Mistakes in dietary management of IBS and how to avoid them

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Mistakes in dietary management of IBS and how to avoid them

Jean W.M. Muris, Daniel Keszthelyi, Jenny Brouns, Zlatan Mujagic

Summary

AI Generated

People with IBS commonly identify food as a symptom trigger and often try dietary modifications independently, yet surveys show less than 10% value dietary intervention from their GP despite nearly all GPs starting treatment with nutritional advice.

More than 85% of people with IBS indicate that food is one of the triggers for their gastrointestinal symptoms.
Many people with IBS have tried diets, eliminated certain foods, taken supplements or used over-the-counter remedies before consulting a doctor or dietitian.
According to surveys of patients' expectations in primary care, patients with IBS expect their GP to provide reassurance or drug treatments, but less than 10% value dietary intervention.
Almost 95% of general practitioners report that they start the treatment of IBS by giving nutritional advice.
Dietary interventions are given a prominent place in guidelines as both first- and second-line treatments for IBS.

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10

Van den Houte K, et al. Prevalence and impact of self-reported irritable bowel symptoms in the general population. United European Gastroenterol J 2019; 7: 307–315. [https://onlinelibrary.wiley.com/doi/10.1177/2050640618821804] [Link]

Tornkvist NT, et al. Health care utilization of individuals with Rome IV irritable bowel syndrome in the general population. United European Gastroenterol J, 2021; 9: 1178–1188. [https://onlinelibrary.wiley.com/doi/10.1002/ueg2.12153] [Link]

Bohn L, et al. Self-reported food-related gastrointestinal symptoms in IBS are common and associated with more severe symptoms and reduced quality of life. Am J Gastroenterol 2013; 108: 634–641. [Link]

Sayuk GS, Wolf R and Chang L. Comparison of symptoms, healthcare utilization, and treatment in diagnosed and undiagnosed individuals with diarrhea-predominant irritable bowel syndrome. Am J Gastroenterol 2017; 112: 892–899. [Link]

Bijkerk CJ, et al. Irritable bowel syndrome in primary care: the patients' and doctors' views on symptoms, etiology and management. Can J Gastroenterol 2003; 17: 363–368. [Link]

Lacy BE, et al. ACG Clinical Guideline: management of irritable bowel syndrome. Am J Gastroenterol 2021; 116: 17–44. [Link]

Vasant DH, et al. British Society of Gastroenterology guidelines on the management of irritable bowel syndrome. Gut 2021; 70: 1214–1240. [Link]

McKenzie YA, et al. British Dietetic Association systematic review and evidence-based practice guidelines for the dietary management of irritable bowel syndrome in adults (2016 update). J Hum Nutr Diet 2016; 29: 549–575. [Link]

Spiller R. Impact of diet on symptoms of the irritable bowel syndrome. Nutrients 2021; 13: 575. [Link]

10.

Moayyedi P, et al. Irritable bowel syndrome diagnosis and management: A simplified algorithm for clinical practice. United European Gastroenterol J 2017; 5: 773–788. [Link]

11.

Tigchelaar EF, et al. Habitual diet and diet quality in irritable bowel syndrome: a case-control study. Neurogastroenterol Motil 2017; 29: e13151. [Link]

12.

Onyimba F, et al. Food allergies and intolerances: a clinical approach to the diagnosis and management of adverse reactions to food. Clin Gastroenterol Hepatol 2021; 19: 2230–2240.e1. [Link]

13.

Lea R and Whorwell PJ. The role of food intolerance in irritable bowel syndrome. Gastroenterol Clin North Am 2005; 34: 247–255. [Link]

14.

Aguilera-Lizarraga J, et al. Local immune response to food antigens drives meal-induced abdominal pain. Nature 2021; 590: 151–156. [Link]

15.

Barbara G, et al. Mast cell-dependent excitation of visceral-nociceptive sensory neurons in irritable bowel syndrome. Gastroenterology 2007; 132: 26–37. [Link]

16.

