Perioperative dietary therapy in inflammatory bowel disease

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 randomized controlled trials of dietary therapy are lacking, expert IBD centres have long established interdisciplinary care, including tailored nutritional therapy, to optimize clinical outcomes and resource utilization. This topical review aims to share expertise and offers current practice recommendations to optimize 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 optimization, 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 that address the needs of IBD patients perioperatively and in the long term following surgery. Routine screening, perioperative optimization 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. CONCLUSION: Perioperative dietary therapy improves the outcomes of IBD patients who undergo a surgical procedure. This topical review shares interdisciplinary expertise and provides guidance to optimize the outcomes of patients with Crohn's disease and ulcerative colitis taking advantage of contemporary nutrition science.