Michel Adamina1,2, Konstantinos Gerasimidis3, Rotem Sigall-Boneh4,5, Oded Zmora6, Anthony de Buck van Overstraeten7, Marjo Campmans-Kuijpers8, Pierre Ellul9, Konstantinos Katsanos10, Paulo Gustavo Kotze11, Nurulamin Noor12, Judit Schäfli-Thurnherr1, Stephan Vavricka13, Catherine Wall14, Nicolette Wierdsma15, Nuha Yassin16, Miranda Lomer14,17. 1. Department of Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland. 2. University of Basel, Basel, Switzerland. 3. Human Nutrition, School of Medicine, Dentistry and Nursing, Glasgow Royal Infirmary, Glasgow, UK. 4. PIBD Research Center, Pediatric Gastroenterology and Nutrition Unit, Wolfson Medical Center, Holon, Israel. 5. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 6. Department of Surgery, Assaf Harofeh Medical Center, Tel Aviv, Israel. 7. Department of Surgery, University of Toronto/ Mount Sinai Hospital, Toronto, ON, Canada. 8. Department of Gastroenterology and Hepatology, University Medical Centre Groningen, Groningen, The Netherlands. 9. Department of Medicine, Division of Gastroenterology, Mater Dei Hospital, Msida, Malta. 10. Division of Gastroenterology, University Hospital of Ioannina, Ioannina, Greece. 11. Colorectal Surgery Unit, Catholic University of Paraná [PUCPR], Curitiba, Brazil. 12. Department of Gastroenterology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK. 13. Department of Surgery, Kantonsspital Winterthur, Winerthur, Switzerland. 14. Department of Nutritional Sciences, King's College London, London, UK. 15. Department of Nutrition and Dietetics, Amsterdam UMC, VU University Medical Centre, Amsterdam, The Netherlands. 16. Department of Colorectal Surgery, Wolverhampton Hospital, Wolverhampton, UK. 17. Department of Nutrition and Dietetics, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Abstract
BACKGROUND AND AIMS: The incidence of inflammatory bowel disease [IBD] is rising worldwide and no cure is available. Many patients require surgery and they often present with nutritional deficiencies. Although randomised controlled trials of dietary therapy are lacking, expert IBD centres have long-established interdisciplinary care, including tailored nutritional therapy, to optimise clinical outcomes and resource utilisation. This topical review aims to share expertise and offers current practice recommendations to optimise outcomes of IBD patients who undergo surgery. METHODS: A consensus expert panel consisting of dietitians, surgeons, and gastroenterologists, convened by the European Crohn's and Colitis Organisation, performed a systematic literature review. Nutritional evaluation and dietary needs, perioperative optimis ation, surgical complications, long-term needs, and special situations were critically appraised. Statements were developed using a Delphi methodology incorporating three successive rounds. Current practice positions were set when ≥80% of participants agreed on a recommendation. RESULTS: A total of 26 current practice positions were formulated which address the needs of IBD patients perioperatively and in the long term following surgery. Routine screening, perioperative optimisation by oral, enteral, or parenteral nutrition, dietary fibre, and supplements were reviewed. IBD-specific situations, including management of patients with a restorative proctocolectomy, an ostomy, strictures, or short-bowel syndrome, were addressed. CONCLUSIONS: Perioperative dietary therapy improves the outcomes of IBD patients who undergo a surgical procedure. This topical review shares interdisciplinary expertise and provides guidance to optimise the outcomes of patients with Crohn's disease and ulcerative colitis. taking advantage of contemporary nutrition science.
BACKGROUND AND AIMS: The incidence of inflammatory bowel disease [IBD] is rising worldwide and no cure is available. Many patients require surgery and they often present with nutritional deficiencies. Although randomised controlled trials of dietary therapy are lacking, expert IBD centres have long-established interdisciplinary care, including tailored nutritional therapy, to optimise clinical outcomes and resource utilisation. This topical review aims to share expertise and offers current practice recommendations to optimise outcomes of IBD patients who undergo surgery. METHODS: A consensus expert panel consisting of dietitians, surgeons, and gastroenterologists, convened by the European Crohn's and Colitis Organisation, performed a systematic literature review. Nutritional evaluation and dietary needs, perioperative optimis ation, surgical complications, long-term needs, and special situations were critically appraised. Statements were developed using a Delphi methodology incorporating three successive rounds. Current practice positions were set when ≥80% of participants agreed on a recommendation. RESULTS: A total of 26 current practice positions were formulated which address the needs of IBD patients perioperatively and in the long term following surgery. Routine screening, perioperative optimisation by oral, enteral, or parenteral nutrition, dietary fibre, and supplements were reviewed. IBD-specific situations, including management of patients with a restorative proctocolectomy, an ostomy, strictures, or short-bowel syndrome, were addressed. CONCLUSIONS: Perioperative dietary therapy improves the outcomes of IBD patients who undergo a surgical procedure. This topical review shares interdisciplinary expertise and provides guidance to optimise the outcomes of patients with Crohn's disease and ulcerative colitis. taking advantage of contemporary nutrition science.
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