Fabisiak A, et al. Targeting histamine receptors in irritable bowel syndrome: a critical appraisal. J Neurogastroenterol Motil 2017; 23: 341–348. [Link]

17.

Klooker TK, et al. The mast cell stabiliser ketotifen decreases visceral hypersensitivity and improves intestinal symptoms in patients with irritable bowel syndrome. Gut 2010; 59: 1213–1221. [Link]

18.

Essa H, et al. Hydrogen and methane breath test results are negatively associated with IBS and may reflect transit time in post-surgical patients. Neurogastroenterol Motil 2021; 33: e14033. [Link]

19.

Black, CJ and Ford AC. Rational investigations in irritable bowel syndrome. Frontline Gastroenterol 2020; 11: 140–147. [Link]

20.

Bonder MJ, et al. The effect of host genetics on the gut microbiome. Nat Genet 2016; 48: 1407–1412. [Link]

21.

So D, et al. Dietary fibres and IBS: translating functional characteristics to clinical value in the era of personalised medicine. Gut 2021; 70: 2383–2394. [Link]

22.

Gunn D, et al. Psyllium reduces inulin-induced colonic gas production in IBS: MRI and in vitro fermentation studies. Gut Epub ahead of print 5 August 2021. DOI: 10.1136/gutjnl-2021-324784. [Link]

23.

Moayyedi P, et al. The effect of fiber supplementation on irritable bowel syndrome: a systematic review and meta-analysis. Am J Gastroenterol 2014; 109: 1367–1374. [Link]

24.

Wilson B, et al. Prebiotics in irritable bowel syndrome and other functional bowel disorders in adults: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr 2019; 109: 1098–1111. [Link]

25.

Dionne J, et al. A systematic review and meta-analysis evaluating the efficacy of a gluten-free diet and a low FODMAPs diet in treating symptoms of irritable bowel syndrome. Am J Gastroenterol 2018; 113: 1290 –1300. [Link]

26.

Barone M, et al. Evaluation of non-celiac gluten sensitivity in patients with previous diagnosis of irritable bowel syndrome: a randomized double-blind placebo-controlled crossover trial. Nutrients 2020; 12: 705. [Link]

27.

Skodje GI, et al. Fructan, rather than gluten, induces symptoms in patients with self-reported non-celiac gluten sensitivity. Gastroenterology 2018; 154: 529–539.e2. [Link]

28.

Cuccioloni M, et al. Interfering with the high-affinity interaction between wheat amylase trypsin inhibitor CM3 and toll-like receptor 4: in silico and biosensor-based studies. Sci Rep 2017; 7: 13169. [Link]

29.

Black CJ, Staudacher HM and Ford AC. Efficacy of a low FODMAP diet in irritable bowel syndrome: systematic review and network meta-analysis. Gut 2021; Aug 10; gutjnl-2021-325214. [Link]

30.

Böhn L, et al. Diet low in FODMAPs reduces symptoms of irritable bowel syndrome as well as traditional dietary advice: a randomized controlled trial. Gastroenterology 2015; 149: 1399–1407.e2. [Link]

31.

Vandeputte D and Joossens M. Effects of low and high FODMAP diets on human gastrointestinal microbiota composition in adults with intestinal diseases: a systematic review. Microorganisms 2020; 8: 1638. [Link]

32.

Wang XJ, et al. Review article: biological mechanisms for symptom causation by individual FODMAP subgroups — the case for a more personalised approach to dietary restriction. Aliment Pharmacol Ther 2019; 50: 517–529. [Link]

33.

Bennet SMP, et al. Multivariate modelling of faecal bacterial profiles of patients with IBS predicts responsiveness to a diet low in FODMAPs. Gut 2018; 67: 872–881. [Link]

34.

Zamani M, Alizadeh-Tabari S and Zamani V. Systematic review with meta-analysis: the prevalence of anxiety and depression in patients with irritable bowel syndrome. Aliment Pharmacol Ther 2019; 50: 132–143. [Link]

35.

