inflammatory%20bowel%20disease
INFLAMMATORY BOWEL DISEASE
Treatment Guideline Chart
Inflammatory bowel disease consists of ulcerative colitis and Crohn's disease.
Ulcerative colitis is a diffuse mucosal inflammation limited to the colon while Crohn's disease is a patchy, transmural inflammation that occurs in any part of the gastrointestinal tract.
The ileum and colon are the most frequently affected sites.

Inflammatory%20bowel%20disease Patient Education

Patient Education

  • Audiovisual or suitable written information on IBD should be given
  • Stress the importance of adherence to therapy
    • Educate and support patient to encourage treatment compliance
  • Avoid use of NSAIDs which can exacerbate disease activity

Lifestyle Modification

Nutrition and Lifestyle Modification 

Ulcerative Colitis 

  • Cessation of smoking may prevent flaring of symptoms in patients with UC
  • Stress management programs may aid in the patient's overall disease outlook
  • Patients are prone to malnutrition and may suffer detrimental effects from it
    • Decrease fiber intake during increased disease activity to reduce frequency of bowel movements
    • High-fiber diets to be given only for those with involvement limited to the rectum
  • Nutritional support is adjunctive in patients who are malnourished or have a difficult time maintaining normal nutritional status and should also be considered in those with intestinal partial obstruction awaiting surgery1
  • Prebiotics and probiotics have no clear evidence on its role as adjunctive therapy
  • Routine multivitamin supplementation for all patients
  • Routine vitamin D and calcium supplementation for those under steroid therapy
  • Iron supplementation, either oral or parenteral, for those with chronic iron deficiency

Crohn's Disease 

  • Smoking cessation should be strongly advised
  • Stress management programs may aid in the patient's overall disease outlook
  • Patients are prone to malnutrition and may suffer detrimental effects from it
    • Decrease fiber intake during increased disease activity to reduce frequency of bowel movements
    • Placing the patient on NPO, or giving only liquid diet or pre-digested formula may decrease obstructive symptoms
  • Elemental or polymeric diets may be used to induce remission in some patients with active CD who have contraindications to corticosteroids or where patients prefer to avoid corticosteroids
    • May reduce inflammatory features of active CD; although, long-term course of the disease is not altered
      • Cost and compliance may be a limiting factor
    • May be attempted as adjunctive therapy to support patient’s nutrition
  • Exclusive enteral nutrition is used as disease-modifying therapy for growth failure1
    • Usually given for 3-6 weeks
  • Nutritional support is adjunctive in patients who are malnourished or have a difficult time maintaining normal nutritional status and should also be considered in those with intestinal partial obstruction awaiting surgery1
  • Avoid use of NSAIDs which can exacerbate disease activity
  • Prebiotics and probiotics have no clear evidence on its role as adjunctive therapy
  • Routine multivitamin supplementation for all patients
  • Routine vitamin D and calcium supplementation for those under steroid therapy
  • Iron supplementation, either oral or parenteral, for those with chronic iron deficiency
  • Vitamin B12 supplementation for deficiency states at 1000 mcg SC every month 

1Various enteral nutritional products are available. Please see the latest MIMS for specific formulations and prescribing information

Editor's Recommendations