseases both in hospitals and ambulatory / outpatients departments. Especially high is the prescribing and consumption of gastric acid inhibiting drugs, but also of antiemetics, laxatives and drugs for diarrhoea. The spectrum of antiulcer drugs available on the market ranges from antacids, H2 receptor antagonists, of proton pump inhibitors to drugs like sucralfate and ranitidine- bismuth-citrate. Although these drug groups are well known both to doctors and patients and are widely prescribed for a number of years, there are still dilemmas connected to their indications and mode of application

Nutritional issues andconsiderations in the elderly: an update

Nutritional aspects of some common clinical conditions of older age are often neglected. Therefore, the aim of this essay is to describe the prevalence, recognition, and gen- eral management of four common and interrelated clini- cal problems in the elderly: sarcopenia, dysphagia, chronic wounds, and dementia. In the modern era of clinical nu- trition tailored to elderly patients, we should encourage a multidimensional personalized approach that includes as- sessment, counseling, dietary modification, targeted oral nutritional supplements, adjusted physical activity or ther- apy, and psychosocial suppor