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.
Bibliographical noteFunding Information:
ANA served on the scientific advisory boards for AbbVie and Ikena Oncology; and reports research funding from the Chleck Family Foundation, Crohn's and Colitis Foundation, and National Institutes of Health. GGK received honoraria for speaking or consultancy from AbbVie, Janssen, Pfizer, Amgen, and Takeda; received research support from Ferring, Janssen, AbbVie, GlaxoSmithKline, Merck, and Shire; has been a consultant for Gilead; and reports shared ownership of a patent: Treatment of Inflammatory Disorders, Autoimmune Disease, and PBC (UTI, assignee; patent WO2019046959A1; PCT/CA2018/051098; Sept 7, 2018). CNB reports being on the advisory board for AbbVie, Amgen Canada, Avir Pharmaceuticals, Bristol Myers Squibb Canada, Janssen Canada, Pfizer Canada, Roche Canada, Sandoz Canada, and Takeda Canada; a consultant to Mylan Pharmaceuticals and Takeda; speaker bureau for AbbVie Canada, Janssen Canada, Takeda Canada, and Pfizer Canada; received educational grants from AbbVie Canada, Janssen Canada, Pfizer Canada, and Takeda Canada; and received research grants from AbbVie Canada, Pfizer Canada, and Sandoz Canada. JS reports being on the advisory board for Pfizer. FS reports consulting for AbbVie, Eurofarma, Ferring, Janssen, Pfizer, Takeda, and UCB; and served as a speaker for AbbVie, Amgen, Ferring, Janssen, Novartis, Pfizer, Sandoz, and Takeda. SCN served as a speaker for AbbVie, Janssen, Tillotts, Menarini, Ferring, Takeda, and Pfizer; and received research funding from Olympus, Janssen, and Ferring. DTR has received grant support from Takeda; and has served as a consultant for AbbVie, AltruBio, Arena Pharmaceuticals, Bristol Myers Squibb, Genentech/Roche, Gilead Sciences, Iterative Scopes, Janssen Pharmaceuticals, Lilly, Pfizer, Prometheus Biosciences, Takeda, and Techlab. J-FC reports receiving research grants from AbbVie, Janssen Pharmaceuticals, and Takeda; receiving payment for lectures from AbbVie, Amgen, Allergan, Ferring Pharmaceuticals, Shire, and Takeda; receiving consulting fees from AbbVie, Amgen, Arena Pharmaceuticals, Boehringer Ingelheim, Bristol Myers Squibb, Celgene Corporation, Eli Lilly, Ferring Pharmaceuticals, Galmed Research, Genentech, GlaxoSmithKline, Janssen Pharmaceuticals, Kaleido Biosciences, Imedex, Immunic, Iterative Scopes, Merck, Microba, Novartis, PBM Capital, Pfizer, Sanofi, Takeda, TiGenix, and Vifor; and holds stock options in Intestinal Biotech Development. RG reports grant support from Janssen, AbbVie, and Zespri NZ; and has been on the advisory board for Janssen, AbbVie, and Zespri NZ. All other authors declare no competing interests.
© 2022 Elsevier Ltd