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Preventive Care In Inflammatory Bowel Disease

You trust your gastroenterologist to help you make the right decisions regarding medical therapy of your ulcerative colitis or Crohn’s disease. But is everything being done to prevent other diseases associated with your inflammatory bowel disease (IBD)? Despite published guidelines, vaccination and preventive screening rates are unacceptably low among patients with IBD. The following is a list of preventive strategies you should discuss with your gastroenterologist in order to maximize your health care:

Colonoscopy – IBD increases one’s risk of colon cancer by 4 fold. It is recommended that patients with ulcerative colitis or Crohn’s disease involving the colon undergo a colonoscopy with surveillance biopsies every 1-3 years starting 8 years after the initial diagnosis.

Vaccinations – This is important for all patients with IBD, but especially those that are immunosuppressed (those taking medications such as prednisone, Imuran, 6-MP, Remicade, or Humira):

  • – Influenza: Every patient with IBD should receive a yearly flu shot (intramuscular, inactivated vaccine)
  • – Pneumococcus: Every immunosuppressed patient with IBD should have a pneumococcal vaccine, with a booster in 5 years
  • – Hepatitis B: All children should receive a hepatitis B vaccination series, but this is especially important for IBD patients who are immunosuppressed.
  • – HPV: This should be given to all males and females up to 26 years of age.
  • – Tdap: This should be given to all patients every 10 years.
  • – Meningococcus: This vaccine should be given to immunosuppressed patients with IBD every 5 years.
  • – The following LIVE vaccines should be administered BEFORE a patient is started on an immunosuppressant, and NEVER when they are already on an immunosuppressant: intranasal influenza, varicella, zoster, MMR, rotavirus, oral polio.

Skin exam – There is an increased risk of melanoma and nonmelanoma skin cancer in immunosuppressed patients with IBD. Imuran and 6-MP may increase the risk of nonmelanoma skin cancer, while biologic therapy (Remicade, Humira) may increase the risk of melanoma. Every immunosuppressed patient with IBD should undergo a yearly skin exam by a dermatologist, and they should be counseled to wear sunscreen and avoid excess sun exposure.

PAP smear – Immunosuppressed women with IBD have an increased prevalence of abnormal PAP smears and cervical cancer. Therefore all of these patients should undergo a yearly PAP smear.

Bone density scan – Osteoporosis is found in 15% of patients with IBD, and their fracture risk is increased by 40%. Chronic steroid use is a major risk factor for osteoporosis as well. Postmenopausal women, older men, and patients on long-term steroids should undergo a DEXA scan. An argument can also be made for having all patients with IBD undergo a DEXA scan for a baseline measurement.

Eye exam – Patients with IBD are at increased risk of developing episcleritis which causes burning and itching of the eye, and uveitis which may lead to eye pain, blurred vision, and headaches. Steroids may increase the risk of glaucoma and cataracts. All patients with IBD should undergo an eye exam every 1-2 years.

Smoking cessation – Smoking worsens Crohn’s disease. It is linked to a more complicated course of Crohn’s disease and an increased requirement for steroids, immunosuppressants, and surgery. All patients with Crohn’s disease should be advised to stop smoking.

Avoidance of NSAIDs – The use of nonsteroidal anti-inflammatory medications such as ibuprofen may increase flares of IBD and should be minimized.

Blood work – Patients with IBD are at increased risk for anemia and liver conditions such as primary sclerosing cholangitis. Patients should have labs drawn for a CBC and CMP yearly. Consideration should also be given to checking yearly labs for vitamin D levels and for vitamin B12 levels in patient with Crohn’s disease of the terminal ileum. Patients receiving Imuran or 6-MP should have labs drawn more frequently.

Exercise – All patients with IBD should exercise regularly and try to get 7-8 hours of sleep each night. Consideration should also be given to a daily multivitamin, 1000-1500 mg of calcium daily, and 600-800 IU of vitamin D daily.

Please contact your provider at Granite Peaks Gastroenterology if you have any questions.

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