ESPEN guideline: Clinical nutrition in inflammatory bowel disease
Open accessAbstract
Introduction The ESPEN guideline presents a multidisciplinary focus on clinical nutrition in inflammatory bowel disease (IBD). Methodology The guideline is based on extensive systematic review of the literature, but relies on expert opinion when objective data were lacking or inconclusive. The conclusions and 64 recommendations have been subject to full peer review and a Delphi process in which uniformly positive responses (agree or strongly agree) were required. Results IBD is increasingly common and potential dietary factors in its aetiology are briefly reviewed. Malnutrition is highly prevalent in IBD - especially in Crohn's disease. Increased energy and protein requirements are observed in some patients. The management of malnutrition in IBD is considered within the general context of support for malnourished patients. Treatment of iron deficiency (parenterally if necessary) is strongly recommended. Routine provision of a special diet in IBD is not however supported. Parenteral nutrition is indicated only when enteral nutrition has failed or is impossible. The recommended perioperative management of patients with IBD undergoing surgery accords with general ESPEN guidance for patients having abdominal surgery. Probiotics may be helpful in UC but not Crohn's disease. Primary therapy using nutrition to treat IBD is not supported in ulcerative colitis, but is moderately well supported in Crohn's disease, especially in children where the adverse consequences of steroid therapy are proportionally greater. However, exclusion diets are generally not recommended and there is little evidence to support any particular formula feed when nutritional regimens are constructed. Conclusions Available objective data to guide nutritional support and primary nutritional therapy in IBD are presented as 64 recommendations, of which 9 are very strong recommendations (grade A), 22 are strong recommendations (grade B) and 12 are based only on sparse evidence (grade 0); 21 recommendations are good practice points (GPP).
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Many guidelines and studies recommend that in initial stages of dysphagia, adequate nutrition intake may be achieved through dietary modification to include soft, semisolid, or semi-liquid consistencies, partnered with appropriate swallowing techniques.
“In initial stages of dysphagia, adequate”
From ESPEN guideline on hospital nutrition (2021) · cites this paper as [189]
The guideline’s commentary on Crohn’s disease strictures recommends soft foods or nutritious fluids for intestinal obstruction, not for dysphagia. Its nutrition-route commentary says enteral feeding should be considered when a patient cannot swallow safely. Neither passage addresses whether modified food consistencies and swallowing techniques maintain adequate intake in early dysphagia (searched: dysphagia, soft or semi-liquid consistencies, swallowing techniques). (LLM, conf=0.76)
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Self-citation
- Authors
- Forbes, A., Escher, J., Hébuterne, X., Kłęk, S., Krznaric, Z., Schneider, S., Shamir, R., Stardelova, K., Wierdsma, N., Wiskin, A. E., & Bischoff, S. C.
- Affiliations
- University of East Anglia (GB)
- Erasmus MC (NL)
- Université Côte d'Azur (FR)
- Szpital Wielospecjalistyczny im. Stanley Dudricka w Skawinie (PL)
- Tel Aviv University (IL)
- Ss. Cyril and Methodius University in Skopje (MK)
- Amsterdam UMC Location Vrije Universiteit Amsterdam (NL)
- Bristol Royal Hospital for Children (GB)
- University of Hohenheim (DE)
- Corresponding author
- Forbes, Alastair
- Escher, Johanna
- Hébuterne, Xavier
- Kłęk, Stanisław
- Schneider, Stéphane
- Shamir, Raanan
- Stardelova, Kalina
- Wierdsma, Nicolette
- Wiskin, Anthony E.
- Bischoff, Stephan C.
- ORCID
- Venue
- Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2017-04
- Volume
- 36
- Issue
- 2
- Pages
- 321-347
- ISSN
- 0261-5614 (ISSN-L)
- OpenAlex
- W2561294066
- Cited by
- 625
- References
- 342
- Citations by year
- 2026: 32 · 2025: 39 · 2024: 60 · 2023: 73 · 2022: 73 · 2021: 102 · 2020: 104 · 2019: 75 · 2018: 43 · 2017: 21 · 2014: 1
- FWCI
- 8.52
- Type
- journal article
- Language
- en
- Status
- Retracted
- Update notices
- Open access
- green
- ueaeprints.uea.ac.uk
- Locations
- Clinical Nutrition (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
- UEA Digital Repository (University of East Anglia) (acceptedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
- Pure Amsterdam UMC (submittedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (submittedVersion)
- RePub (Erasmus University Rotterdam) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- ESPEN
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Inflammatory Bowel Disease
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Health Professions › Health Information Management › Dietetics, Nutrition, and Education
- Keywords
- inflammatory bowel disease, Crohn's disease, ulcerative colitis, nutritional support, malnutrition, energy and protein requirements, iron deficiency, parenteral nutrition, enteral nutrition, perioperative care, probiotics, dietary therapy, elimination diet, bottle feeding, pediatric inflammatory bowel disease, steroid-sparing therapy
- MeSH terms
- Breast Feeding, Diet, Dietary Fats, Dietary Fiber, Dietary Proteins, Humans, Nutritional Requirements, Meta-Analysis as Topic, Inflammatory Bowel Diseases, Randomized Controlled Trials as Topic, Practice Guidelines as Topic, Nutritional Support, Micronutrients, Probiotics, Malnutrition
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