Ashwin Ananthakrishnan, MBBS, MPH

A multitude of environmental factors affect the presentation, outcome, and treatment of IBD.¹ An expert consensus statement, published in April, discussed these environmental factors and provided guidelines in their management.¹ Of the many environmental factors examined, 2 commonly reported triggers were stress and diet. Stress-related mental health conditions are common in IBD, with 21.1% of patients with IBD reporting anxiety and 25.5% reporting depression.² Biologically, stress has been linked to changes in the gut microbiome, which may contribute to intestinal inflammation.³ Modifying stress has also been shown to improve quality of life in patients with IBD and potentially decrease relapses.⁴

Among the various dietary factors examined, both individual macronutrients or micronutrients and broad dietary patterns such as a Mediterranean diet can positively influence both IBD symptoms and inflammation. In addition to nutritive content, the consumption of processed foods may also play a role in the development of IBD. In prospective cohorts, a diet high in ultraprocessed foods was associated with an increased risk of IBD.^5,6 Along with assessing dietary changes, studies examined how a patient feels his diet affects his symptoms.⁷ As for technology, apps have been developed that help patients track their dietary and lifestyle behaviors and aim to improve IBD symptoms.⁸ Overall, environmental factors such as these play an important role in IBD etiology, presentation, and treatment, highlighting the importance of more comprehensive approaches that incorporate dietary and psychological interventions in the management of IBD.