Perioperative Dietary Therapy in Inflammatory Bowel Disease

Abstract

Background and Aims The incidence of inflammatory bowel disease [IBD] is rising worldwide and no cure is available. Many patients require surgery and they often present with nutritional deficiencies. Although randomised controlled trials of dietary therapy are lacking, expert IBD centres have long-established interdisciplinary care, including tailored nutritional therapy, to optimise clinical outcomes and resource utilisation. This topical review aims to share expertise and offers current practice recommendations to optimise outcomes of IBD patients who undergo surgery. Methods A consensus expert panel consisting of dietitians, surgeons, and gastroenterologists, convened by the European Crohn’s and Colitis Organisation, performed a systematic literature review. Nutritional evaluation and dietary needs, perioperative optimis ation, surgical complications, long-term needs, and special situations were critically appraised. Statements were developed using a Delphi methodology incorporating three successive rounds. Current practice positions were set when ≥80% of participants agreed on a recommendation. Results A total of 26 current practice positions were formulated which address the needs of IBD patients perioperatively and in the long term following surgery. Routine screening, perioperative optimisation by oral, enteral, or parenteral nutrition, dietary fibre, and supplements were reviewed. IBD-specific situations, including management of patients with a restorative proctocolectomy, an ostomy, strictures, or short-bowel syndrome, were addressed. Conclusions Perioperative dietary therapy improves the outcomes of IBD patients who undergo a surgical procedure. This topical review shares interdisciplinary expertise and provides guidance to optimise the outcomes of patients with Crohn’s disease and ulcerative colitis. taking advantage of contemporary nutrition science.

ECCO Guidelines on Therapeutics in Crohn’s Disease: Surgical Treatment

“…Conversely, emergency surgery without prior PD and sepsis control is associated with a higher rate of complications and stoma than with initial PD followed by surgery 53 . Successful PD can be considered as a bridge to elective surgery, allowing nutritional and medical optimization and hence improved postoperative outcomes 3,54 .…”

“…At least half of patients with CD undergo one or more surgical procedures during their lifetime. CD patients frequently suffer from malnutrition, psychological comorbidities, and may have to live with a stoma [2][3][4][5] . Care for CD has become more complex for both medical and surgical disciplines.…”

“…The present guidelines focus on surgery for CD, including preoperative aspects and drug management before surgery, and provide technical advice for a variety of common clinical presentations. Further guidance on most aspects of interdisciplinary and interprofessional care for CD has been elaborated by ECCO in separate publications 3,[11][12][13][14][15][16] .…”

Nutrition Considerations in Inflammatory Bowel Disease

“…42 High ostomy output is defined by the European Crohn's and Colitis Organisation (ECCO) as >1000-2000 mL of liquid waste per day. 43 Chronic high ostomy output can lead to dehydration, electrolyte imbalances, and ultimately malnutrition due to poor intestinal absorption of nutrients. 44 In a British study of 687 new stoma creations, the incidence of high ostomy output was 16% in ileostomies/jejunostomies and 0% in colostomies.…”

Dietary Strategies for Maintenance of Clinical Remission in Inflammatory Bowel Diseases: Are We There Yet?

“…EEN has been shown to reduce FC levels in pediatric populations by approximately 50% [ 28 ]. EEN, along with other forms of nutritional support, such as total parenteral nutrition (TPN) have also been efficacious in reducing post-operative occurrence in patients with CD undergoing surgery [ 29 , 30 ].…”