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

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

Collaborators

International Organization for Study of Inflammatory Bowel Diseases: 

M Abreu, V Ahuja, M Allez, A Ananthakrishnan, W Bemelman, C Bernstein, J Braun, Y Chowers, J-F Colombel, S Danese, G D'Haens, A D'Hoore, A Dignass, I Dotan, M Dubinsky, A Ekbom, P Fleshner, C Gasche, M A Gassull, R Gearry, S Ghosh, P Gibson, A Griffiths, J Halfvarson, S Hanauer, N Harpaz, A Hart, T Hibi, M Kamm, G Kaplan, A Kaser, B Korelitz, P Kotze, I Koutroubakis, W Kruis, P Lakatos, J Lewis, J Lindsay, E Loftus, E Louis, M Lukas, F Magro, U Mahadevan, G Mantzaris, J-Y Mary, D McGovern, B Moum, P Munkholm, M Neurath, S Ng, C O'Morain, T Oresland, R Panaccione, J Panes, Y Panis, J Pemberton, L Peyrin-Biroulet, C Prantera, D Rachmilewitz, Z Ran, W Reinisch, F Remzi, J Rhodes, R Riddell, G Rogler, D Rubin, D Sachar, W Sandborn, B Sands, B Sartor, J Schoelmerich, S Schreiber, C Siegel, B Siegmund, M Silverberg, J Söderholm, A Sood, A Spinelli, E Stange, F Steinwurz, S Targan, S Travis, D Turner, C Tysk, M Vatn, S Vermeire, M Watanabe, T Yamamoto, J 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.

Abstract

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.