Ketogenic diet therapy for epilepsy in conjunction with concurrent inflammatory bowel disease: Case series and recommendations.

The combined occurrence of ketogenic diet therapy (KDT) and inflammatory bowel disease (IBD) has not been previously described. Seven patients from 6 institutions were identified from 2005 to 2025. Five were receiving KDT when the IBD diagnosis was made, with two subjects with Crohn's disease subsequently starting KDT to improve their refractory seizures. The mean age at the combined KDT/IBD presentation was 9.3 years, with a range of 4.7-23 years. The duration of combined KDT/IBD ranged from 10 months to 15 years to date. Six of 7 patients had reported 90-100% seizure control on KDT, with infrequent worsening during IBD flares, despite steroid use. These results suggest patients on KDT can develop IBD, but also IBD should not be considered a contraindication for KDT use. Recommendations for management of a potential KDT/IBD situation are provided.