IBD patients need multidisciplinary health maintenance team: guideline

Last Updated: 2017-01-30

By Will Boggs MD

NEW YORK (Reuters Health) - A variety of health maintenance issues faced by patients with inflammatory bowel disease (IBD) require joint management by the gastroenterologist and the primary care team, according to a new clinical guideline from the American College of Gastroenterology.

"The treating gastroenterologist should partner with the primary care provider (PCP) to be certain that vaccinations are administered in a timely fashion and educate the PCP of the unique needs of IBD patients on immunosuppressive agents or biologics," Dr. Francis A. Farraye from Boston Medical Center and Boston University School of Medicine told Reuters Health by email.

"In addition, the GI clinician and PCP will need to be certain that at-risk patients be referred to dermatology, endocrinology, gynecology, and behavioral health as needed," Dr. Farraye said.

IBD patients do not receive preventive care services at the same rate as general medical patients, according to recent data.

Dr. Farraye and colleagues evaluated published reports and developed 14 recommendations to address the preventive care needs of patients with IBD.

Patients should receive appropriate vaccinations - influenza, pneumococcal, herpes zoster, varicella, and other vaccines, as appropriate for age and travel history - and family members of those on immunosuppressive therapies should also receive the non-live trivalent inactivated influenza vaccine, rather than the live inhaled vaccine.

"Ideally vaccinations should be administered prior to initiation of immunosuppression, as these agents may decrease the effectiveness of the vaccines," Dr. Farraye said.

Women with IBD on immunosuppressive therapy should have annual cervical cancer screening, and all patients with IBD should undergo screening for depression and anxiety.

Screening for melanoma is also recommended, and patients on immunomodulators should undergo screening for non-melanoma skin cancer.

Individuals with risk factors for osteoporosis should have bone mineral density testing at the time of diagnosis and periodically afterward.

Crohn's disease patients who smoke should be encouraged to quit.

"Some individuals might want evidence that these recommendations are associated with better outcomes in IBD patients," Dr. Farraye said. "Despite the lack of high quality evidence, the authors, based on an extensive literature review, felt that the recommendations were justified and would improve the quality of care we deliver to patients with IBD."

The complete list of statements and the evidence supporting the recommendations appeared January 10th online in the American Journal of Gastroenterology.

SOURCE: http://go.nature.com/2kCSF9g

Am J Gastroenterol 2017.