The importance of preventive care to people with inflammatory bowel disease (IBD) is stressed in a new guideline by the American College of Gastroenterology (ACG), with specific recommendations of measures IBD patients should take to stay healthy.
The guideline, “ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease,” was recently published in the American Journal of Gastroenterology.
Recommendations cover vaccinations, quitting smoking, screening for two particularly relevant types of cancer (cervical and skin cancer), osteoporosis, depression, and anxiety.
The guideline’s development was led by Francis A. Farraye, MD, MSc, FACG, a professor of medicine at the Boston University School of Medicine. Farraye and colleagues outlined preventive care required by IBD patients and also recommend that a multidisciplinary team of gastroenterologists, primary care providers and other specialists work to deliver it.
Vaccinations were emphasized, particularly for IBD patients on immunosuppressive therapies, due to the increased risk for infections these therapies pose.
“Combinations of an immunomodulator and biologic agent are being used more frequently and earlier in subsets of patients with ulcerative colitis and Crohn’s disease who present with or have signs and symptoms of an aggressive course,” Farraye said in a news release.
“Patients on steroids, immunomodulators or biologics are at an increased risk of developing infectious complications including infections with opportunistic organisms,” she said. “Vaccinations may lower the risk of infections with some of these organisms but vaccination rates in IBD patients remain too low.”
The authors recommend that vaccination schedules be age-appropriate, except if patients are receiving or initiating treatment with immunosuppressants.
“Ideally vaccinations should be administered prior to starting immunosuppressive therapy, as vaccine efficacy is higher in the non-immunosuppressed IBD patient,” Farraye said.
All adult IBD patients are advised to receive non-live vaccines, including “trivalent inactivated influenza vaccine, pneumococcal vaccination (PCV13 and PPSV23), hepatitis A, hepatitis B, Haemophilus influenza B, human papilloma virus (HBV), tetanus, and pertussis.” Exceptions are made for certain live vaccines, like the herpes zoster, for patients on low-level immunosuppression.
Patients are strongly encouraged to stop smoking, as well as to be screened for depression and anxiety, osteoporosis, and certain non-gastrointestinal cancers.
Specifically, women with IBD on immunosuppressants should be screened for cervical cancer on an annual basis, and all patients should be screened for melanoma (skin cancer) regardless of whether they are on biologic therapy or not.
Depression and anxiety were mentioned as they can impact outcomes, and are more common in IBD patients than in the general public.
Anxiety was found to affect 19 percent of patients (compared to 9.6 percent of public) and depression 21.2 percent (compared to 13.4), according to a review cited in the guideline.
Regarding smoking, the authors highlighted data linking the habit to the development and progression of Crohn’s.
Finally, Farraye noted that gastroenterologists are often the only clinician an IBD patient sees on a regular basis, and it is critical for them to have a proactive role in their patients’ healthcare needs.
Farraye’s team developed the guideline by reviewing the latest literature and assessing the strength of their recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system, an approach to making judgments about quality of evidence and strength of recommendations.