Lifestyle, behaviour, and environmental modification for the management of patients with inflammatory bowel diseases: an International Organization for Study of Inflammatory Bowel Diseases consensus

Lancet Gastroenterol Hepatol. 2022 Jul;7(7):666-678.doi: 10.1016/S2468-1253(22)00021-8. Epub 2022 Apr 27.


Ashwin N Ananthakrishnan 1Gilaad G Kaplan 2Charles N Bernstein 3Kristin E Burke 4Paul J Lochhead 4Alexa N Sasson 4Manasi Agrawal 5Jimmy Ho Tuan Tiong 6Joshua Steinberg 7Wolfgang Kruis 8Flavio Steinwurz 9Vineet Ahuja 10Siew C Ng 11David T Rubin 7Jean-Frederic Colombel 12Richard Gearry 6International Organization for Study of Inflammatory Bowel Diseases


International Organization for Study of Inflammatory Bowel Diseases: 

M AbreuV AhujaM AllezA AnanthakrishnanW BemelmanC BernsteinJ BraunY ChowersJ-F ColombelS DaneseG D'HaensA D'HooreA DignassI DotanM DubinskyA EkbomP FleshnerC GascheM A GassullR GearryS GhoshP GibsonA GriffithsJ HalfvarsonS HanauerN HarpazA HartT HibiM KammG KaplanA KaserB KorelitzP KotzeI KoutroubakisW KruisP LakatosJ LewisJ LindsayE LoftusE LouisM LukasF MagroU MahadevanG MantzarisJ-Y MaryD McGovernB MoumP MunkholmM NeurathS NgC O'MorainT OreslandR PanaccioneJ PanesY PanisJ PembertonL Peyrin-BirouletC PranteraD RachmilewitzZ RanW ReinischF RemziJ RhodesR RiddellG RoglerD RubinD SacharW SandbornB SandsB SartorJ SchoelmerichS SchreiberC SiegelB SiegmundM SilverbergJ SöderholmA SoodA SpinelliE StangeF SteinwurzS TarganS TravisD TurnerC TyskM VatnS VermeireM WatanabeT YamamotoJ Yamamoto-Furusho


Author information

1Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. Electronic address: aananthakrishnan@mgh.harvard.edu.

2Division of Gastroenterology & Hepatology, University of Calgary, Calgary, AB, Canada.

3Section of Gastroenterology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.

4Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.

5Dr Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Clinical Medicine, Center for Molecular Prediction of Inflammatory Bowel Disease (PREDICT), Aalborg University, Copenhagen, Denmark.

6Department of Gastroenterology, Christchurch Hospital, Christchurch, New Zealand.

7Department of Gastroenterology, Hepatology, and Nutrition, Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, IL, USA.

8Department of Internal Medicine, University of Cologne, Cologne, Germany.

9Department of Gastroenterology, Hospital Israelita Albert Einstein, São Paulo, Brazil.

10Department of Gastroenterology & Human Nutrition, All India Institute of Medical Sciences, New Delhi, India.

11Department of Medicine and Therapeutics, LKS Institute of Health Science and Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China.

12Dr Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.


Environmental and lifestyle factors play an important role in the natural history of Crohn's disease and ulcerative colitis. A group of international experts from the International Organization for the Study of Inflammatory Bowel Diseases voted on a series of consensus statements to inform the management of inflammatory bowel disease (IBD). The recommendations include avoiding traditional cigarette smoking in patients with Crohn's disease or ulcerative colitis, screening for symptoms of depression, anxiety, and psychosocial stressors at diagnosis and during flares (with referral to mental health professionals when appropriate), and encouraging regular physical activity as tolerated. Patients using dietary approaches for treatment of their IBD should be encouraged to adopt diets that are best supported by evidence and involve monitoring for the objective resolution of inflammation. We recommend formal assessment for obesity and nutritional deficiencies, and patients should be encouraged to maintain a normal body-mass index. A shared decision-making approach to contraception should include the consideration of IBD-related factors, and risk factors for venous thromboembolism. Long-term or frequent use of high-dose non-steroidal anti-inflammatory drugs should be avoided. For primary prevention of disease in the offspring of patients with IBD, we recommend avoiding passive exposure to tobacco, using antibiotics judiciously, and considering breastfeeding when able.


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