Simons M, et al. Narrative review: Risk of eating disorders and nutritional deficiencies with dietary therapies for irritable bowel syndrome. Neurogastroenterol Motil 2021; 34: e14188. [Link]

Abstract

People with irritable bowel syndrome (IBS) experience chronic intermittent symptoms, such as abdominal pain, bloating and/or altered bowel movements. These symptoms may negatively impact their daily life, prohibiting participation in social activities or leading to work absenteeism, and they are associated with increased healthcare utilisation.More than 85% of people with IBS indicate that food is one of the triggers for their gastrointestinal symptoms. Many of them have also tried diets, eliminated certain foods, taken supplements or used over-the-counter remedies before consulting a doctor or dietitian.4 Somewhat contradictorily, according to surveys of patients’ expectations in primary care, patients with IBS expect their general practitioner to provide reassurance or drug treatments, but less than 10% value dietary intervention. This is despite the fact that almost 95% of general practitioners report that they start the treatment of IBS by giving nutritional advice.5 Dietary interventions are also given a prominent place in the guidelines as both first- and second-line treatments for IBS.

Topics

Neurogastroenterology & Motility

Citation

Mujagic Z, Brouns J, Keszthelyi D and Muris JWM. Mistakes in dietary management of IBS and how to avoid them. UEG Education 2022; 22: 1–4.

Published

2022

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Management of gastric preneoplastic lesions (MAPS 3) - what’s new? With Mario Dinis-Ribeiro (Part 2)

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AI Generated

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Abstract

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Stomach & H. Pylori

Published

2025

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Mistakes in Familial Mediterranean Fever and how to avoid them

Manik Gemilyan, Gagik Hakobyan

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Summary is not available for this content yet.

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10

Bijkerk CJ, et al. Irritable bowel syndrome in primary care: the patients' and doctors' views on symptoms, etiology and management. Can J Gastroenterol 2003; 17: 363–368. [Link]

Lacy BE, et al. ACG Clinical Guideline: management of irritable bowel syndrome. Am J Gastroenterol 2021; 116: 17–44. [Link]

Vasant DH, et al. British Society of Gastroenterology guidelines on the management of irritable bowel syndrome. Gut 2021; 70: 1214–1240. [Link]

Spiller R. Impact of diet on symptoms of the irritable bowel syndrome. Nutrients 2021; 13: 575. [Link]

10.

Moayyedi P, et al. Irritable bowel syndrome diagnosis and management: A simplified algorithm for clinical practice. United European Gastroenterol J 2017; 5: 773–788. [Link]

11.

Tigchelaar EF, et al. Habitual diet and diet quality in irritable bowel syndrome: a case-control study. Neurogastroenterol Motil 2017; 29: e13151. [Link]

12.

Onyimba F, et al. Food allergies and intolerances: a clinical approach to the diagnosis and management of adverse reactions to food. Clin Gastroenterol Hepatol 2021; 19: 2230–2240.e1. [Link]

13.

Lea R and Whorwell PJ. The role of food intolerance in irritable bowel syndrome. Gastroenterol Clin North Am 2005; 34: 247–255. [Link]

14.

Aguilera-Lizarraga J, et al. Local immune response to food antigens drives meal-induced abdominal pain. Nature 2021; 590: 151–156. [Link]

15.

Barbara G, et al. Mast cell-dependent excitation of visceral-nociceptive sensory neurons in irritable bowel syndrome. Gastroenterology 2007; 132: 26–37. [Link]

16.

Fabisiak A, et al. Targeting histamine receptors in irritable bowel syndrome: a critical appraisal. J Neurogastroenterol Motil 2017; 23: 341–348. [Link]

17.

Klooker TK, et al. The mast cell stabiliser ketotifen decreases visceral hypersensitivity and improves intestinal symptoms in patients with irritable bowel syndrome. Gut 2010; 59: 1213–1221. [Link]

18.

Essa H, et al. Hydrogen and methane breath test results are negatively associated with IBS and may reflect transit time in post-surgical patients. Neurogastroenterol Motil 2021; 33: e14033. [Link]

19.

Black, CJ and Ford AC. Rational investigations in irritable bowel syndrome. Frontline Gastroenterol 2020; 11: 140–147. [Link]

20.

