Inflammatory bowel disease: ulcerative colitis and Crohn's disease
IBD is chronic, relapsing inflammation of the gut: ulcerative colitis in the colon, Crohn's anywhere from mouth to anus. In a flare, give enough energy, high protein, low residue.
At a glance
Ulcerative colitis vs Crohn's disease
| Feature | Ulcerative colitis | Crohn's disease |
|---|---|---|
| Site | Colon and rectum only, starting at the rectum | Any part from mouth to anus; most often the end of the ileum |
| Pattern | Continuous inflammation | Patchy 'skip lesions' with normal gut between |
| Depth | Inner lining (mucosa) only | Whole thickness of the wall (transmural) |
| Stools | Bloody diarrhoea with mucus, urgency | Diarrhoea and cramping pain, less blood |
| Complications | Severe bleeding, toxic megacolon, raised colon cancer risk | Strictures, fistulas, abscesses, malabsorption, B12 deficiency, kidney stones |
Dietary principles
| Nutrient | In a flare | In remission |
|---|---|---|
| Energy | Enough to stop weight loss: about 30-35 kcal/kg (textbooks; ESPEN: usually like a healthy person's), small frequent meals | Normal, to keep a healthy weight |
| Protein | High: about 1.2-1.5 g/kg (egg, fish, chicken, paneer, curd, soft dal) | About 1 g/kg |
| Fat | Moderate; low if fat is not absorbed (steatorrhoea); MCT oil helps | Normal |
| Fibre | Low residue during flares and when there are strictures | Increase slowly; whole fruits and vegetables as tolerated |
| Lactose | Limit milk if intolerant; curd is usually tolerated | As tolerated |
| Fluid and electrolytes | Extra fluids, ORS if diarrhoea is heavy | Normal |
| Micronutrients | Iron, folate, B12 (injections if the ileum is affected), calcium, vitamin D, zinc | Check blood levels regularly |
Foods to include and avoid, and a sample menu (flare)
| Item | Details |
|---|---|
| Include | Soft rice, idli, rava upma, refined-flour chapati, moong dal, egg, steamed fish, chicken stew, paneer, curd, peeled cooked vegetables, banana, papaya, stewed apple |
| Avoid during a flare | Whole grains with bran, whole pulses, raw salads, skins and seeds, nuts, popcorn, fried foods, spicy curries, alcohol, sugary drinks |
| Early morning | Oral nutrition supplement or milkshake made with lactose-free milk |
| Breakfast | Idli (3) with moong dal; boiled egg |
| Mid-morning | Ripe banana; curd |
| Lunch | Soft rice, fish stew (mild), mashed carrot-potato, curd |
| Evening | Rava upma with peeled vegetables; buttermilk |
| Dinner | Soft chapati (refined flour), paneer bhurji (mild), bottle gourd curry |
| Bedtime | Custard or a supplement drink |
On the ward, weigh IBD patients twice a week; weight loss is often hidden by fluid shifts. Patients with strictures must stay on low-residue food to avoid a blocked bowel, and those with ileal disease usually need B12 injections.
2 marks: “What are skip lesions?” Patches of diseased bowel separated by normal bowel; typical of Crohn's disease.
5 marks: “Differentiate ulcerative colitis and Crohn's disease.” Site, pattern, depth, stools and complications in a five-row table.
10 marks: “Discuss the dietary management of inflammatory bowel disease.” Define IBD, UC vs Crohn's, causes, symptoms, nutrition problems, principles table for flare and remission, foods and a flare menu.
UC = Unbroken Colon (continuous, colon only). Crohn's = Can be anywhere, Chunks skipped.