01
Key timings for dietetic interventions At diagnosis
Treat malnutrition/micronutrient deficiencies
Provide practical dietary and lifestyle advice, avoiding unnecessary confusion and dietary restrictions
Advise on appropriate specialist diets depending on site/severity of disease activity e.g. cinnamon & benzoate free, polymeric, loflex, fibre modification, low FODMAP, lactose free etc.
At key life stages e.g. during pregnancy, to meet additional nutritional demands
During acute disease flare
Exclusive enteral nutrition (EEN) can be as effective as corticosteroids at inducing disease remission when appropriately prescribed and supported. This can be managed as an outpatient, reducing the need for inpatient stays
EEN can help reduce nutritional losses, improve symptom management and protect bone health
Pre-operatively
To optimise nutritional status and rest the gut (potentially reducing length of bowel resected and improving chance of successful anastomosis)
Severe malnutrition (BMI <18.5kg/m2 and recent weight loss >10% body weight) is associated with a higher risk of post-operative complications, particularly intra-abdominal sepsis and increased mortality
Post operatively
Manage nutritional losses depending on site/ length of bowel resected
Manage symptoms from stoma losses through practical dietary advice
Ref BSG 2019<br>
02
Testimonials- a collaborative approach
“In the beginning I was really struggling with symptoms, I couldn’t even walk due to the severity of pain. After the first week on a polymeric diet I felt such a difference. My pain disappeared and I was able to enjoy looking after my grandson again. I have really appreciated that I have been able to seek advice as needed and felt so well supported with this. If this option wasn’t there, I would probably have ended up in hospital again with pain and obstruction. The practical advice which was given was so easy to follow. I am so grateful to the dietitians in Salford Royal” Mrs D Young, Service User, (Trialled PIFU during Covid).
“The ability to have rapid access to a dietitian is essential to facilitate the initiation of polymeric diet as a therapy for IBD. The dietitian’s role within this therapy is vastly underestimated, and without it compliance with this therapy would be significantly reduced.
Within QI projects we have seen the dietitian role transform pre-operative care, reducing length of stay and improving patient experience in IBD. In some cases the role of nutrition and the dietitian has meant that patients have had a limited resection rather than a stoma. The impact of this cannot be underestimated.” Cath Stansfield, Consultant Nurse, Gastroenterology, Salford Royal NHS Trust.
“ As a surgeon who operates on patients with IBD, I couldn’t be more supportive of this bid. We have already seen the massive impact Specialist Dietetic input can make to patients both pre operatively getting them optimised to as good a state as possible to improve outcomes, and post operatively, particularly for patients who are left with short bowel, to try to optimise their functional outcome.” Mr J Epstein, Consultant Surgeon, Salford Royal NHS Trust.<br>
