Gap Persists in Patient-Clinician Communication Despite Similar Views on Diet’s Role in IBD

New research highlights a communication gap between patients and clinicians in discussing the role of diet in inflammatory bowel disease (IBD) that must be addressed to improve adherence to dietary advice.1

“Whilst multiple studies exist exploring patients' views on diet and IBD, clinician perspectives remain underexplored.2 Furthermore, no recent studies have examined the interplay between patients and clinicians’ attitudes towards diet in IBD. This study aimed to re-evaluate the attitudes of both patients and clinicians regarding the role of diet in IBD and to assess how these perspectives may have changed over time compared with our index survey,” lead investigator Nikita Parkash, Department of Gastroenterology and Hepatology, Monash Health, Melbourne, Victoria, Australia, and colleagues wrote.1

Parkash and colleagues conducted a cross-sectional study in Australia including members of national IBD organizations and their patients, with a survey sent to each group. The questionnaires collected data on demographics, disease phenotype, dietary awareness and beliefs. Responses were compared to index survey responses from a survey they conducted nearly a decade ago using the χ2 or Fisher's exact tests.

Overall, 82 patients completed the survey. Participants with a median age of 40 years; 72% of which were female. Around half (52%) had Crohn disease (CD) and 47% had ulcerative colitis (UC). Most (89%) felt diet was important to their IBD, almost half (49%) felt their diet could be improved, and 39% had not seen a dietitian. Current patients were more likely to believe diet affects their IBD (78%) than in the index survey (89%; P =.019).1

The clinician survey was completed by 50 participants, including gastroenterologists, dietitians, surgeons and nurses. Over 82% believed diet plays a role in IBD pathogenesis, symptoms, complications, microbiota, and treatment response, compared to 31% in the index study, when the role of diet in pathogenesis was more debated. Most clinicians (78%) thought exclusive enteral nutrition and the CD Exclusion Diet were effective, with most (87%) non-dietitian clinicians referring to dietitians for these therapies.1

Notably, the study highlighted that while participants’ surveyed views were similar, participants perceived them to be significantly different, with 57% of clinicians feeling that their views differed from their patients', which was similar to that seen in the index study. Furthermore, while 94% of clinicians reported providing dietary education, only 18% of patients reported receiving such advice from their specialist. Again, this gap was similar to that in the index study (98% and 26%, respectively).1

“While the body of evidence surrounding the association of diet and inflammatory bowel disease is rapidly growing, with it comes a heterogeneity of dietary advice and subsequently a paucity of consensus guidelines for clinicians and patients. This study highlights that patient and clinician attitudes have shifted over time, to now largely aligning by acknowledging this importance of diet in IBD pathogenesis, complications and management. However, owing to the lack of guidelines, patients and clinicians are left without clear pathways for dietary advice, and there remains a persistent communication gap, with patients often turning to unregulated online resources in the absence of professional guidance. The implementation of misguided dietary advice may lead to harmful outcomes including nutritional deficiencies, orthorexia and disordered eating,” Parkash and colleagues wrote.1 “To bridge this divide, there is a clear need for consensus dietary guidelines, improved clinician education, and greater integration of dietitians into multidisciplinary care teams.”

REFERENCES

1. Parkash N, Holt D, Moore GT. Surveying Dietary Beliefs of Patients With Inflammatory Bowel Disease and Their Treating Clinicians-Have These Changed Over Time? PubMed. 2025;38(4):e70098-e70098. doi: 10.1111/jhn.70098

2. Verdina M, Seibold F, Grandmaison G, et al. Survey of dietary beliefs and habits of inflammatory bowel disease patients. Clinical Nutrition ESPEN. 2023;57:624-629. doi: 10.1016/j.clnesp.2023.07.090