Initial approach to nutrition and dietary management for adult patients with inflammatory bowel disease in the outpatient setting

IBD: inflammatory bowel disease; IBS: irritable bowel syndrome; FODMAP: fermentable oligo- di- and monosaccharides and polyols.
* We determine if a patient has undernutrition based on our review of the following: Clinical history, dietary assessment, body mass index, and physical examination.
¶ Disease severity is based on clinical, endoscopic, and histologic assessment. Please refer to UTD topics on the evaluation and management of adult patients with Crohn disease or ulcerative colitis.
Δ The goal of induction therapy is to achieve clinical, endoscopic, and histologic remission. Please refer to UTD topics on medical management of inflammatory bowel disease.
◊ For patients who have undernutrition, individualized nutritional management is guided either by a clinican with expertise in nutrition or jointly by the clinician and dietician.
§ The goal of maintenance therapy is to prevent disease relapse. Please refer to UTD topics on medical management of inflammatory bowel disease.
¥ For patients with chronic stricturing Crohn disease resulting in luminal narrowing and/or prior bowel obstruction, we advise them to adhere to a low fiber diet (ie, limit of 5 grams of fiber daily).
‡ A low FODMAP diet is one that is low in fermentable oligo-, di-, and monosaccharides and polyols. Low FODMAP dietary education is provided by a dietician to avoid unnecessary dietary over-restriction.
† Symptoms suggestive of lactose intolerance include bloating, abdominal pain, and/or diarrhea following lactose ingestion.