Which patient would be the best candidate for a trial of dietary therapy for IBD?
67-year-old man with a PMH of mild ulcerative colitis (proctitis), treated with rectal mesalamine with intermittent flares who would like to consider diet therapy to reduce the need for topical steroids when he flares.
Incorrect, try again!
19-year-old man with a PMH of mild to moderate ileo-colonic Crohn’s disease who is having a flare and is now inquiring about dietary therapeutics instead of starting steroids to treat the flare while discussing biologic initiation.
Correct!
The current data supports the use of enteral nutrition as a therapeutic modality for patients with mild to moderate Crohn’s disease. There is no consensus on its use in patients with ulcerative colitis.
Some points to consider when deciding if a patient is a good candidate for dietary therapeutics, such as exclusive enteral nutrition:
•Is the patient motivated to try a diet to treat their IBD? This is an important question as it can be very hard to make a dietary change and it will often impact the entire family. It is important to assess the patient’s motivation and goals with the diet.
•Diet is often used as a bridge to a new medication or as a steroid preserving agent while another medication takes effect. EEN is not a good long-term solution, as it is difficult to sustain. After inducing remission with EEN, it is important to have a plan for transitioning the patient to solid food. Maintaining remission can be accomplished with medical therapies such as a biologic and/or additional dietary strategies that are more sustainable.
•Patients with a history of an eating disorder or disordered eating should not try a dietary therapeutic trial.
•Be cautious with patients whose work revolves around eating- it can be very hard for a chef or food critic to start one of these formula-based diets, as their social and work environments revolve around solid food.
28-year-old woman with a new diagnosis of mild isolated ileal Crohn’s disease with no complications (no fistula/stricture/abscess) who is very interested in diet and nutrition, as she recovered from an eating disorder as a child.
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48-year-old woman with 5 cm of ileal Crohn’s disease, not on therapy due to concerns about medication safety, who works as a chef in a 5-star restaurant and is very interested in hearing more about diet and IBD.
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