Frequent Use of Restricted Oral Intake During Hospitalization for IBD Flares Was Not Associated with Improved Clinical Outcomes: A Multicenter Retrospective Cohort Study

BACKGROUND: There are limited indications for bowel rest in hospitalized patients with inflammatory bowel disease (IBD) flares, particularly in patients with only inflammatory disease (i.e., no obstruction, abscess, or fistula). We aimed to assess the frequency of restricted oral intake and its impact on IBD-related outcomes. METHODS: Patients hospitalized with flares between 2015 and 2020 in a large urban multi-hospital network were included. Patients with obstruction, active intra-abdominal abscess or fistula, elective surgery, or new IBD diagnoses were excluded. Restricted oral intake, defined as time spent nil per os (NPO) or on a clear liquid diet (CLD), was calculated as a proportion of total hospital stay and analyzed by quartiles. RESULTS: A total of 315 patients (137 CD, 174 UC, 4 IBDU) were included. Most patients (90.1%) had at least one period of restricted oral intake, accounting for a mean of 35.4% of hospitalization. There were no significant differences across quartiles in 30-day or 90-day readmission, unplanned surgery, or inpatient biologic use. Similar findings were observed in subgroup analyses of Crohn's disease and ulcerative colitis. CONCLUSION: Restricted oral intake is common among hospitalized patients with IBD flares and accounts for a substantial proportion of hospitalization time. Increased duration of restricted oral intake was not associated with improved clinical outcomes. These findings support current guideline recommendations that routine dietary restriction in the absence of clear indications should be reconsidered.