Background and Aim: Exclusive enteral nutrition (EEN) is progressively being used as a therapeutic option for adults with Crohn's Disease (CD); however, there is no standardized approach to delivering this therapy. The aim of this study is to develop an optimal care pathway for using EEN in adults with CD. This will create a standard of care that can be used as a benchmark practice and will provide direction for future research.Methods: A working group of 12 multidisciplinary inflammatory bowel disease specialists across Australia and New Zealand was convened to develop a practical, clinically focused care pathway for using EEN in adults with active CD. Six key areas were identified as part of the care pathway: clinical indications, nutrition assessment, EEN protocol, monitoring, accessing formula, and food reintroduction. Current literature was identified via systematic review, and quality of evidence was graded. Consensus expert opinion was used where literature gaps were identified.Results: An optimal care pathway for using EEN in adults with CD was developed with six key consensus statements on how to use EEN in adults with active CD. These key statements identify clinical indications for use, nutrition assessment, enteral prescription and duration of therapy, monitoring criteria, food reintroduction, and the role of partial EEN. An accompanying patient resource was also developed.Conclusion: EEN is recommended as a treatment option to induce remission in adults with active CD. The consensus statements developed are practical and are based on best available evidence and expert opinion to assist in developing a standardized approach to delivering EEN therapy.

Summary: Background: Although dietary emulsifiers are implicated in the pathogenesis of Crohn's disease, their effect has not been studied in humans.Aim: To determine the effects of high‐ and low‐emulsifier diets (HED, LED) on intestinal barrier function in healthy subjects in unstressed and acutely stressed states.Methods: We conducted a single‐blinded, cross‐over, controlled feeding trial in 22 healthy adults. After recording 7 days of their habitual diet, we randomised participants to HED or LED with ≥3‐week washout between diets. On dietary completion, acute stress was induced via intravenous corticotrophin‐releasing hormone. We assessed dietary adherence, effects on 2‐h urinary lactulose: rhamnose ratio (LRR), serum concentrations of lipopolysaccharide‐binding protein, soluble‐CD14 and markers of epithelial injury and inflammation.Results: Dietary adherence was excellent. In an unstressed state, median (interquartile range) LRR during HED was 0.030 (0.018–0.042); on LED, this was 0.042 (0.029–0.078; p = 0.04). LPB concentrations were lower on HED than LED (p = 0.026), but no differences were observed for epithelial injury or inflammation. Under acute stress, LRR increased by 89% (−1% to 486%) on HED (p = 0.004), differing (p = 0.001) from 39% (1%–90%) decrease on LED (p = 0.009). Soluble‐CD14 also increased (p < 0.001). The LED had a prolonged carry‐over effect on suppressing HED‐induced changes during stress. Similar changes in LRR and soluble‐CD14 were observed when HED was used as the first diet (both p < 0.01).Conclusion: High intake of emulsifiers improved barrier function in the unstressed state, but increased intestinal permeability to stress, without evidence of inflammation. A LED was protective of the stress effect.

Background: Advice to avoid dietary emulsifiers in Crohn's disease (CD) is based on preclinical data.Aims: To examine the effect of diets high (HED) and low (LED) in emulsifiers in the food supply on disease activity in CD.Methods: In a double‐blinded, randomised feeding study, we randomised adults with symptomatic, sonographically active CD with ileal involvement on ≥ 2 months' stable medical therapy to 4 weeks of a HED or LED modelled on Australian healthy eating guidelines. We measured the Harvey‐Bradshaw Index (HBI), sonographic indices (IBUS‐SAS, bowel wall thickness), quality of life (QOL) and fatigue at baseline and study completion.Results: We randomised 24 patients, mean age 37 (95% CI 32, 41) years, 12 male, HBI 6 (6, 8), bowel wall thickness 6.0 (5.5–6.6) mm. Adherence was > 95%. Clinical remission (HBI < 5) occurred in 9/12 on HED and 7/12 on LED; 2 and 3, respectively, withdrew early with increasing gastrointestinal symptoms. IBUS‐SAS fell from 51 (35, 68) to 33 (15, 51) on HED (p = 0.014) and from 57 (38, 76) to 44 (29, 59) on LED (p = 0.01). Bowel wall thickness reduced by 34% on HED and 15% on LED in those who completed the study. QOL and fatigue improved on both diets (p ≤ 0.05). There were no statistically significant differences in outcomes between diets.Conclusions: In the context of a healthy diet, the emulsifier content had no influence over disease activity over 4 weeks in patients with CD. Recommendations to avoid emulsifiers in patients with active CD are not supported.Australian New Zealand Clinical Trials Registry (ACTRN12619001099112).

