17December2019

Collaborative ECCO Topical Review: Perioperative dietary therapy in IBD

Catherine Wall, D-ECCO Member

No video selected.

Catherine Wall
© ECCO

Definition of collaboration (noun): 1. the action of working with someone to produce something or 2. traitorous cooperation with an enemy!6.

Collaborative projects, such as topical reviews, are excellent opportunities to increase communication between ECCO Members and encourage clinicians and researchers from across disclipines to work together to achieve a common goal. Furthermore, collaborative working, in clinical practice and research, allows us to appreciate and utilise the specialised perspectives of our peers. Clinical collaboration (a multidisclipinary team) provides a structured setting where cross-discipline discussion of complex clinical cases can occur. A multidisclipinary Inflammatory Bowel Disease (IBD) model of care is recommended [1] and can be effective [2, 3]; however, the structure of the team will likely vary by site depending on the aim and expertise of each IBD service [2–4].

Last year the D-ECCO and S-ECCO Committees initiated a collaborative topical review of dietary therapy before, during and after IBD surgery. The aim and outcomes of this topical review are summarised below. The members of D-ECCO look forward to working more closely with the wider ECCO Community on many future projects.

Why was a topical review of perioperative dietary therapy in IBD initiated?

It is well documented that malnourished patients have poorer surgical outcomes than well-nourished patients. However, in an IBD population poor nutritional status may present in many forms. The aim of this review is to summarise and interpret the current literature and provide clinicians with practice recommendations in order to achieve the best outcomes for their IBD patients who require surgery.

What are the outcomes of the review?

The topical review contains 26 practice positions that encompass the whole surgical care pathway, from screening the nutritional status of patients who need surgery through to long-term outcomes of surgery. A summary of the evidence accompanies each practice statement. Readers are encouraged to read the full topical review here; we trust you will find it a useful document to support your clinical practice.

Example practice positions

The following are a selection of practice statements from different stages of the surgical care pathway.

Aetiology, presentation and assessment of malnutrition 

“ECCO Current Practice Position 1.2

Micronutrient deficiency may be seen in IBD and is often associated with complicated disease. Reliable assessment of body micronutrient status requires patients to be in biochemical remission. Plasma protein, such as albumin, should not be used as markers of nutrition in active disease. Correction of micronutrient deficiency is best achieved by a multidisclipary team.”

Perioperative nutritional optimisation in Crohn’s Disease

“ECCO Current Practice Position 2.1

Malnutrition is common amoung Crohn’s Disease patients awaiting surgery and is a risk factor for adverse postoperative outcomes and complications.”

Postoperative nutritional care in IBD

“ECCO Current Practice Position 3.1

Postoperative nutritional status in IBD patients should be assessed and appropriate nutritional support provide in a timely manner.”

Long-term nutritional needs

“ECCO Current Practice Position 4.1

There is no evidence to support withholding dietary fibre in patients with IBD with the exception of patients with stricturing Crohn’s Disease.”

References

  1. Lamb CA, Kennedy NA, Raine T, et al. British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults. Gut. 2019;68(Suppl 3):s1–s106.
  2. Tulchinsky H, Dotan I, Alper A, et al. Comprehensive pouch clinic concept for follow-up of patients after ileal pouch anal anastomosis: report of 3 years' experience in a tertiary referral center. Inflamm Bowel Dis. 2008;14:1125–32.
  3. Ferman M, Lim AH, Hossain M et al. Multidisciplinary team meetings appear to be effective in inflammatory bowel disease management: an audit of process and outcomes. Internal Med J. 2018;482:1102–8.
  4. Morar PS, Sevdalis N, Warusavitarne J, et al. Establishing the aims, format and function for multidisciplinary team-driven care within an inflammatory bowel disease service: a multicentre qualitative specialist-based consensus study Frontline Gastroenterol. 2018;9:29–36.
  5. Ianco O, Tulchinsky H, Lusthaus M, et al. Diet of patients after pouch surgery may affect pouch inflammation. World J Gastroenterol. 2013;19(38):6458-6464. doi:10.3748/wjg.v19.i38.6458

Posted in ECCO News, Committee News, D-ECCO, Volume 14, Issue 4