Bonder MJ, et al. The effect of host genetics on the gut microbiome. Nat Genet 2016; 48: 1407–1412. [Link]

21.

So D, et al. Dietary fibres and IBS: translating functional characteristics to clinical value in the era of personalised medicine. Gut 2021; 70: 2383–2394. [Link]

22.

Gunn D, et al. Psyllium reduces inulin-induced colonic gas production in IBS: MRI and in vitro fermentation studies. Gut Epub ahead of print 5 August 2021. DOI: 10.1136/gutjnl-2021-324784. [Link]

23.

Moayyedi P, et al. The effect of fiber supplementation on irritable bowel syndrome: a systematic review and meta-analysis. Am J Gastroenterol 2014; 109: 1367–1374. [Link]

24.

25.

26.

27.

Skodje GI, et al. Fructan, rather than gluten, induces symptoms in patients with self-reported non-celiac gluten sensitivity. Gastroenterology 2018; 154: 529–539.e2. [Link]

28.

29.

Black CJ, Staudacher HM and Ford AC. Efficacy of a low FODMAP diet in irritable bowel syndrome: systematic review and network meta-analysis. Gut 2021; Aug 10; gutjnl-2021-325214. [Link]

30.

31.

32.

33.

Bennet SMP, et al. Multivariate modelling of faecal bacterial profiles of patients with IBS predicts responsiveness to a diet low in FODMAPs. Gut 2018; 67: 872–881. [Link]

34.

35.

Simons M, et al. Narrative review: Risk of eating disorders and nutritional deficiencies with dietary therapies for irritable bowel syndrome. Neurogastroenterol Motil 2021; 34: e14188. [Link]

Abstract

Familial Mediterranean fever (FMF), also called periodic disease, Armenian disease, etc., is a prototypical autoinflammatory disorder where the underlying mechanism is the dysfunction of innate immunity, resulting in unprovoked episodes of inflammation.¹ Although considered rare worldwide, it is prevalent in people of Mediterranean origin; however, one can expect to encounter patients in all parts of the modern world. FMF is a monogenic disease with autosomal recessive inheritance.² Unlike other monogenic disorders, the diagnosis remains largely clinical, and it is important to understand the limitations of genetic testing. Another distinguishing feature is the well-established effectiveness of lifelong monotherapy with colchicine in preventing attacks and complications.³

Topics

Primary Care

Published

2025

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Mistakes in the management of carbohydrate intolerance and how to avoid them

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Functional bowel disorders with diarrhoea: Clinical guidelines of the United European Gastroenterology and European Society for Neurogastroenterology and Motility

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UEG Mistakes In Articles

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

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Mistakes in the management of carbohydrate intolerance and how to avoid them

Johann Hammer, Heinz Florian Hammer, Mark Fox

Summary

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Summary is not available for this content yet.

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10

Bijkerk CJ, et al. Irritable bowel syndrome in primary care: the patients' and doctors' views on symptoms, etiology and management. Can J Gastroenterol 2003; 17: 363–368. [Link]

Lacy BE, et al. ACG Clinical Guideline: management of irritable bowel syndrome. Am J Gastroenterol 2021; 116: 17–44. [Link]

Vasant DH, et al. British Society of Gastroenterology guidelines on the management of irritable bowel syndrome. Gut 2021; 70: 1214–1240. [Link]

Spiller R. Impact of diet on symptoms of the irritable bowel syndrome. Nutrients 2021; 13: 575. [Link]

10.

Moayyedi P, et al. Irritable bowel syndrome diagnosis and management: A simplified algorithm for clinical practice. United European Gastroenterol J 2017; 5: 773–788. [Link]

11.

Tigchelaar EF, et al. Habitual diet and diet quality in irritable bowel syndrome: a case-control study. Neurogastroenterol Motil 2017; 29: e13151. [Link]

12.

Onyimba F, et al. Food allergies and intolerances: a clinical approach to the diagnosis and management of adverse reactions to food. Clin Gastroenterol Hepatol 2021; 19: 2230–2240.e1. [Link]

13.