Disorders of brain–gut interaction (DGBI) are highly prevalent in our community with a negative burden on the quality of life and function. Symptoms are frequently food‐induced, and psychological disorders are commonly co‐morbid and contribute greatly to symptom severity and healthcare utilization, which can complicate management. Pathophysiological contributors to the development and maintenance of DGBI are best appreciated within the biopsychosocial model of illness. Established treatments include medical therapies targeting gastrointestinal physiology, luminal microbiota or visceral sensitivity, dietary treatments including dietary optimization and specific therapeutic diets such as a low‐FODMAP diet, and psychological interventions. The traditional “medical model” of care, driven predominantly by doctors, poorly serves sufferers of DBGI, with research indicating that a multidisciplinary, integrated‐care approach produces better outcomes. This narrative review explores the current evidence for multidisciplinary care and provides the best practice recommendations for physicians and healthcare systems managing such patients.

Dietary patterns contribute to overall health and diseases of ageing but are understudied in older adults. As such, we first aimed to develop dietary indices to quantify Mediterranean Diet Score (MDS) utilisation and Ultra-processed Food (UPF) intake in a well-characterised cohort of relatively healthy community-dwelling older Australian adults. Second, we aimed to understand the relationship between these scores and the association of these scores with prevalent cardiometabolic disease and frailty. Our major findings are that in this population of older adults, (a) pre-frailty and frailty are associated with reduced MDS and increased UPF intake; (b) adherence to MDS eating patterns does not preclude relatively high intake of UPF (and vice versa); and (c) high utilisation of an MDS eating pattern does not prevent an increased risk of frailty with higher UPF intakes. As such, the Mediterranean Diet pattern should be encouraged in older adults to potentially reduce the risk of frailty, while the impact of UPF intake should be further explored given the convenience these foods provide to a population whose access to unprocessed food may be limited due to socioeconomic, health, and lifestyle factors.

Summary: Background: Disturbance of skeletal muscle mass has clinically important implications in patients with inflammatory bowel disease (IBD), but accurate quantification requires radiation‐intense techniques.Aims: We aimed to compare point‐of‐care muscle assessments and their change with therapy with those using reference‐standard whole‐body dual energy X‐ray absorptiometry (DXA).Methods: Adult patients with IBD and healthy controls underwent prospective assessment of muscularity by ultrasound of the dominant arm and both thighs, bioelectrical impedance analysis (BIA), anthropometric measurements, and DXA. Patients with active IBD were assessed again ≥13 weeks after initiating biologic induction therapy.Results: In 54 patients with IBD and 30 controls, all muscle assessments correlated significantly with DXA‐derived skeletal muscle index (SMI). In IBD, ultrasound of the arm and legs had the best agreement with DXA‐derived SMI (mean difference 0 kg/m², 95% limits of agreement −1.3 to 1.3), while BIA overestimated DXA‐derived SMI by 1.07 (−0.16 to +2.30) kg/m². In 17 patients who underwent biologic therapy, the percentage change in DXA‐derived SMI correlated significantly with the percentage change in all other muscle assessment techniques. Responders (n = 9) increased SMI from baseline to follow‐up when derived from DXA (mean 7.8–8.5 kg/m², p = 0.004), ultrasound of the arm and legs (300–343 cm², p = 0.021) and BIA (9.2–9.6 kg/m², p = 0.011).Conclusions: Ultrasound of the arm and legs out‐performed other point‐of‐care methods in its accuracy of measuring muscle mass. All methods, except mid‐arm circumference, were responsive to therapy‐induced change. Ultrasound is the preferred non‐invasive test for measuring muscle mass in patients with IBD.