Diet therapy for inflammatory bowel diseases: The established and the new

World J Gastroenterol. 2016 Feb 21;22(7):2179-94. doi: 10.3748/wjg.v22.i7.2179.


Although patients with inflammatory bowel diseases (IBD) have a strong interest in dietary modifications as part of their therapeutic management, dietary advice plays only a minor part in published guidelines. The scientific literature shows that dietary factors might influence the risk of developing IBD, that dysbiosis induced by nutrition contributes to the pathogenesis of IBD, and that diet may serve as a symptomatic treatment for irritable bowel syndrome-like symptoms in IBD. The role of nutrition in IBD is underscored by the effect of various dietary therapies. In paediatric patients with Crohn's disease (CD) enteral nutrition (EN) reaches remission rates similar to steroids. In adult patients, however, EN is inferior to corticosteroids. EN is not effective in ulcerative colitis (UC). Total parenteral nutrition in IBD is not superior to steroids or EN. The use of specific probiotics in patients with IBD can be recommended only in special clinical situations. There is no evidence for efficacy of probiotics in CD. By contrast, studies in UC have shown a beneficial effect in selected patients. For patients with pouchitis, antibiotic treatment followed by probiotics, like VSL#3 or Lactobacillus GG, is effective. When probiotics are used, the risk of bacterial translocation and subsequent bacteremia has to be considered. More understanding of the normal intestinal microflora, and better characterization of probiotic strains at the phenotypic and genomic levels is needed as well as clarification of the mechanisms of action in different clinical settings. A FODMAP reduced diet may improve symptoms in IBD.

Keywords: Crohn’s disease; Enteral nutrition; Fermentable oligo-, di-, and monosaccharides and polyols; Parenteral nutrition; Probiotics; Ulcerative colitis.

Publication types

  • Review

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Colitis, Ulcerative / diagnosis
  • Colitis, Ulcerative / immunology
  • Colitis, Ulcerative / physiopathology
  • Colitis, Ulcerative / therapy*
  • Crohn Disease / diagnosis
  • Crohn Disease / immunology
  • Crohn Disease / physiopathology
  • Crohn Disease / therapy*
  • Diet, Carbohydrate-Restricted* / adverse effects
  • Dietary Carbohydrates / adverse effects
  • Dietary Carbohydrates / metabolism
  • Enteral Nutrition* / adverse effects
  • Fermentation
  • Gastrointestinal Microbiome
  • Humans
  • Intestines / microbiology
  • Nutritional Status
  • Parenteral Nutrition, Total* / adverse effects
  • Probiotics / adverse effects
  • Probiotics / therapeutic use*
  • Remission Induction
  • Treatment Outcome


  • Adrenal Cortex Hormones
  • Dietary Carbohydrates

Supplementary concepts

  • Pediatric Crohn's disease
  • Pediatric ulcerative colitis