Lea R and Whorwell PJ. The role of food intolerance in irritable bowel syndrome. Gastroenterol Clin North Am 2005; 34: 247–255. [Link]

14.

Aguilera-Lizarraga J, et al. Local immune response to food antigens drives meal-induced abdominal pain. Nature 2021; 590: 151–156. [Link]

15.

Barbara G, et al. Mast cell-dependent excitation of visceral-nociceptive sensory neurons in irritable bowel syndrome. Gastroenterology 2007; 132: 26–37. [Link]

16.

Fabisiak A, et al. Targeting histamine receptors in irritable bowel syndrome: a critical appraisal. J Neurogastroenterol Motil 2017; 23: 341–348. [Link]

17.

Klooker TK, et al. The mast cell stabiliser ketotifen decreases visceral hypersensitivity and improves intestinal symptoms in patients with irritable bowel syndrome. Gut 2010; 59: 1213–1221. [Link]

18.

Essa H, et al. Hydrogen and methane breath test results are negatively associated with IBS and may reflect transit time in post-surgical patients. Neurogastroenterol Motil 2021; 33: e14033. [Link]

19.

Black, CJ and Ford AC. Rational investigations in irritable bowel syndrome. Frontline Gastroenterol 2020; 11: 140–147. [Link]

20.

Bonder MJ, et al. The effect of host genetics on the gut microbiome. Nat Genet 2016; 48: 1407–1412. [Link]

21.

So D, et al. Dietary fibres and IBS: translating functional characteristics to clinical value in the era of personalised medicine. Gut 2021; 70: 2383–2394. [Link]

22.

Gunn D, et al. Psyllium reduces inulin-induced colonic gas production in IBS: MRI and in vitro fermentation studies. Gut Epub ahead of print 5 August 2021. DOI: 10.1136/gutjnl-2021-324784. [Link]

23.

Moayyedi P, et al. The effect of fiber supplementation on irritable bowel syndrome: a systematic review and meta-analysis. Am J Gastroenterol 2014; 109: 1367–1374. [Link]

24.

25.

26.

27.

Skodje GI, et al. Fructan, rather than gluten, induces symptoms in patients with self-reported non-celiac gluten sensitivity. Gastroenterology 2018; 154: 529–539.e2. [Link]

28.

29.

Black CJ, Staudacher HM and Ford AC. Efficacy of a low FODMAP diet in irritable bowel syndrome: systematic review and network meta-analysis. Gut 2021; Aug 10; gutjnl-2021-325214. [Link]

30.

31.

32.

33.

Bennet SMP, et al. Multivariate modelling of faecal bacterial profiles of patients with IBS predicts responsiveness to a diet low in FODMAPs. Gut 2018; 67: 872–881. [Link]

34.

35.

Simons M, et al. Narrative review: Risk of eating disorders and nutritional deficiencies with dietary therapies for irritable bowel syndrome. Neurogastroenterol Motil 2021; 34: e14188. [Link]

Abstract

Carbohydrates not absorbed in the small intestine are fermented by colonic bacteria to organic acids and gases(e.g. carbon dioxide, hydrogen and methane), part of which is absorbed in the colon, the other part remaining in the lumen. Large interindividual differences have been demonstrated for the production of such acids and gas. Carbohydrate malabsorption can be diagnosed by using the hydrogen breath test, because the gases produced after administration of a provocative dose of carbohydrate are unique products of bacterial carbohydrate fermentation.

Topics

Small Intestine & Nutrition

Citation

Hammer HF, Hammer J and Fox M. Mistakes in the management of carbohydrate intolerance and how to avoid them. UEG Education 2019; 19: 9–14

Published

2019

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Mistakes in the management of carbohydrate intolerance and how to avoid them

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ESPEN micronutrient guideline

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Clinical Practice Guideline

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This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Not sure what you can access? Learn more about account types.

Functional bowel disorders with diarrhoea: Clinical guidelines of the United European Gastroenterology and European Society for Neurogastroenterology and Motility

Edoardo Vincenzo Savarino

Summary

AI Generated

Summary is not available for this content yet.

