Dietary management for people with an ileostomy: A scoping review

Objective: To identify and map the evidence for oral dietary management of ileostomies.
Introduction: Dietary advice is commonly provided for ileostomy management but can be inconsistent, conflicting, and inadequate. There is a lack of high-quality research investigating dietary management of ileostomies. This scoping review highlights gaps in the literature that need addressing to inform practice and identifies dietary strategies and outcomes to be investigated in future studies.
Inclusion criteria: Evidence relating to the use of oral dietary strategies in humans to manage complications and nutritional consequences associated with having an ileostomy. Evidence included all types of original research, i.e. quantitative and qualitative methodologies, and expert opinion articles and consensus guidelines.
Methods: This review followed the JBI methodology for systematic scoping reviews. A pre-determined search of 13 databases, including MEDLINE, Embase and Web of Science, was conducted in August 2019. The search was not limited by date but during screening expert opinion evidence was limited to 2008 onwards. Data extraction was carried out by two reviewers for each study/article using a database tool designed specifically for this review. Results are presented using a combination of tabular summaries and narrative report.
Results: 31 research studies were included; 11 experimental (including four crossover RCTs), three pre-post design, 13 observational (12 cross-sectional, one longitudinal), and four qualitative. 44 expert opinion articles/guidelines were also included. In experimental studies, nine nutrient modifications and 34 individual foods/drinks were investigated. In pre-post studies, ten nutrient modifications, 80 foods/drinks, and 11 eating-related behaviors were investigated. In observational studies, eight nutrient modifications, 94 foods/drinks, and five eating-related behaviors were reported. In qualitative studies, two nutrient modifications, 17 foods/drinks, and one eating-related behavior were reported. In expert opinion articles/guidelines, recommendations relating to 51 nutrient modifications, 339 foods/drinks, and 23 eating-related behaviors were reported. Although large numbers of individual foods and drinks were suggested to be associated with outcomes relating to ileostomy management, findings from observational studies showed these were mostly only reported by <50% of people with an ileostomy. The most common nutrients reported in association with outcomes related to ileostomy management were fiber, fat, and alcohol. Across most outcomes and studies/expert opinion, low fiber and low fat were suggested to be beneficial, while alcohol was detrimental. Other nutrient associations frequently reported in expert opinion (but with minimal attention in research studies), included negative consequences of caffeinated drinks and positive effects of white, starchy carbohydrates on stoma output. Output volume and consistency were the most commonly reported outcomes relating to ileostomy management across all study types. Flatulence and odor were also common outcomes in observational studies.
Conclusions: This review found an abundance of literature, particularly expert opinion, reporting on dietary management for people with an ileostomy. However, this literature was highly heterogenous in terms of dietary strategies and outcomes reported. It is likely that most dietary advice provided in practice is based on expert opinion with some supported by limited research. High-quality research investigating the effect of the dietary strategies identified in this review on commonly associated outcomes relating to ileostomy management is needed to improve evidence-based advice.