Role of nutrition in the management of inflammatory bowel disease - current status -

Abstract

A lot of medical literature is lately dedicated to nutrition in inflammatory bowel disease (IBD). The growing recognition of the importance of nutrition in the management of IBD is reflected by the increasing number of papers dedicated to the topic and by the evidence based guidelines. When analyzing nutrition and IBD, three major aspects must be concerned: the influence of nutritional components in the pathogenesis of IBD, the impact of IBD on nutritional status and the potential
role of nutritional therapy. Many nutrients are under scrutiny for their involvement in the pathogenesis of IBD: carbohydrates, fibers, fruits, vegetables, fats, proteins. Their role is still under debate. Modern food may induce in predisposed individuals mucosal damage and increased translocation, continuous exposure to bacterial antigens and sustained immunologic stimulation. Malnutrition is frequently associated with IBD and its severity is influenced by the phase of
disease activity and the length and site of inflammation. It is the result of a combination of factors: inadequate oral intake, malabsorbtion, increased intestinal loss and increased calorie need. Undernutrition should be constantly suspected; therefore frequent evaluation of the nutritional status should be made along with disease treatment and follow-up. Oral intake should be adapted to individual needs and tolerance. If nutritional support is decided, enteral nutrition is the first choice. It should be adapted to the actual needs and tolerance of the patient. Enteral nutrition is the first line therapy in children with IBD. In adult patients corticosteroids are more active, but enteral nutrition should be used as adjunctive therapy. A lot of medical literature is lately dedicated to nutrition in inflammatory bowel disease (IBD). The growing recognition of the importance of nutrition in the management of IBD is reflected by the increasing number of papers dedicated to the topic: clinical trials and review papers. All these data were collected and analyzed and panels of experts formulated evidence based guidelines. The latest in the field are The Guidelines of the British Society of Gastroenterology, published in Gut 2004,1 The Guidelines of European Society of Enteral and Parenteral Nutrition, published in Clinical Nutrition in 20062 and The European evidence based consensus on the diagnosis and management of Crohn's disease, emitted by the European Crohn's and Colitis Organization, published in 2006.3 Currently IBD includes Crohn's disease and ulcerative colitis. Some authors add puchitis, a new disease, in which diagnostic criteria have only recently been proposed.1 When analyzing nutrition and IBD, three major aspects must be concerned: the influence of nutritional components in the pathogenesis of IBD, the impact of IBD on nutritional status and the potential role of nutritional therapy. Currently the appropriate nutritional management of IBD is an essential part of the therapeutic surgery.