Nutritional Therapy in Inflammatory Bowel Disease

Chen Sarbagili-Shabat; Rotem Sigall-Boneh; Arie Levine

Disclosures

Curr Opin Gastroenterol. 2015;31(4):303-308. 

In This Article

Abstract and Introduction

Abstract

Purpose of review An increasing body of evidence has linked diet to inflammatory bowel diseases (IBD), both Crohn's disease and ulcerative colitis. Most of our current knowledge pertains to the link between diet and Crohn's disease. Exclusive enteral nutrition and partial enteral nutrition are the best known dietary intervention for the induction of remission and maintenance of remission in Crohn's disease both in children and in adults, but the mechanism whereby these interventions may cause or maintain remission and mucosal healing has remained elusive.

Recent findings Recent studies have shed light on the possible mechanisms of response to dietary intervention. Epidemiological and rodent model studies over the last year have supplied us with several dietary candidates for an effect of diet on inflammation and disease pathogenesis. Others have shed insight into the effect of diet on dysbiosis and the microbiota. An elimination diet based on some of these candidates has shown clinical efficacy, and bridged the knowledge obtained from rodent models to a human intervention.

Summary These studies may allow better understanding of the pathogenesis of IBD and provide new tools to treat these difficult diseases. Elimination diets based on the identification of deleterious dietary components may pave the way for an improved control of the disease in the future.

Video abstract: http://links.lww.com/COG/A10.

Introduction

Dietary therapy is an established, but underutilized and poorly understood therapy that can induce and maintain remission in Crohn's disease.[1–3] Dietary therapy offers the possibility of reducing the burden of immunosuppressive medications, promoting growth in children, and providing insight into the possible environmental factors that may impact the disease.

Inflammatory bowel diseases (IBD) arise at the interface between the resident intestinal bacteria and the innate immune system. These diseases are characterized by a decrease in microbial diversity, dysbiosis and epithelial damage.[4,5] Under normal circumstances, the mucous layer, intestinal epithelial cells and the tight junctions serve as an efficient barrier to potentially harmful bacteria, whereas the innate immune system serves as a backup mechanism to exclude enteric bacteria from penetrating or interacting with the mucosal immune cells.[3–12] Multiple studies raise the possibility that a variety of dietary factors may be associated with IBD. These include epidemiologic studies[13,14] demonstrating a protective or harmful effect for dietary components, and rodent models that demonstrate the ability of dietary factors to induce dysbiosis, increase colonization or adherence of pathobionts associated with Crohn's disease, or to impair the barrier function.[3,13–16] The current review will summarize the studies published over the last year that provide new insight into the role of diet on the pathogenesis and treatment for all IBD patients. As a result of the large body of literature available on vitamin D, we have excluded this component from the review.

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