Diet for strictures and Crohn’s disease

What is a stricture?

An intestinal stricture (or stenosis) is a narrowing of the intestinal lumen (space inside of the intestine) which can occur in the small or large bowel, but are more common in the small bowel.

A stricture may be from swelling caused by inflammation or from scar tissue (fibrosis) caused by long term inflammation, or both. For people who have had surgery, sometimes narrowing can also occur around where the bowel has been joined back together (the anastomosis).

Risks with a stricture

If strictures are not well treated, it can cause a blockage, called a bowel obstruction.

How do I know if I have a stricture?

It is important to recognise what symptoms may indicate a partial or full bowel obstruction. These symptoms are called obstructive symptoms.

The following symptoms are common obstructive symptoms:

• Severe abdominal pain, particularly after eating
• Nausea and vomiting
• Constipation or not having bowel motions

These symptoms can be similar to your usual symptoms of Crohn’s disease. It is important that if you think you are having obstructive symptoms that you contact your IBD team or for severe symptoms, present to a hospital emergency department.

Strictures can be sometimes identified on a colonoscopy, but are usually fully assessed using imaging, such as a CT, MRE or intestinal ultrasound.

Treatment of strictures

Inflammatory strictures – are managed by adjusting your medical therapy to treat the inflammation so that the stricture is reduced or eliminated. These treatments often include corticosteroids, some biologic agents or exclusive enteral nutrition (see section below). Your IBD doctor will discuss the best options for you.

Fibrotic strictures – are managed by stretching the stricture with an endoscopic balloon, via a surgical procedure called a stricturoplasty or through surgery to remove the stricture.

Diet for strictures

1. Reduced (modified) Fibre Diet

Most commonly, you may be advised to follow a reduced (modified) fibre diet, to reduce the risk of a bowel obstruction. This may be a temporary diet if the stricture is inflammatory and being treated with therapy or if the stricture is surgically removed. These diets may be recommended in the longer-term if the stricture cannot be treated or removed.

A reduced fibre diet must be done in conjunction with an IBD dietitian to ensure you are following the diet correctly, you understand different types of fibres to help keep your bowel functioning well and you do not compromise on your nutrition.

Once your strictures have been treated or removed, you are encouraged to have a high fibre, healthy balanced diet. For further information, refer to the Nutrition webpage or DECCAN Eating well with Crohn’s disease video.

2. Exclusive Enteral Nutrition

Exclusive enteral nutrition (EEN) involves a strict liquid diet, consuming nutritional
supplement drinks in place of food over a 6-8 week period. A course of EEN can
reduce inflammation and treat strictures. After a course of EEN, an IBD dietitian will
discuss with your doctor whether the inflammatory stricture has resolved and
advise you how to reintroduce foods. For further information, refer to the Exclusive Enteral Nutrition for Crohn’s Disease webpage.

EEN must be done in conjunction with an IBD dietitian to ensure you are following the diet correctly and consuming the required amount to meet your individual nutritional needs and transition you back to solid foods.