1. 2013 Advances in Inflammatory Bowel Diseases Hollywood, Florida December 12, 2013 Carol S. Brotherton, PhD, MSN, RN George Mason University, Fairfax, Virginia 1 Nurse-Led Investigation of the Relationship Between Dietary Fiber and Crohn's Disease Symptoms

2. 2 Nothing to Disclose Disclosures

3. 3 My background… Family and community experiences (beginning in 1977) Some people with Crohn’s disease can control their symptoms through therapeutic use of dietary fiber Clinical nursing in gastroenterology/outpatient surgery settings (1992 - 2007) 1.Benefits of dietary fiber are not taught in conventional Crohn’s disease care 2.Patients can be taught about the benefits of fiber and observe improvements similar to that of individuals in the community NIH-funded researcher (2008 – present) Research program focused on lifestyle factors that affect CD symptoms

4. 4 Contraindications… ◦ Recent surgery ◦ Obstructive strictures ◦ Open fistulas ◦ Short bowel syndrome ◦ Wheat allergy/gluten intolerance/celiac disease

5. 5 What I taught… ◦ Epidemiology evidence ◦ Fiber effects in the GI tract ◦ Fiber heterogeneity ◦ Anecdotal evidence ◦ Label reading

6. 6 What we did… Design: 4-week, 2-group, single-blind, randomized, controlled Purpose: to investigate the effects of fiber-related dietary instructions specifying wheat bran consumption on GI symptoms and HQoL in individuals diagnosed with CD Dependent Variables Independent Variable

7. 7 No group differences at baseline What we found…

8. 8 Partial Harvey Bradshaw Index (pHBI) Lower Scores=Diminished Symptoms Groups Bran treatment Control Repeated Measures ANOVA P = 0.008

9. 9 Inflammatory Bowel Disease Questionnaire (IBDQ) Higher Scores=Better Quality of Life What we found… Repeated Measures ANOVA P = 0.028 Groups Bran treatment Control

10. 10 Conclusions… Limitations Implications Future Research Small sample size Limited generalizability Limited power for objective measures Disconnect between research and practice Patients with Crohn’s disease may benefit from receiving information from nurses about the effects of dietary fiber in the gastrointestinal tract Test intervention in a larger, more diverse sample Choose outcomes and measures that are not affected by biologic drugs (effect of fiber on microbiota?)

11. 11 Thank you! Questions? Email: cbrothe2@gmu.edu