Patient with stricturing ileal Crohn’s disease and a history of ileal-cecal resection (ICR) 3 years prior endorses a fear of eating due to a history of pain and obstructive symptoms associated with vegetables and fibrous foods prior to their ICR. The client states they would like to reintroduce fiber, but are fearful of the consequences (pain, vomiting). They share that immediately after their ICR, they tried an apple and experienced lots of gas afterward. They have not tried other fibrous foods since. They are currently in clinical remission.

Current colonoscopy and pathology reports reveal the patient is in deep remission, Rutgeerts i0.

Diet recall reveals the patient eats eggs and toast for breakfast, a grilled cheese sandwich for lunch, and chicken with mashed potatoes for dinner.

The registered dietitian (RD) provides education on the role of fiber in maintaining remission in IBD and for the prevention of chronic disease. The RD also educates on normal sensations that may be experienced with fiber reintroduction (gas, bloating, pain), and that these may be mitigated with a slow reintroduction of small portions of fiber. The RD reassures the patient that food reintroduction will happen at a pace they are most comfortable with.

Through shared decision-making, the patient decides to add roasted potatoes (same food, different texture) to their breakfast.

On follow-up, the patient reports they have successfully reintroduced the new food texture, and they feel ready to try a new food: oranges. They would like to continue to limit apples in their diet for now but are open to other fruits.