Dietary Strategies for Maintenance of Clinical Remission in Inflammatory Bowel Diseases: Are We There Yet?

Konstantinos Gkikas, Konstantinos Gerasimidis, Simon Milling, Umer Z Ijaz, Richard Hansen, Richard K Russell, Konstantinos Gkikas, Konstantinos Gerasimidis, Simon Milling, Umer Z Ijaz, Richard Hansen, Richard K Russell

Abstract

The etiopathogenesis of Inflammatory bowel disease (IBD) is a result of a complex interaction between host immune response, the gut microbiome and environmental factors, such as diet. Although scientific advances, with the use of biological medications, have revolutionized IBD treatment, the challenge for maintaining clinical remission and delaying clinical relapse is still present. As exclusive enteral nutrition has become a well-established treatment for the induction of remission in pediatric Crohn's disease, the scientific interest regarding diet in IBD is now focused on the development of follow-on dietary strategies, which aim to suppress colonic inflammation and delay a disease flare. The objective of this review is to present an extensive overview of the dietary strategies, which have been used in the literature to maintain clinical remission in both Crohn's disease and Ulcerative colitis, and the evidence surrounding the association of dietary components with clinical relapse. We also aim to provide study-related recommendations to be encompassed in future research studies aiming to investigate the role of diet during remission periods in IBD.

Keywords: Crohn’s disease; Ulcerative colitis; clinical relapse; dietary therapy; dietary triggers; inflammatory bowel disease; maintenance enteral nutrition.

Conflict of interest statement

K.G. (Konstantinos Gerasimidis) has received research grants, speakers’ fees, consultancy and had conference attendance paid by Nutricia, Nestle, Baxter and Dr Falk Pharma. S.M. has participated in medical board meetings with Pfizer. R.H. has received speakers/consultancy fees or conference support from Nutricia, Dr Falk Pharma, MSD Immunology and 4D Pharma. R.K.R. has received speaker’s fees, travel support and/or participated in medical board meetings with Nestle, MSD Immunology, AbbVie, Dr Falk Pharma, Takeda, Napp, Mead Johnson, Nutricia and 4D Pharma. UZI does not have any relevant personal conflict of interest to declare.

Figures

Figure 1
Figure 1
(A) Comparison of 1-year clinical relapse rates in patients using MEN against those who did not use MEN in studies reporting the amount of MEN formula consumed (≤35%/>35% of energy requirements). ✶ indicates statistically significant differences in clinical relapse rates between MEN group and control group in the total duration of each study. Dark colored bar charts indicate RCTs. + Clinical relapse rates in Esaki et al., 2006, Hirai et al., 2013 and Hirai et al., 2019 are approximate numbers extracted from figures. ++ only 6-month relapse rates were available. (B) Median clinical relapse rates in patients consuming MEN, based on amount of formula consumed (≤35%/>35% of energy requirements).

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