Abstract
Background: Crohn's disease (CD) is a chronic inflammatory bowel disease that significantly affects patients' quality of life. Nutrition is increasingly recognized as a modifiable factor influencing disease activity and symptom management. Despite growing interest, structured dietary guidelines for CD are lacking, and patients often rely on personal experience or fragmented advice. This study aimed to investigate patients' perceptions of diet, the support they receive, and the psychosocial burden of dietary management in CD. Methods: A nationwide online survey was conducted in Italy from April to May 2025 among individuals diagnosed with CD. The questionnaire, developed in line with the CROSS reporting guidelines, comprised 30 multiple-choice questions across five sections: demographics, disease characteristics, dietary habits during remission, dietary habits during flare-ups, and psychological impact. Invitations were distributed through patient associations, webinars, and gastroenterology professionals. Responses were anonymized. Results: A total of 222 participants completed the survey (59.5% female, most aged 30-39 years). Fatigue was the most common symptom (71.6%), frequently persisting even during remission. Nearly half of respondents reported diet as "very important" in disease management, yet only 32% had received a formal referral to a nutritionist. The most commonly adopted dietary approach was a low-fiber diet, while awareness of evidence-based protocols like the Crohn's disease exclusion diet (CDED) was limited (11.7%). Social and psychological burdens were significant, with 79.2% reporting anxiety when outside their home. Conclusions: Dietary education and psychological support are unmet needs for CD patients. Improved access to tailored nutritional counseling and greater awareness of validated dietary approaches may enhance disease management and quality of life.