关键词: 慢性胃肠疾病； 慢性肝病； 肥胖症； 管理； 实用指南

Abstract: The '2023 practical guideline for the management of obesity in patients with gastrointestinal and liver diseases' was jointly issued by the European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Society of Gastroenterology（UEG）.It focuses on clinical management issues related to patients with chronic gastrointestinal diseases (such as Inflammatory Bowel Disease,Irritable Bowel Syndrome,Gastroesophageal Reflux Disease,etc.) and chronic liver diseases (CLD) combined with obesity.The guidelines provide guidance for practitioners in internal medicine,gastroenterology,surgery,and nutrition.Following the ESPEN standard process,the guidelines formulated 100 recommendations with a consensus exceeding 90% (3 Level A,33 Level B,24 Level 0,and 40 GPP level).They emphasize the bidirectional association between obesity and gastrointestinal diseases,systematically integrating disease-specific screening,assessment,and intervention strategies for the first time,paying attention to sarcopenic obesity,and setting a special chapter for the management of bariatric surgery patients.In disease-specific management,inflammatory bowel disease is recommended to undergo a three-tiered screening (nutritional risk,obesity-related indicators,sarcopenia).During remission,weight loss of 5%-10% is achieved through lifestyle interventions;orlistat is contraindicated;and weight-loss surgery preserving the small intestine may be selected in specific situations.For irritable bowel syndrome,regular nutritional screening is emphasized,with weight loss prioritized through lifestyle adjustments;weight-loss medications should be used cautiously;and specific probiotics are recommended.Gastroesophageal reflux disease is assessed by combining body mass index,waist circumference with esophageal pH monitoring.Lifestyle-induced weight loss is prioritized,and Roux-en-Y gastric bypass may be considered for severe obesity.For CLD (particularly NAFLD/NASH),specialized tools are used to screen nutritional status;liver steatosis is graded using ultrasound,CAP,and MRI-PDFF;a Mediterranean diet and specific medications[such as glucagon-like peptide-1(GLP-1) receptor agonists] are recommended;and Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy may be considered for severe obesity.In addition,the guidelines standardize the full-cycle management of weight-loss surgery,including preoperative assessment from multiple dimensions of nutrition,function,and psychology,and postoperative focus on protein supplementation to maintain muscle mass and standardized prevention and control of postoperative hypoglycemia.The guidelines also propose structural requirements,including clinical doctors following relevant guidelines,encouraging patient participation,primary healthcare collaboration,and utilization of electronic health tools,to ensure effective implementation of the guidelines.

Key words: chronic gastrointestinal diseases; chronic liver disease; obesity; managment; practical guideline