New guidelines on dietary management of inflammatory bowel disease

By Rebecca Jenkins

Every person with inflammatory bowel disease (IBD) should have access to a dietitian with experience in IBD, new guidance recommends.

In its first consensus guidelines on dietary management of IBD, which encompasses Crohn’s disease and ulcerative colitis (UC), the European Crohn’s and Colitis Organisation (ECCO) also recommended that patients with IBD should follow healthy eating guidelines, unless an IBD healthcare professional had specified a particular dietary intervention.

‘Ideally, nutritional assessment should be performed by a dietitian, who can assess and correct abnormalities in nutrition and eating behaviour,’ the consensus, published in Journal of Crohn’s and Colitis, stated.

‘A dietitian well-versed in IBD should execute and monitor IBD-specific dietary interventions, in particular diets of restricted nature, as such diets carry nutritional and psychosocial risks and require skilled dietetic supervision.’

Where dietetic expertise was unavailable, a healthcare professional with training in nutrition assessment and optimisation should be consulted, it added.

In other recommendations, the consensus guidelines  said the Mediterranean diet and limited intake of red meat could be considered to maintain remission in UC.

Recommended diets to induce remission in Crohn’s disease included exclusive enteral nutrition and the Crohn’s disease exclusion diet with partial enteral nutrition.

The guidelines also highlighted that there was evidence to support a healthy eating pattern being associated with a reduced risk of developing IBD.

Welcoming the guidelines, Professor Paul Pavli, Specialist in Gastroenterology at Canberra Hospital and the School of Medicine and Psychology, Australian National University, Canberra, said patients with Crohn’s disease and UC would often try nonevidence-based dietary strategies promoted on the internet to try to improve symptoms.

Professor Pavli backed the recommendation for every patient with the conditions to access a dietitian, noting there were many aspects of diet that were important for patients with Crohn’s and UC, not just in terms of disease causation or treatment.

‘In my practice, the dietitian is extremely valuable in many ways, particularly in monitoring and advising on nutritional status and progressive assessments of body composition, but also in dispelling many of the myths around dietary therapy,’ he told Medicine Today.

One common patient strategy was to eliminate dairy products, Professor Pavli said, noting the consensus found insufficient evidence to support that approach.

‘There are similar beliefs about virtually everything dietary, and very few of them are justified,’ he said.

‘So, this consensus document is very useful for doctors to have available to use as a  discussion point with patients.’

Professor Pavli noted the guidelines also recommended a low FODMAP diet for irritable bowel syndrome-like symptoms in people with Crohn’s disease and UC in remission, adding that patients often described disease ‘flares’ that arose and subsided over a few days, rather than weeks or months.

‘These brief episodes are probably irritable bowel syndrome – and often respond to a low FODMAP diet – or sometimes a transient gut infection,’ he said.

However, he cautioned these flares could be mistaken for inflammatory activity, resulting in a short course of corticosteroid treatment.

‘This is inappropriate if there is no convincing proof of an inflammatory flare for patients with UC, and almost never appropriate for patients with Crohn’s who should have escalation of nonsteroid therapy,’ he said.

‘Referral to their gastroenterologist is advised if the flares are likely to be due to inflammation or stricturing disease.’

J Crohns Colitis 2025; https://doi.org/10.1093/ecco-jcc/jjaf122.