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Guideline

Abstract

Irritable bowel syndrome with diarrhoea (IBS-D) and functional diarrhoea (FDr) are the two major functional bowel disorders characterized by diarrhoea. In spite of their high prevalence, IBS-D and FDr are associated with major uncertainties, especially regarding their optimal diagnostic work-up and management. A Delphi consensus was performed with experts from 10 European countries who conducted a literature summary and voting process on 31 statements. Quality of evidence was evaluated using the grading of recommendations, assessment, development, and evaluation criteria. Consensus (defined as >80% agreement) was reached for all the statements. The panel agreed with the potential overlapping of IBS-D and FDr. In terms of diagnosis, the consensus supports a symptom-based approach also with the exclusion of alarm symptoms, recommending the evaluation of full blood count, C-reactive protein, serology for coeliac disease, and faecal calprotectin, and consideration of diagnosing bile acid diarrhoea. Colonoscopy with random biopsies in both the right and left colon is recommended in patients older than 50 years and in presence of alarm features. Regarding treatment, a strong consensus was achieved for the use of a diet low fermentable oligo-, di-, monosaccharides and polyols, gut-directed psychological therapies, rifaximin, loperamide, and eluxadoline. A weak or conditional recommendation was achieved for antispasmodics, probiotics, tryciclic antidepressants, bile acid sequestrants, 5-hydroxytryptamine-3 antagonists (i.e. alosetron, ondansetron, or ramosetron). A multinational group of European experts summarized the current state of consensus on the definition, diagnosis, and management of IBS-D and FDr.

Keywords: abdominal pain, clinical practice guidelines, diarrhea, FDr, functional bowel disorders, functional diarrhea, IBS-D, irritable bowel syndrome

Publisher

European Society of Neurogastroenterology and Motility

Guideline

Clinical Practice Guideline

Topics

Neurogastroenterology & Motility

Citation

United European Gastroenterol J.2022;10:556–584

Published

2022

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Pradeep Mundre

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Gagik Hakobyan

Mistakes in the management of carbohydrate intolerance and how to avoid them

Johann Hammer

Functional bowel disorders with diarrhoea: Clinical guidelines of the United European Gastroenterology and European Society for Neurogastroenterology and Motility

Edoardo Vincenzo Savarino

ESPEN micronutrient guideline

Mette M. Berger

European guideline on obesity care in patients with gastrointestinal and liver diseases – Joint European Society for Clinical Nutrition and Metabolism / United European Gastroenterology guideline

Stephan Bischoff

UEG Standards and Guidelines

Clinical Practice Guideline

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Not sure what you can access? Learn more about account types.

ESPEN micronutrient guideline

Mette M. Berger

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Guideline

Abstract

Background: Trace elements and vitamins, named together micronutrients (MNs), are essential for human metabolism. Recent research has shown the importance of MNs in common pathologies, with significant deficiencies impacting the outcome.

Objective: This guideline aims to provide information for daily clinical nutrition practice regarding assessment of MN status, monitoring, and prescription. It proposes a consensus terminology, since many words are used imprecisely, resulting in confusion. This is particularly true for the words “deficiency”, “repletion”, “complement”, and “supplement”.

Methods: The expert group attempted to apply the 2015 standard operating procedures (SOP) for ESPEN which focuses on disease. However, this approach could not be applied due to the multiple diseases requiring clinical nutrition resulting in one text for each MN, rather than for diseases. An extensive search of the literature was conducted in the databases Medline, PubMed, Cochrane, Google Scholar, and CINAHL. The search focused on physiological data, historical evidence (published before PubMed release in 1996), and observational and/or randomized trials. For each MN, the main functions, optimal analytical methods, impact of inflammation, potential toxicity, and provision during enteral or parenteral nutrition were addressed. The SOP wording was applied for strength of recommendations.

