Diet in Benign Colonic Disorders: A Narrative Review.

PURPOSE: Diet plays an important role in common benign colorectal diseases. This article reviews the evidence for diet and supplemental fiber in patients with chronic constipation, irritable bowel syndrome, inflammatory bowel disease, colonic diverticulitis, and fecal incontinence.

METHODS

We performed a narrative review of the evidence for diet and supplemental fiber in patients with 5 common benign colonic diseases and summarized guideline recommendations for each condition. We generated tables of practical dietary advice by disease.

FINDINGS: Diet advice must be individualized and depends on underlying conditions, disease severity, symptom burden, and nutrition status. Guidance from a registered dietitian is highly recommended when making any dietary changes. Data from trials suggest that soluble fiber is effective for patients with chronic constipation, irritable bowel syndrome, and fecal incontinence. A diet low in select fermentable, oligo-, di-, and monosaccharides, and polyols may benefit patients with irritable bowel syndrome. Patients with inflammatory bowel disease, especially those with active disease, are at risk for malnutrition. Dietary restrictions may further increase that risk. There is limited evidence to recommend increasing or avoiding select food groups in patients with inflammatory bowel disease. Patients who have recovered from diverticulitis should adopt a prudent dietary pattern high in fruits, vegetables, whole grains, legumes, poultry, and fish.

IMPLICATIONS: Clinicians should counsel patients on the contribution of diet to their colorectal condition and the benefits and harms of dietary modification. Dietary advice should be practical and accompanied by realistic expectations for benefit.