The American College of Gastroenterology has issued an updated clinical practice guideline on preventive care for patients with inflammatory bowel disease (IBD) that covers vaccinations, cancer surveillance, bone health monitoring, lifestyle counseling, and other important “health maintenance” issues.
“Patients with IBD often consider their gastroenterologist to be the primary provider of care. Because more than 70% of patients with IBD will at some time be on medications that will affect the immune system, it is essential that the gastroenterology team promote vaccinations and other health maintenance activities,” said the writing group, led by Francis Farraye, MD, director, Inflammatory Bowel Disease Center, Mayo Clinic, Jacksonville, Florida.
The panel noted that referral to dermatology, endocrinology, gynecology, primary care, and psychiatry “may be necessary on a case-by-case basis. Coordination between the gastroenterology team and other providers is crucial for improving the quality of care that we provide to our patients living with IBD.”
The 27-page updated guideline on preventive care in IBD was published earlier this month in The American Journal of Gastroenterology, along with a one-page visual highlights summary.
The update provides 12 recommendation statements and 11 key concepts. It replaces the 2017 ACG guideline on preventive care in IBD.
Prioritize Vaccinations
“Patients with IBD are at increased risk for infections as a consequence of their disease, and this risk may be amplified by certain immune-modifying therapies,” the writing group noted.
They strongly recommend that all adults with IBD aged 50 years and older with no prior pneumococcal vaccination receive the pneumococcal conjugate vaccine (PCV) 20 or PCV21. There is a conditional recommendation that adults aged 19-49 years on immune-modifying therapy and with no prior pneumococcal vaccination also receive the PCV20 or PCV21 vaccine.
Patients with IBD who previously received a pneumococcal vaccine should follow revaccination advice from the CDC.
Vaccination against herpes zoster with the two-dose inactive recombinant herpes zoster vaccine is advised for patients with IBD aged 50 years or more and for younger patients about to start or already on immune-modifying therapy (both conditional recommendations).
Other conditional recommendations include vaccination against SARS-CoV-2 in accordance with national guidelines and live rotavirus vaccine for children with in-utero exposure to biologics.
In addition, all adults with IBD should receive annual influenza vaccines; those receiving immune-modifying therapies and their household contacts should receive the nonlive trivalent inactivated influenza vaccine but not the live inhaled influenza vaccine.
Respiratory syncytial virus (RSV) vaccine is advised for all patients aged 75 and older and for those aged 50-74 years with certain chronic medical conditions or other risk factors for severe RSV disease.
Household members of patients receiving immune-modifying therapies can receive live vaccines with certain precautions.
Vaccinations against tetanus, diphtheria, and pertussis (Tdap), hepatitis A virus, human papillomavirus (HPV), and meningococcus should be administered according to CDC recommendations. Adults with IBD should receive vaccination against hepatitis B if not immune.
Skin and Cervical Cancer Surveillance
“In addition to vaccination issues, it is important to identify subgroups of patients with IBD that have an increased risk of developing cervical cancer, nonmelanoma skin cancer (NMSC), and melanoma,” the panel said.
In women with IBD on immune-modifying therapies, there is a conditional recommendation for annual cervical cancer screening within a year of sexual activity onset; in women younger than 30 years, screening should continue for 3 consecutive years before increasing to every 3 years.
Annual screening for melanoma (independent of biologic therapy) and for NMSC (particularly in adults aged 50+) is also suggested (conditional recommendations).
Bone and Mental Health
Patients with IBD are at increased risk for bone loss, which can lead to osteopenia and osteoporosis. The guideline suggests screening for osteoporosis with bone mineral density testing at the time of diagnosis and periodically after diagnosis (conditional recommendation).
Given data showing worse outcomes among smokers with IBD, smoking cessation counseling is strongly encouraged.
The guideline also addresses the mental health of patients with IBD. “Current evidence suggests that mood disorders, in particular depression and anxiety, are more prevalent in patients with IBD than the background population, the panel noted.
Therefore, they recommend that all patients with IBD be screened for depression and anxiety at baseline and annually. Patients who screen positive for anxiety and/or depression should be referred for counseling/therapy.
This research had no commercial funding. A complete list of author disclosures is available with the original article.