Review
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 28, 2018; 24(28): 3055-3070
Published online Jul 28, 2018. doi: 10.3748/wjg.v24.i28.3055
Non-pharmacological therapies for inflammatory bowel disease: Recommendations for self-care and physician guidance
Sharyle Fowler, Paulette Hunter, Jane Alcorn, Gillian Potter, Natasha Haskey, Whitney Duff
Whitney Duff, College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan S7N 5B2, Canada
Natasha Haskey, Irving K Barber School of Arts and Science, University of British Columbia-Okanagan, Kelowna, British Columbia V1V 1V7, Canada
Gillian Potter, Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan S7N 5A5, Canada
Jane Alcorn, College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan S7N 5E5, Canada
Paulette Hunter, St Thomas More College, University of Saskatchewan, Saskatoon, SK S7N 0W6, Canada
Sharyle Fowler, Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan S7N 0W8, Canada
Author contributions: Duff W, Haskey N, and Potter G designed research, performed research, analysed data, and wrote the paper; Alcorn J, Hunter P, and Fowler S designed research and wrote the paper.
Conflict-of-interest statement: No potential conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Whitney Duff, MD, PhD, Doctor, College of Kinesiology, University of Saskatchewan, 87 Campus Drive, Saskatoon, Saskatchewan S7N 5B2, Canada. Whitney.duff@usask.ca
Telephone: +1-306-9661082 Fax: +1-306-9666464
Received: March 14, 2018
Peer-review started: March 14, 2018
First decision: April 18, 2018
Revised: April 23, 2018
Accepted: June 2, 2018
Article in press: June 2, 2018
Published online: July 28, 2018
Abstract

We performed a scoping review on sought-after complementary therapies for patients with inflammatory bowel disease (IBD), specifically diet, physical activity and exercise (PA/E), and psychotherapy. We aim to update patients with IBD on therapies for self-care and provide physicians with guidance on how to direct their patients for the management of IBD. A search of MEDLINE, EMBASE, and PUBMED was completed in Sept 2016. Studies on diet, PA/E, or psychotherapy in patients with IBD were included. Medical Subject Heading terms and Boolean operators were used. The search was limited to full-text English articles describing an adult population. This review included 67 studies: Diet (n = 19); PA/E (n = 19); and psychotherapy (n = 29). We have made the following recommendations: (1) Diet: Consumption of diets rich in vegetables, fruit and soluble fiber may be beneficial in IBD. A trial of a low FODMAP diet can be considered in those patients with functional gastrointestinal symptoms. Restrictive diets are lacking in evidence and should be avoided; (2) PA/E: Regular low-moderate intensity activity, including cardiovascular and resistance exercise, has been shown to improve quality of life (QOL) and may improve inflammation; and (3) psychotherapy: Therapies such as cognitive-behavioural interventions, mindfulness, hypnosis, and stress management have been shown to improve QOL, but evidence is limited on their impact on anxiety, depression, and disease activity. Overall, these complementary therapies are promising and should be used to treat patients with IBD from a more holistic perspective.

Keywords: Scoping review, Inflammatory bowel disease, Diet, Exercise, Psychotherapy

Core tip: For diet, consumption of diets rich in vegetables, fruit and soluble fiber may be beneficial in inflammatory bowel disease. A low FODMAP diet can be considered in those patients with functional gastrointestinal symptoms. Restrictive diets are lacking in evidence and should be avoided. Regular low-moderate intensity activity has been shown to improve quality of life (QOL) and may improve inflammation. Therapies such as cognitive-behavioural interventions, mindfulness, hypnosis, and stress management have been shown to improve QOL, but limited evidence shown the impact on anxiety, depression, and disease activity.