Low Dose Methotrexate in Inflammatory Bowel Disease: Current Status and Future Directions

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Abstract Background Dietary modification shows promise as therapy in inflammatory bowel disease (IBD); however, it is unknown whether adolescents are interested in a dietary approach. Methods Cross-sectional survey of adolescents with IBD ages 14–21 on disease knowledge, dietary habits, and perceptions of diet therapy. Results A total of 132 subjects (48.5% female), mean age of 17.8 years and median disease length of 5 years (range 0, 16), completed the survey. Diet was perceived as a symptom trigger by 59.8% of subjects, and 45.4% had tried using diet as a treatment for symptom resolution, often without physician supervision and with limited success. Overall, subjects reported following a diet significantly more often than documented in the electronic medical record (EMR) by the physician (25.0% vs. 15.0%, p=0.033), with 72% agreement between subject response and EMR documentation on current status of diet modification (AC1=0.59, CI=0.45, 0.73). Subjects experiencing active disease symptoms as determined by Manitoba IBD Index were more likely to be currently modifying their diet compared to subjects without active disease symptoms (OR = 4.11, CI=1.58, 10.73, p=0.003). The subjects reporting unsuccessful dietary modification compliancy (25.7%, n=34) most commonly cited perceived lack of improvement in their IBD symptoms as the primary reason for stopping the diet (48.4%, n=15). Conclusions Adolescents with IBD perceive a relationship between diet and disease symptoms and are interested in dietary modification as a symptom management option. Our study suggests that a large proportion of adolescent IBD patients may already be attempting dietary modification, and therefore would be receptive to a modified dietary plan under the guidance of their gastroenterologist and dietitian. Much is still unknown about how dietary modification will fit in with current treatment regimens, but patient interest informs us that it is necessary to continue development and research of this promising therapeutic option.


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