Inflammatory Bowel Disease

Patients with Crohn's disease have widespread and intermittent gastrointestinal inflammation. Some patients with inflammatory bowel disease may require complete bowel rest for several days or even a few weeks to allow time for mucosal healing. In order to provide nutrition during this period, parenteral nutrition may be needed.

Numerous studies have shown that patients with Crohn's disease may safely and effectively achieve clinical remission with primary nutritional therapy. Early literature in the field highlighted the use of protein hydrolysate formulas that, due to unpalatability, often required supplementation with a nasogastric or gastrostomy tube. Recent data have confirmed that intact protein formulas, termed 'polymeric' formulas when describing formulas designed for adults, may work as well as protein hydrolysates, and these formulas can feasibly be given by mouth.

As patients are recovering from an exacerbation and begin advancing their diet, they should temporarily minimize the amount of fiber ingested to decrease trauma to healing mucosa. Patients whose disease affects the small intestine often benefit from temporary avoidance of lactose products as the mucosa heals and brush border membrane enzyme production is restored.

Micronutrients are also needed in the nutritional management of inflammatory bowel disease. Iron supplementation is recommended for anemia that may be secondary to acute or chronic blood loss. Treatment of inflammatory bowel disease frequently requires the use of steroids, which affects bone density. Calcium and vitamin D supplementation is commonly needed to minimize the osteopenic effects of steroid therapy and/or the effects of malabsorption and chronic inflammation.

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