Non-pharmacological therapies for inflammatory bowel disease: Recommendations for self-care and physician guidance

Abstract

We performed a scoping review on sought-after complementary therapies for patients with inflammatory bowel disease (IBD), specifically diet, physical activity and exercise (PA/E), and psychotherapy. We aim to update patients with IBD on therapies for self-care and provide physicians with guidance on how to direct their patients for the management of IBD. A search of MEDLINE, EMBASE, and PUBMED was completed in Sept 2016. Studies on diet, PA/E, or psychotherapy in patients with IBD were included. Medical Subject Heading terms and Boolean operators were used. The search was limited to full-text English articles describing an adult population. This review included 67 studies: Diet ( = 19); PA/E ( = 19); and psychotherapy ( = 29). We have made the following recommendations: (1) Diet: Consumption of diets rich in vegetables, fruit and soluble fiber may be beneficial in IBD. A trial of a low FODMAP diet can be considered in those patients with functional gastrointestinal symptoms. Restrictive diets are lacking in evidence and should be avoided; (2) PA/E: Regular low-moderate intensity activity, including cardiovascular and resistance exercise, has been shown to improve quality of life (QOL) and may improve inflammation; and (3) psychotherapy: Therapies such as cognitive-behavioural interventions, mindfulness, hypnosis, and stress management have been shown to improve QOL, but evidence is limited on their impact on anxiety, depression, and disease activity. Overall, these complementary therapies are promising and should be used to treat patients with IBD from a more holistic perspective.

Self-care: the way to find balance in life : Development and evaluation of a self-care questionnaire for patients with inflammatory bowel disease

“…A number of environmental factors have been associated with development of IBD, such as enteric infections, certain foods, and changes in nutritional behavior (31). The impact of nutrition varies, but so far there is no evidence that any food has effect (32)(33)(34). Smoking is a risk factor, because nicotine negatively affects the microcirculation, reducing the blood flow to the mucosa, the microbiome, the smooth muscles, and the intestinal permeability (35).…”

“…Self-care as regards medical treatment, exercise, diet management, stress management, and information on tobacco and alcohol must be provided to the patient, and is especially important for patients with IBD (34). For patients with CD, tobacco cessation is the most effective way to reduce relapse.…”

“…Higher levels of stress are associated with relapse (67). However, among patients with depression in IBD, there is limited support for the use of stress management (34). To reduce stress, enhance nutritional status, and improve mental and physical health, exercise is recommended (34,68).…”

“…However, among patients with depression in IBD, there is limited support for the use of stress management (34). To reduce stress, enhance nutritional status, and improve mental and physical health, exercise is recommended (34,68). Dietary recommendations include regular meals and a balanced diet every day.…”

“…Onions, leguminous plants, fruit, juice, dairy products, and carbonated drinks are examples of dietary content that can be reduced. Patients with IBD may have difficulty maintaining adequate nutrition in periods of relapse (34).…”