Published online Feb 21, 2016. doi: 10.3748/wjg.v22.i7.2179
Peer-review started: June 27, 2015
First decision: September 29, 2015
Revised: November 10, 2015
Accepted: December 30, 2015
Article in press: December 30, 2015
Published online: February 21, 2016
Although patients with inflammatory bowel diseases (IBD) have a strong interest in dietary modifications as part of their therapeutic management, dietary advice plays only a minor part in published guidelines. The scientific literature shows that dietary factors might influence the risk of developing IBD, that dysbiosis induced by nutrition contributes to the pathogenesis of IBD, and that diet may serve as a symptomatic treatment for irritable bowel syndrome-like symptoms in IBD. The role of nutrition in IBD is underscored by the effect of various dietary therapies. In paediatric patients with Crohn’s disease (CD) enteral nutrition (EN) reaches remission rates similar to steroids. In adult patients, however, EN is inferior to corticosteroids. EN is not effective in ulcerative colitis (UC). Total parenteral nutrition in IBD is not superior to steroids or EN. The use of specific probiotics in patients with IBD can be recommended only in special clinical situations. There is no evidence for efficacy of probiotics in CD. By contrast, studies in UC have shown a beneficial effect in selected patients. For patients with pouchitis, antibiotic treatment followed by probiotics, like VSL#3 or Lactobacillus GG, is effective. When probiotics are used, the risk of bacterial translocation and subsequent bacteremia has to be considered. More understanding of the normal intestinal microflora, and better characterization of probiotic strains at the phenotypic and genomic levels is needed as well as clarification of the mechanisms of action in different clinical settings. A FODMAP reduced diet may improve symptoms in IBD.
Core tip: Over the last decades various dietary components like milk, fructose, salty foods and sweetened beverages have been implicated to play a role in the pathogenesis of inflammatory bowel disease (IBD), possibly by interacting with gut microbiota and the mucosal immune system. The role of nutrition in IBD is underscored by the effect of various dietary therapies. In paediatric patients with Crohn’s disease enteral nutrition reaches remission rates similar to steroids. The use of specific probiotics in patients with IBD can be recommended only in special clinical situations. A FODMAP reduced diet may improve symptoms in IBD.