The AGA has issued new GI practice guidelines for diet and nutritional therapies for IBD:
The Guideline:
https://www.gastrojournal.org/action/showPdf?pii=S0016-5085(23)05597-X
Summary:
A Starting Point
First, the panelists advise that, unless contraindicated, all patients with IBD follow a Mediterranean diet while minimizing salt, sugar, and ultraprocessed foods.
Patients with symptomatic intestinal strictures may struggle to digest raw fruits and vegetables due to their fibrous nature, they added, so these patients should first soften these foods through cooking, steaming, or "careful chewing" before consumption.
"No diet has consistently been found to decrease the rate of flares in adults with IBD," the update panelists noted. "A diet low in red and processed meat may reduce ulcerative colitis flares, but has not been found to reduce relapse in Crohn's disease."
Beyond these dietary suggestions for adults, the update advises breastfeeding for newborns and a Mediterranean diet for children, as both may reduce risk of developing IBD.
Enteral Nutrition
The update suggests that exclusive enteral nutrition is a reasonable option to induce clinical remission and endoscopic response, or as a steroid-sparing bridge, in Crohn's disease, although this may be more effective in children than adults.
Malnourished patients may also benefit from exclusive enteral nutrition prior to elective surgery for Crohn's disease, the authors added, as this strategy can "optimize nutritional status and reduce postoperative complications."
A Crohn's disease exclusion diet, which involves partial enteral nutrition therapy, may be considered in mild or moderate cases, according to the update.
"Data on the use of enteral nutrition in the treatment of active ulcerative colitis are limited," the panelists wrote, although early data suggest it is safe and well tolerated, and can improve prealbumin levels.
Parenteral Nutrition
The update recommends short-term parenteral nutrition for patients with phlegmonous inflammation and/or an intra-abdominal abscess, as this can act as a bridge to surgical intervention.
Patients with prolonged ileus, short bowel syndrome, or high-output gastrointestinal fistula may also be candidates for parenteral nutrition, as well as those who have tried and failed both oral and enteral nutrition.
Lastly, the update encourages transition from long-term parenteral nutrition to oral intake and customized hydration management "whenever possible."
Monitoring and Multidisciplinary Care
The authors concluded by advising that all patients with complicated IBD be comanaged by a gastroenterologist and a registered dietitian, both of whom should remain watchful for signs of malnutrition.
Using serum protein as a surrogate marker of malnutrition is no longer recommended and there are different criteria that should be utilized to identify malnutrition. Routine iron and vitamin D testing are warranted, as well as B12 testing for patients with extensive ileal disease or a history of ileal surgery.
The Guideline:
https://www.gastrojournal.org/action/showPdf?pii=S0016-5085(23)05597-X
Summary:
A Starting Point
First, the panelists advise that, unless contraindicated, all patients with IBD follow a Mediterranean diet while minimizing salt, sugar, and ultraprocessed foods.
Patients with symptomatic intestinal strictures may struggle to digest raw fruits and vegetables due to their fibrous nature, they added, so these patients should first soften these foods through cooking, steaming, or "careful chewing" before consumption.
"No diet has consistently been found to decrease the rate of flares in adults with IBD," the update panelists noted. "A diet low in red and processed meat may reduce ulcerative colitis flares, but has not been found to reduce relapse in Crohn's disease."
Beyond these dietary suggestions for adults, the update advises breastfeeding for newborns and a Mediterranean diet for children, as both may reduce risk of developing IBD.
Enteral Nutrition
The update suggests that exclusive enteral nutrition is a reasonable option to induce clinical remission and endoscopic response, or as a steroid-sparing bridge, in Crohn's disease, although this may be more effective in children than adults.
Malnourished patients may also benefit from exclusive enteral nutrition prior to elective surgery for Crohn's disease, the authors added, as this strategy can "optimize nutritional status and reduce postoperative complications."
A Crohn's disease exclusion diet, which involves partial enteral nutrition therapy, may be considered in mild or moderate cases, according to the update.
"Data on the use of enteral nutrition in the treatment of active ulcerative colitis are limited," the panelists wrote, although early data suggest it is safe and well tolerated, and can improve prealbumin levels.
Parenteral Nutrition
The update recommends short-term parenteral nutrition for patients with phlegmonous inflammation and/or an intra-abdominal abscess, as this can act as a bridge to surgical intervention.
Patients with prolonged ileus, short bowel syndrome, or high-output gastrointestinal fistula may also be candidates for parenteral nutrition, as well as those who have tried and failed both oral and enteral nutrition.
Lastly, the update encourages transition from long-term parenteral nutrition to oral intake and customized hydration management "whenever possible."
Monitoring and Multidisciplinary Care
The authors concluded by advising that all patients with complicated IBD be comanaged by a gastroenterologist and a registered dietitian, both of whom should remain watchful for signs of malnutrition.
Using serum protein as a surrogate marker of malnutrition is no longer recommended and there are different criteria that should be utilized to identify malnutrition. Routine iron and vitamin D testing are warranted, as well as B12 testing for patients with extensive ileal disease or a history of ileal surgery.
