New guideline for preventive care in inflammatory bowel disease

Health Care Comments Off

A new clinical guideline from the American College of Gastroenterology has said that the primary care physician should also be involved in the management of a patient with inflammatory bowel disease (IBD), especially with regard to preventive health maintenance such as vaccinations. The guideline published in the February 2017 issue of the American Journal of Gastroenterology says, “To improve the care delivered to IBD patients, health maintenance issues need to be co-managed by both the gastroenterologist and primary care team. It is equally important to educate the primary care clinician to the unique health maintenance needs of the IBD patient, especially those on immunomodulators and biologic agents.” The guideline includes 14 recommendations to address the preventive care needs of these patients.

• Guideline recommends appropriate vaccinations including influenza, pneumococcal, herpes zoster, varicella, Tdap (tetanus toxoid, reduced diphtheria toxoid and acellular pertussis), hepatitis A and B and HPV, as per guidelines.
• Consult an infectious disease specialist prior to travel to endemic areas for yellow fever.
• Household members of immunosuppressed patients can receive live vaccines with certain precautions.
• Women on immunosuppressive therapy should be evaluated for cervical cancer annually.
• All patients should be screened for depression and anxiety.
• Evaluate these patients for melanoma independent of the use of biologic therapy; patients on immunomodulators should be screened for non-melanoma squamous cell cancer.
• Screen for osteoporosis at the time of diagnosis as well as at regular intervals in at-risk patients.
• Crohn’s disease patients who smoke should be counselled to quit.

(Source: Am J Gastroenterol. 2017;112:241-58)