{"id":2552,"date":"2016-12-13T14:02:35","date_gmt":"2016-12-13T20:02:35","guid":{"rendered":"http:\/\/www.granitepeaksgi.com\/?p=2552"},"modified":"2019-04-18T10:45:03","modified_gmt":"2019-04-18T16:45:03","slug":"preventive-care-inflammatory-bowel-disease","status":"publish","type":"post","link":"https:\/\/www.granitepeaksgi.com\/preventive-care-inflammatory-bowel-disease\/","title":{"rendered":"Preventive Care In Inflammatory Bowel Disease"},"content":{"rendered":"<p>You trust your gastroenterologist to help you make the right decisions regarding medical therapy of your ulcerative colitis or Crohn\u2019s disease. But is everything being done to prevent other diseases associated with your <a href=\"http:\/\/www.granitepeaksgi.com\/service\/inflammatory-bowel-disease\/\">inflammatory bowel disease<\/a> (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:<\/p>\n<p><strong>Colonoscopy<\/strong> \u2013 IBD increases one\u2019s risk of colon cancer by 4 fold. It is recommended that patients with ulcerative colitis or Crohn\u2019s disease involving the colon <a href=\"http:\/\/www.granitepeaksgi.com\/service\/colonoscopy-screening\/\">undergo a colonoscopy<\/a> with surveillance biopsies every 1-3 years starting 8 years after the initial diagnosis.<\/p>\n<p><strong>Vaccinations<\/strong> \u2013 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):<\/p>\n<ul>\n<li>\u2013 Influenza: Every patient with IBD should receive a yearly flu shot (intramuscular, inactivated vaccine)<\/li>\n<li>\u2013 Pneumococcus: Every immunosuppressed patient with IBD should have a pneumococcal vaccine, with a booster in 5 years<\/li>\n<li>\u2013 Hepatitis B: All children should receive a hepatitis B vaccination series, but this is especially important for IBD patients who are immunosuppressed.<\/li>\n<li>\u2013 HPV: This should be given to all males and females up to 26 years of age.<\/li>\n<li>\u2013 Tdap: This should be given to all patients every 10 years.<\/li>\n<li>\u2013 Meningococcus: This vaccine should be given to immunosuppressed patients with IBD every 5 years.<\/li>\n<li>\u2013 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.<\/li>\n<\/ul>\n<p><strong>Skin exam<\/strong> \u2013 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.<\/p>\n<p><strong>PAP smear<\/strong> \u2013 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.<\/p>\n<p><strong>Bone density scan<\/strong> \u2013 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.<\/p>\n<p><strong>Eye exam<\/strong> \u2013 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.<\/p>\n<p><strong>Smoking cessation<\/strong> \u2013 Smoking worsens Crohn\u2019s disease. It is linked to a more complicated course of Crohn\u2019s disease and an increased requirement for steroids, immunosuppressants, and surgery. All patients with Crohn\u2019s disease should be advised to stop smoking.<\/p>\n<p><strong>Avoidance of NSAIDs<\/strong> \u2013 The use of nonsteroidal anti-inflammatory medications such as ibuprofen may increase flares of IBD and should be minimized.<\/p>\n<p><strong>Blood work<\/strong> \u2013 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\u2019s disease of the terminal ileum. Patients receiving Imuran or 6-MP should have labs drawn more frequently.<\/p>\n<p><strong>Exercise<\/strong> \u2013 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.<\/p>\n<p>Please <a href=\"http:\/\/www.granitepeaksgi.com\/providers\/\" target=\"_blank\" rel=\"noopener noreferrer\">contact your provider<\/a> at Granite Peaks Gastroenterology if you have any questions.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>You<a href=\"http:\/\/www.granitepeaksgi.com\/condition\/heartburn-acid-reflux\/symptoms\/\"> <\/a>trust your gastroenterologist to help you make the right decisions regarding medical therapy of your ulcerative colitis or Crohn\u2019s disease. But is everything being done to prevent other diseases associated with your<a href=\"http:\/\/www.granitepeaksgi.com\/condition\/inflammatory-bowel-disease\/\"> inflammatory bowel disease<\/a> (IBD)? Despite published guidelines, vaccination and preventive screening rates are unacceptably low among patients with IBD. The following is [&hellip;]<\/p>\n","protected":false},"author":40,"featured_media":2555,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"wds_primary_category":0,"footnotes":""},"categories":[183,186],"tags":[391,173,392,45],"acf":[],"_links":{"self":[{"href":"https:\/\/www.granitepeaksgi.com\/wp-json\/wp\/v2\/posts\/2552"}],"collection":[{"href":"https:\/\/www.granitepeaksgi.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.granitepeaksgi.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.granitepeaksgi.com\/wp-json\/wp\/v2\/users\/40"}],"replies":[{"embeddable":true,"href":"https:\/\/www.granitepeaksgi.com\/wp-json\/wp\/v2\/comments?post=2552"}],"version-history":[{"count":0,"href":"https:\/\/www.granitepeaksgi.com\/wp-json\/wp\/v2\/posts\/2552\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.granitepeaksgi.com\/wp-json\/wp\/v2\/media\/2555"}],"wp:attachment":[{"href":"https:\/\/www.granitepeaksgi.com\/wp-json\/wp\/v2\/media?parent=2552"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.granitepeaksgi.com\/wp-json\/wp\/v2\/categories?post=2552"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.granitepeaksgi.com\/wp-json\/wp\/v2\/tags?post=2552"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}