Dietary Management of Inflammatory
Bowel Disease (IBD)
Types of Inflammatory Bowel Disease (IBD) - answer> Crohns Disease (CD)
> Ulcerative Colitis (UC)
Onset and Prevalence - answer> Chronic relapsing debilitating disborder of the small or
large intestine or both
> Periods of inactivity (remission) and activity (relapse)
> Anyone can develop IBD
> Age of onset 10-40 years
> More common in developed countries
> 146,000 affected by ulcerated colitis
> 115,000 affected by crohn's disease
Genetic Factors - answer> Established through family studies
> Seen more in crohns thant in UC
> Genetic defect
Microbiota - answer> Compositional & functional changes
> Invasion of epithelial cells of pathogenic bacteria, cytokines, dysregulated immune
response, damage to intestinal barrier
Immune factors - answer> Abnormal intestinal permeability
> Defects in mucus production
> Inadequate, progressive production of proinflammatory cytokines e.g. TNF
Environmental Triggers - Diet - answer> Carbohydrate - study by Sakamoto et. al -
Japan using semi-structures FFQ pre-illness
> 108 crohns disease. 126 with UC (and 211 controls)
> Increased consumption of sugars, sweeteners and sweets was positively associated
with increased risk of crohns
> Higher consumption of sweets with UC
> High intake of fruit and veg reduced risk of both ?Due to NSP
> Protein, positive association iwth animal meat, fats, milk and diary products
> Saccharin and sucralose
> Other triggers - smoking
Fibre intake and the development of inflammatory bowel disease: A European
prospective multi-centre cohort study (EPIC-IBD). Andersen et.al. (2018) - answer>
Cohort study
> 401326 participants, 8 countries, 1991-1998
, > Baseline fibre intake recorded FFQ
> Monitored for the development of UC or CD
> Match with 4 controls
> Ther were no differences in the median intakes of either total or the specific types of
fibres between cases and controls
> No associations with the intakes of total fibre, or fibre from fruit. vegetables or cereals,
and the subsequent developement of either CD or UC
Crohn's Clinical features - answer> Patchy, transmural (deep) inflammation which may
affect any part of the GI tract from mouth to anus
> Most commonly affects the small bowel and colon
> Abdominal pain, diarrhoea, weight loss
> May cause intestinal obstruction due to strictures, fistulae or abscesses
> Surgery is not curative
> 50% of pts may require surgical treatment in the first 10 years of disease
> Often associated inflammation of joints, skin or eyes
UC clinical features - answer> Diffuse mucosal inflammation in the colon
> if the inflammation is only in the rectum it is known as proctitis
> Blood diarrhoea, colicky abdominal pain urgency
> About 50% of patients have a relapse in any year
> 20-30% of pts with pancolitis (spread throughout the large intestine) come to
colectomy
> Surgery is curative
Clinical presentation of IBD - answer> Growth failure/delayed puberty in children
> Diarrhoea
> Increased bowel frequency
> Urgency
> Blood & mucus in stools
> Fatigue
> Anaemia
> Abdominal pain
> Weight loss
> Fever
> Perianal abcessess/discharge
> Nausea/vomiting
> Joint liver eye and skin conditions
> Reduced QoL
Diagnosis - answer> History and examination
> Investigations:
- Bloods (FBC, electrolytes, LFT's, ESR/CRp, ferritin, B12, folate) WBC
- Stool sample, faecal calprotectin >70mg/kg positive appropriate for further tests
- Abdominal X-ray
> Endoscopy
Bowel Disease (IBD)
Types of Inflammatory Bowel Disease (IBD) - answer> Crohns Disease (CD)
> Ulcerative Colitis (UC)
Onset and Prevalence - answer> Chronic relapsing debilitating disborder of the small or
large intestine or both
> Periods of inactivity (remission) and activity (relapse)
> Anyone can develop IBD
> Age of onset 10-40 years
> More common in developed countries
> 146,000 affected by ulcerated colitis
> 115,000 affected by crohn's disease
Genetic Factors - answer> Established through family studies
> Seen more in crohns thant in UC
> Genetic defect
Microbiota - answer> Compositional & functional changes
> Invasion of epithelial cells of pathogenic bacteria, cytokines, dysregulated immune
response, damage to intestinal barrier
Immune factors - answer> Abnormal intestinal permeability
> Defects in mucus production
> Inadequate, progressive production of proinflammatory cytokines e.g. TNF
Environmental Triggers - Diet - answer> Carbohydrate - study by Sakamoto et. al -
Japan using semi-structures FFQ pre-illness
> 108 crohns disease. 126 with UC (and 211 controls)
> Increased consumption of sugars, sweeteners and sweets was positively associated
with increased risk of crohns
> Higher consumption of sweets with UC
> High intake of fruit and veg reduced risk of both ?Due to NSP
> Protein, positive association iwth animal meat, fats, milk and diary products
> Saccharin and sucralose
> Other triggers - smoking
Fibre intake and the development of inflammatory bowel disease: A European
prospective multi-centre cohort study (EPIC-IBD). Andersen et.al. (2018) - answer>
Cohort study
> 401326 participants, 8 countries, 1991-1998
, > Baseline fibre intake recorded FFQ
> Monitored for the development of UC or CD
> Match with 4 controls
> Ther were no differences in the median intakes of either total or the specific types of
fibres between cases and controls
> No associations with the intakes of total fibre, or fibre from fruit. vegetables or cereals,
and the subsequent developement of either CD or UC
Crohn's Clinical features - answer> Patchy, transmural (deep) inflammation which may
affect any part of the GI tract from mouth to anus
> Most commonly affects the small bowel and colon
> Abdominal pain, diarrhoea, weight loss
> May cause intestinal obstruction due to strictures, fistulae or abscesses
> Surgery is not curative
> 50% of pts may require surgical treatment in the first 10 years of disease
> Often associated inflammation of joints, skin or eyes
UC clinical features - answer> Diffuse mucosal inflammation in the colon
> if the inflammation is only in the rectum it is known as proctitis
> Blood diarrhoea, colicky abdominal pain urgency
> About 50% of patients have a relapse in any year
> 20-30% of pts with pancolitis (spread throughout the large intestine) come to
colectomy
> Surgery is curative
Clinical presentation of IBD - answer> Growth failure/delayed puberty in children
> Diarrhoea
> Increased bowel frequency
> Urgency
> Blood & mucus in stools
> Fatigue
> Anaemia
> Abdominal pain
> Weight loss
> Fever
> Perianal abcessess/discharge
> Nausea/vomiting
> Joint liver eye and skin conditions
> Reduced QoL
Diagnosis - answer> History and examination
> Investigations:
- Bloods (FBC, electrolytes, LFT's, ESR/CRp, ferritin, B12, folate) WBC
- Stool sample, faecal calprotectin >70mg/kg positive appropriate for further tests
- Abdominal X-ray
> Endoscopy
