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World J Gastroenterol. Feb 21, 2016; 22(7): 2179-2194
Published online Feb 21, 2016. doi: 10.3748/wjg.v22.i7.2179
Diet therapy for inflammatory bowel diseases: The established and the new
Franziska Durchschein, Wolfgang Petritsch, Heinz F Hammer
Franziska Durchschein, Wolfgang Petritsch, Heinz F Hammer, Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, 8036 Graz, Austria
Author contributions: Durchschein F searched literature, drafted the manuscript, incorporated corrections by coauthors into the final manuscript and organized details for submission of manuscript; Petritsch W reviewed the manuscript and approved the final manuscript; Hammer HF contributed to writing the manuscript, reviews and corrections, final approval and submission.
Conflict-of-interest statement: The authors declare no conflict of interest related to this publication.
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: Heinz F Hammer, MD, Associate Professor of Internal Medicine and Gastroenterology, Division of Gastroenterology and Hepatology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria. heinz.hammer@medunigraz.at
Telephone: +43-316-38580269 Fax: +43-316-38512648
Received: June 25, 2015
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
Processing time: 219 Days and 20.4 Hours
Abstract

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.

Keywords: Enteral nutrition; Parenteral nutrition; Probiotics; Fermentable oligo-, di-, and monosaccharides and polyols; Crohn’s disease; Ulcerative colitis

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.