New BSG Guidelines Consider Nutrition as Part of IBD Management in Adults

The new guidelines encompass, among others, malnutrition screening, the benefits of an all-formula diet in Crohn’s disease for reducing surgical complications, and patient-centered education interventions to improve physical and mental health-related quality of life.

Recent guidelines from the American Gastroenterological Association and the European Society for Clinical Nutrition and Metabolism highlighted the central role of diet and nutrition in the induction and maintenance of IBD, alongside medication. 

The British Society of Gastroenterology has recently released a new guideline on IBD in adults, updating the 2019 version. The guideline, while developed primarily for the UK, is structured to support IBD management internationally.  

1. Screening for Undernutrition is the First Step to Managing It

• Malnutrition screening, nutritional assessment, and correction of nutritional status should be a routine practice in all patients with IBD undergoing surgery‍
• Nutritional support in the form of oral nutritional supplements, an all-formula diet, or parenteral nutrition should be provided as required

2. An All-Formula Diet May Help to Decrease Surgical Complications in CD Patients

• Exclusive enteral nutrition (an all-formula diet) that excludes all food and drink except still water is nutritionally complete and may help to:
  
  • Reduce infectious complications (i.e, infected fluid and pus that is surrounded by inflamed tissue inside the belly, and escape of gastrointestinal contents into the abdominal cavity)
  • Lower C-reactive protein
  • Reduce the number of patients requiring stoma formation
• It is effective even for high-surgical-risk patients
• While the effectiveness of an only-liquid diet is not affected by the type of formula used or the route of administration, whole-protein (polymeric) formulas are generally preferred for their better taste and palatability compared to elemental formulas
• Starting by increasing the prescribed daily volume gradually over a few days while reducing food intake is essential to build up tolerance and prevent the risk of refeeding
• Exclusive enteral nutrition should be continued for 6-8 weeks to induce mucosal healing
• While most adult patients can tolerate a nutritionally complete liquid diet orally, nasogastric feeding may be required
• A multidisciplinary approach involving IBD physicians, surgeons, radiologists, clinical nurse specialists, dietitians, psychologists, and peer support is recommended to achieve the most benefits, alongside regular monitoring via email or telephone

3. Diet and Nutritional Status Are Central to Managing Low Mineral Density in IBD 

• The British Society of Gastroenterology 2019 guidelines recognized that calcium, vitamin D supplementation, weight training or running, stopping smoking, and reducing excess alcohol intake have a positive impact on bone mineral density
• Te new guidelines align with the statements above and highlight that diet and nutritional status are central to the management of low mineral density
• Assessing and managing low bone mineral density is recommended for IBD, while the best timing for it relies on the healthcare team

4. A Careful Review of Dietary Habits is Recommended in Patients With New or Worsening Symptoms of IBD

• New onset or worsening of symptoms in IBD should be scrutinised to discern disease relapse from an infection origin, which should be promptly identified and treated before initiation or alterations of any immunosuppressive therapies
• Poor nutrition and a recent travel abroad history can be a risk factor for infections and should be screened for in patients with new onset or worsening of symptoms

5. Probiotics Are Not Suggested for  Patients with CD and UC

• There is no evidence to suggest that probiotics are beneficial for the induction or maintenance of remission in patients with CD and UC

6. Patient-Centered Dietary Educational Interventions May Improve IBD Outcomes

• Patient education interventions offered shortly after diagnosis as a complement to standard care can have a positive impact on psychological distress, quality of life, and self-management skills

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Read the full guidelines.

Reference:

^{1. Moran GW, Gordon M, Sinopolou V, et al. British Society of Gastroenterology guidelines on inflammatory bowel disease in adults: 2025. Gut. 2025; 74(Suppl 2):s1-s101. doi: 10.1136/gutjnl-2024-334395.r}

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‍Dr. Andreu Prados is a science and medical writer specializing in making reliable evidence of non-prescription therapeutics for gastrointestinal conditions understandable, engaging and ready for use for healthcare professionals and patients.

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