Results: There was a limited number of interventional trials, preventing meta-analysis and leading to a low level of evidence. The recommendations underwent a consensus process, which resulted in a percentage of agreement (%): strong consensus required of >90% of votes. Altogether the guideline proposes sets of recommendations for 26 MNs, resulting in 170 single recommendations. Critical MNs were identified with deficiencies being present in numerous acute and chronic diseases. Monitoring and management strategies are proposed.

Conclusion: This guideline should enable addressing suboptimal and deficient status of a bundle of MNs in at-risk diseases. In particular, it offers practical advice on MN provision and monitoring during nutritional support.

Keywords: Trace elements, Vitamins, Deficiency, Monitoring, Enteral Nutrition, Parenteral Nutrition

Publisher

The European Society for Clinical Nutrition and Metabolism

Guideline

Clinical Practice Guideline

Topics

Small Intestine & Nutrition

Citation

Clinical Nutrition 41 (2022) 1357-1424

Published

2022

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Management of gastric preneoplastic lesions (MAPS 3) - what’s new? With Mario Dinis-Ribeiro (Part 2)

Pradeep Mundre

Mistakes in Familial Mediterranean Fever and how to avoid them

Gagik Hakobyan

Mistakes in the management of carbohydrate intolerance and how to avoid them

Johann Hammer

Functional bowel disorders with diarrhoea: Clinical guidelines of the United European Gastroenterology and European Society for Neurogastroenterology and Motility

Edoardo Vincenzo Savarino

ESPEN micronutrient guideline

Mette M. Berger

European guideline on obesity care in patients with gastrointestinal and liver diseases – Joint European Society for Clinical Nutrition and Metabolism / United European Gastroenterology guideline

Stephan Bischoff

UEG Standards and Guidelines

Clinical Practice Guideline

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

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European guideline on obesity care in patients with gastrointestinal and liver diseases – Joint European Society for Clinical Nutrition and Metabolism / United European Gastroenterology guideline

Stephan Bischoff

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Guideline

Abstract

Background
Patients with chronic gastrointestinal (GI) disease such as inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), celiac disease, gastroesophageal reflux disease (GERD), pancreatitis, and chronic liver disease (CLD) often suffer from obesity because of coincidence (IBD, IBS, celiac disease) or related pathophysiology (GERD, pancreatitis and CLD). It is unclear if such patients need a particular diagnostic and treatment that differs from the needs of lean GI patients. The present guideline addresses this question according to current knowledge and evidence.

Objective
The objective of the guideline is to give advice to all professionals working in the field of gastroenterology care including physicians, surgeons, dietitians and others how to handle patients with GI disease and obesity.

Methods
The present guideline was developed according to the standard operating procedure for European Society for Clinical Nutrition and Metabolism guidelines, following the Scottish Intercollegiate Guidelines Network grading system (A, B, 0, and good practice point [GPP]). The procedure included an online voting (Delphi) and a final consensus conference.

Results
In 100 recommendations (3x A, 33x B, 24x 0, 40x GPP, all with a consensus grade of 90% or more) care of GI patients with obesity – including sarcopenic obesity – is addressed in a multidisciplinary way. A particular emphasis is on CLD, especially fatty liver disease, since such diseases are closely related to obesity, whereas liver cirrhosis is rather associated with sarcopenic obesity. A special chapter is dedicated to obesity care in patients undergoing bariatric surgery. The guideline focuses on adults, not on children, for whom data are scarce. Whether some of the recommendations apply to children must be left to the judgment of the experienced pediatrician.

Conclusion
The present guideline offers for the first time evidence-based advice how to care for patients with chronic GI diseases and concomitant obesity, an increasingly frequent constellation in clinical practice.

Keywords: bariatric surgery, celiac disease, cirrhosis, gastroesophageal reflux disease, inflammatory bowel disease, irritable bowel syndrome, non-alcoholic fatty liver disease, obesity, pancreatitis, sarcopenic obesity

Publisher

The European Society for Clinical Nutrition and Metabolism

Guideline

Clinical Practice Guideline

Topics

Primary Care Small Intestine & Nutrition

Citation

United European Gastroenterol J.2022;10:665–722

Published

2022

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