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DOP05 Perioperative Dietary Therapy in inflammatory bowel disease

M. Adamina1, K. Gerasimidis2, R. Sigall-Boneh3,4, O. Zmora5, A. de Buck van Overstraeten6,7, M. Campmans-Kuijpers8, P. Ellul9, K. Katsanos10, P. Kotze11, N. Noor12, J. Schäfli-Thurnherr13, S. Vavricka13, C. Wall14, N. Wierdsma15, N. Yassin16, M. Lomer17, ECCO Topical Review on Perioperative Dietary Therapy in Inflammatory Bowel Disease

1Department of Visceral and Thoracic Surgery, Kantonsspital Winterthur, Winterthur, Switzerland, 2Department of Human Nutrition, Glasgow Royal Infirmary, School of Medicine, Dentistry and Nursing, Glasgow, UK, 3Pediatric Gastroenterology and Nutrition Unit, Wolfson Medical Center, PIBD Research Center, Holon, Israel, 4Sackler faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, 5Department of Surgery, Assaf Harofeh Medical Center, Tel Aviv, Israel, 6Department of Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada, 7Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada, 8Department of Gastroenterology and Hepatology, University Medical Centre Groningen, Groningen, The Netherlands, 9Department of Medicine, Division of Gastroenterology, Mater Dei Hospital, Msida, Malta, 10Division of Gastroenterology, University Hospital of Ioannina, Ionnanina, Greece, 11Colorectal Surgery Unit, Catholic University of Paraná, Curitiba, Brazil, 12Department of Gastroenterology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK, 13Department of Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland, 14Department of Nutritional Sciences, King’s College London, London, UK, 15Department of Nutrition and Dietetics, Amsterdam UMC, location VU University Medical Centre, Amsterdam, The Netherlands, 16Department of Colorectal Surgery, The Royal Wolverhampton Hospitals, Wolverhampton Hospital, Wolverhampton, UK, 17Guy’s and St Thomas’ NHS Foundation Trust and King’s College, London, London, UK

Background

The incidence of inflammatory bowel disease [IBD] is rising worldwide and no cure is available. Many patients require surgery and they often present with nutritional deficiencies. Although randomised controlled trials of dietary therapy are lacking, expert IBD centres have long-established interdisciplinary care, including tailored nutritional therapy, to optimise clinical outcomes and resource utilisation. This topical review aims to share expertise and offers current practice recommendations to optimise outcomes of IBD patients who undergo surgery.

Methods

A consensus expert panel consisting of dietitians, surgeons, and gastroenterologists, convened by the European Crohn’s and Colitis Organisation, performed a systematic literature review. Nutritional evaluation and dietary needs, perioperative optimisation, surgical complications, long-term needs, and special situations were critically appraised. Statements were developed using a Delphi methodology incorporating three successive rounds. Current practice positions were set when ≥80% of participants agreed on a recommendation.

Results

A total of 26 current practice positions were formulated which address the needs of IBD patients perioperatively and in the long term following surgery. Routine screening, perioperative optimisation by oral, enteral, or parenteral nutrition, dietary fibre, and supplements were reviewed. IBD-specific situations, including management of patients with a restorative proctocolectomy, an ostomy, strictures, or short-bowel syndrome, were addressed.

Conclusion

Perioperative dietary therapy improves the outcomes of IBD patients who undergo a surgical procedure. This topical review shares interdisciplinary expertise and provides guidance to optimise the outcomes of patients with Crohn’s disease and ulcerative colitis. taking advantage of contemporary nutrition science.

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