Abstract
The etiopathogenesis of Inflammatory bowel disease (IBD) is a result of a complex interaction between host immune response, the gut microbiome and environmental factors, such as diet. Although scientific advances, with the use of biological medications, have revolutionized IBD treatment, the challenge for maintaining clinical remission and delaying clinical relapse is still present. As exclusive enteral nutrition has become a well-established treatment for the induction of remission in pediatric Crohn’s disease, the scientific interest regarding diet in IBD is now focused on the development of follow-on dietary strategies, which aim to suppress colonic inflammation and delay a disease flare. The objective of this review is to present an extensive overview of the dietary strategies, which have been used in the literature to maintain clinical remission in both Crohn’s disease and Ulcerative colitis, and the evidence surrounding the association of dietary components with clinical relapse. We also aim to provide study-related recommendations to be encompassed in future research studies aiming to investigate the role of diet during remission periods in IBD.
Highlights
Inflammatory bowel diseases (IBD) are chronic, relapsing and debilitating inflammatory disorders, of which Crohn’s disease (CD) and Ulcerative colitis (UC) are the most common [1]
We aimed to provide a list with essential and desirable study-related characteristics, which we believe, should form the basis of future research investigating the role of diet in prolonging clinical remission in IBD
We propose several essential and desirable features that we believe should be incorporated in the design of trials investigating dietary therapies for maintenance of clinical remission and observational studies, aiming to identify dietary triggers of relapse in IBD (Table 2)
Summary
Inflammatory bowel diseases (IBD) are chronic, relapsing and debilitating inflammatory disorders, of which Crohn’s disease (CD) and Ulcerative colitis (UC) are the most common [1]. Multiple lines of research, including systematic reviews, meta-analyses and Cochrane reviews, have demonstrated the efficacy of EEN, in children with CD, with clinical remission rates at least comparable to those from corticosteroids [19,20,21,22]. EEN efficacy has not yet been demonstrated consistently in adult populations, it is suggested that this is partly a result of lower compliance, potentially derived from limited formula palatability and a lack of established support mechanisms from the relevant clinical teams [23]. We aimed to provide a list with essential and desirable study-related characteristics, which we believe, should form the basis of future research investigating the role of diet in prolonging clinical remission in IBD
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