Avoid IBD complications with 3-tiered preventive care approach
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It is critical to consider all aspects of preventive care in patients with inflammatory bowel disease to avoid serious infections or complications, according to a presenter at GUILD 2022.
“When I'm having conversations with patients about initiating immunosuppressive or biologic medications, obviously we have to talk about risks,” Millie D. Long, MD, MPH, professor of gastroenterology and hepatology at the University of North Carolina at Chapel Hill, said during the presentation. “But when we actually emphasize to them that many of these risks are potentially preventable, and there's something they can do to prevent those complications, it often helps the conversation. They will be active and engaged in their care, particularly their preventive care associated with that new treatment.”
Long noted there are three forms of preventive care in IBD: primary prevention, which includes immunizations; secondary prevention, including early-disease detection through screening programs; and tertiary prevention, which includes managing long-term disease and disability to prevent further complications.
“Each of these forms of prevention needs to be addressed with our inflammatory bowel disease patients,” Long said.
Long noted that immunosuppressive therapy can often cause serious infections in patients with IBD, which can lead to hospitalizations and the need for IV antibiotics.
Because patients with IBD are at an increased risk for both serious and opportunistic infections, “we can address preventive aspects to try to prevent this,” Long said. “When we look at what the risks for serious infection are, there are a number of external factors that include immunosuppression therapy, exposure to pathogens and geographic clustering.”
According to Long, infections and malignancies that are common complications in IBD patients include:
Herpes zoster
Influenza
Pneumonia
COVID-19
Cervical cancer
Dysplasia
Skin cancer
“Please remember primary, secondary and tertiary prevention at the time of IBD diagnosis,” Long said. “Really think about things like initiating a medication for IBD to prevent downstream complications, that's tertiary. Think about sunscreen, use vaccines, that's primary; and then do appropriate secondary prevention screenings for your individual patient.”
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Long MD. Prevention of Complications of Inflammatory Bowel Disease. Presented at: GUILD 2022; Feb. 20-23, 2022 (hybrid meeting).
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