MEDIX, God. 19 Br. 107/108  •  Pregledni članak HR ENG

Nutritivna potpora u bolesnika s tumorima probavnoga sustavaNutritional support in patients with tumors of the digestive system

Željko Krznarić, Darija Vranešić Bender, Dina Ljubas Kelečić

U znatnom broju bolesnika sa zloćudnim tumorima probavnoga sustava već pri postavljanju dijagnoze uočava se zamjetan gubitak tjelesne mase, gubitak masnoga tkiva te osobito gubitak skeletnih mišića uz naglašenu upalnu aktivnost. Ovaj nepovoljan slijed događaja koji dovodi do tjelesnoga propadanja naziva se sindromom tumorske kaheksije, uz često prisutnu anoreksiju. Tumorska kaheksija utječe na proces liječenja bolesnika i učestalost komplikacija te znatno narušava kvalitetu života. Standardnom nutritivnom potporom nije moguće zaustaviti tjelesno propadanje u sindromu tumorske anoreksije i kaheksije. U pristupu liječenju tumorske kaheksije i anoreksije unatrag nekoliko godina propituje se svrhovitost primjene pojedinih nutritivnih sastojaka i lijekova ili njihovih kombinacija. Osobito je aktualna primjena eikozapentaenske kiseline (EPA), β-hidroksi β-metil butirata (HMB), glutamina, aminokiselina razgrananih lanaca (BCAA), antioksidansa, vitamina D, ali i lijekova kao što su glukokortikosteroidi, megestrol-acetat, nesteroidni antireumatici (NSAR) i kanabinoidi u liječenju onkoloških bolesnika sa sindromom tumorske kaheksije i anoreksije. 

Ključne riječi:
anoreksija; eikozapentaenska kiselina (EPA); β-hidroksi β-metil butirat (HMB); megestrol- acetat; tumorska kaheksija

Članak u cijelosti pročitajte u tiskanom izdanju MEDIX, God. 19 Br. 107/108

Significant weight loss, fat loss, and especially the loss of skeletal muscle where prevalent inflammatory activity is present can be seen in a large number of patients who at the time of diagnosis already had malignant tumors of the digestive system. This unfortunate sequence of events that leads to physical deterioration is known as cancer cachexia syndrome, often present with anorexia. Tumor cachexia affects the treatment process of patients, and frequency of complications, and it significantly impairs the quality of life. Standard nutritional support is not enough to prevent to physical deterioration caused by tumor induced anorexia and cachexia. During the last few years, the different approaches in treating tumor cachexia and anorexia, have questioned the relevance of certain drugs and nutritive supplements or their combinations. Particularly, topical application of eicosapentaenoic acid (EPA), β-hydroxy β-methyl butyrate (HMB), glutamine, branched chain amino acids (BCAA), antioxidants, vitamin D, as well as drugs such as glucocorticosteroids, megestrol acetate, NSAIDs (NSAIDs) and cannabinoids have been used in the treatment of cancer patients with the syndrome of tumor cachexia and anorexia. 

Key words:
anorexia; β-hydroxy β-methyl butyrate (HMB); cancer cachexia; eicosapentaenoic acid (EPA); megestrol acetate