What are the American College of Gastroenterology guidelines on preventive care in inflammatory bowel disease (IBD)?

Updated: Jul 26, 2019
  • Author: Leyla J Ghazi, MD; Chief Editor: Praveen K Roy, MD, AGAF  more...
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Answer

The American College of Gastroenterology released their guideline on preventive care in inflammatory bowel disease (IBD) in 2017. [148] Their preventive health maintenance recommendations are outlined below.

Strong recommendations

These include the following:

  • Patients with IBD (both ulcerative colitis and Crohn disease) should undergo screening for melanoma independent of the use of biologic therapy. IBD patients on immunomodulators (6-mercaptopurine or azathioprine) should undergo screening for nonmelanoma skin cancer (NMSC) while using these agents, particularly those older than 50 years. 
  • Patients with conventional risk factors for abnormal bone mineral density with ulcerative colitis and Crohn disease should undergo screening for osteoporosis with bone mineral density testing at the time of diagnosis and periodically after diagnosis.
  • Adults with IBD older than 50 years should consider vaccination against herpes zoster, including certain subgroups of immunosuppressed patients.

Conditional recommendations

These include the following:

  • Patients with conventional risk factors for abnormal bone mineral density with ulcerative colitis and CD should undergo screening for osteoporosis with bone mineral density testing at the time of diagnosis and periodically after diagnosis.
  • Adults with IBD should receive age-appropriate vaccinations before initiation of immune suppression when possible.
  • Household members of immunosuppressed patients can receive live vaccines with certain precautions.
  • All adult patients with IBD should undergo annual vaccination against influenza. Those on immunosuppressive therapies and their household contacts should receive the non-live trivalent inactivated influenza vaccine, but not the live inhaled influenza vaccine.
  • Adult patients with IBD receiving immunosuppressive therapy should receive pneumococcal vaccination with both the PCV13 and PPSV23 vaccines, in accordance with national guidelines.
  • Adults with IBD should be assessed for prior exposure to varicella and vaccinated if naive before initiation of immunosuppressive therapy when possible.
  • Patients with IBD who are immunosuppressed and traveling to areas that are endemic for yellow fever should consult with a travel medicine or infectious disease specialist prior to travel
  • Adolescents with IBD should receive meningococcal vaccination in accordance with routine vaccination recommendations.
  • Vaccination against tetanus, diphtheria, and pertussis (Tdap); hepatitis A and B (HAV, HBV, respectively); and human papillomavirus (HPV) should be administered as per Advisory Committee on Immunization Practice (ACIP) guidelines.
  • Women with IBD on immunosuppressive therapy should undergo annual cervical cancer screening.
  • Screening for depression and anxiety is recommended in patients with IBD.

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