Abstract
Due to the intestinal inflammation, tissue damage, and painful abdominal symptoms restricting dietary intake associated with both diseases, patients with intestinal pelvic radiation disease (PRD) or inflammatory bowel disease (IBD) are at increased risk to develop protein calorie malnutrition and micronutrient deficiencies. In the current paper, we review the nutritional management of both diseases, listing the similar approaches of nutritional management and the nutritional implications of intestinal dysfunction of both diseases. Malnutrition is prevalent in patients with either disease and nutritional risk screening and assessment of nutritional status are required for designing the proper nutritional intervention plan. This plan may include dietary management, oral nutritional supplementation, and enteral and/or parenteral nutrition. In addition to managing malnutrition, nutrients exert immune modulating effects during periods of intestinal inflammation and can play a role in mitigating the risks associated with the disease activity. Consistently, exclusive enteral feeding is recommended for inducing remission in pediatric patients with active Crohn's disease, with less clear guidelines on use in patients with ulcerative colitis. The field of immune modulating nutrition is an evolving science that takes into consideration the specific mechanism of action of nutrients, nutrient-nutrient interaction, and preexisting nutritional status of the patients.
Highlights
Inflammatory bowel disease (IBD) comprising Crohn’s disease (CD) and ulcerative colitis (UC) is a major health problem
The many factors that contribute to malnutrition such as weight loss, decreased intake, absorption, or digestion and increased diarrhea, vomiting, or steatorrhea are present in patients with intestinal pelvic radiation disease (PRD) leading to the assumption that malnutrition is present
Nutrition plays a major role meeting the nutritional needs for patients with both diseases but enteral nutrition exerts immune modulating effects that could help optimize the management of the two diseases
Summary
Inflammatory bowel disease (IBD) comprising Crohn’s disease (CD) and ulcerative colitis (UC) is a major health problem. The many factors that contribute to malnutrition such as weight loss, decreased intake, absorption, or digestion and increased diarrhea, vomiting, or steatorrhea are present in patients with intestinal PRD leading to the assumption that malnutrition is present. It is important to minimize any food restrictions in order to ensure enough protein and calories are being consumed to prevent weight loss and malnutrition These goals can be achieved through diet and with the help of oral nutritional supplementation (ONS), enteral tube feeding, or a combination of all. ONS can be useful in helping patients consume enough calories and protein to meet their elevated nutritional needs given the catabolic state of inflammation induced by radiation or active disease. ONS should be considered when patients are at risk for malnutrition [24]
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