Dietary management in inflammatory bowel disease: A narrative review of the current evidence.

Abstract

Abstract: Diet is increasingly recognized as both an environmental determinant and a therapeutic target in inflammatory bowel disease (IBD), yet dietary guidance for clinicians has historically been inconsistent and, in many cases, excessively restrictive. This narrative review synthesizes current evidence-based dietary recommendations for the management of IBD across disease phases, anchored on the European Crohn's and Colitis Organization (ECCO) 2025 Dietary Management Consensus and supplemented by landmark randomized controlled trials, systematic reviews, meta-analyses, and consensus guidelines published through September 2025. The ECCO 2025 Dietary Management Consensus (published September 2025) and select regional Saudi guidelines published after the initial literature search were incorporated as pre-specified anchor references given their direct relevance to this review's framework. No single IBD diet is universally applicable. During active Crohn's disease (CD), exclusive enteral nutrition (EEN) has the strongest evidence for inducing remission, while the Crohn's Disease Exclusion Diet with Partial Enteral Nutrition (CDED + PEN) offers an evidence-based, food-based alternative, particularly for biologic-naive patients. Specific dietary modifications are warranted in patients with fibrostenotic strictures. During remission, dietary fiber is associated with a lower relapse risk, the Mediterranean dietary pattern supports remission maintenance in ulcerative colitis (UC), and partial enteral nutrition may sustain remission in CD. Dietary fiber and dairy products do not require routine restriction; ultra-processed foods and excessive red meat intake should be reduced. Micronutrient deficiencies - affecting more than 50% of IBD patients - require systematic monitoring and targeted supplementation rather than empirical universal supplementation. Multiple prevalent dietary misconceptions lack scientific support and cause measurable nutritional harm if left uncorrected. Evidence-based dietary management of IBD requires individualized, phase-specific recommendations, access to IBD-experienced dietitians, and systematic micronutrient monitoring. Gastroenterologists are well-positioned to translate this evidence into meaningful clinical practice for their patients. As a narrative review, this work is subject to inherent methodological limitations, including potential selection bias in the literature and the absence of formal quality assessment of individual studies.