New guideline for preventive care in inflammatory bowel disease

New guideline for preventive care in inflammatory bowel disease New Delhi, Feb 14, 2017: IBD is characterised by the chronic inflammation of gut and other parts of the digestive tract. A new clinical guideline from the American College of Gastroenterology has said that the primary care physician (PCP) should also be involved in the management of a patient with inflammatory bowel disease (IBD), especially with regard to preventive health maintenance such as vaccinations. The guideline published in the February 2017 issue of the American Journal of Gastroenterology says, “To improve the care delivered to IBD patients, health maintenance issues need to be co-managed by both the gastroenterologist and primary care team. It is equally important to educate the primary care clinician to the unique health maintenance needs of the IBD patient, especially those on immunomodulators and biologic agents.” The guideline includes 14 recommendations to address the preventive care needs of these patients. Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement stated that, “PCPs when integrated with routine practice for treating patients with IBD can help bridge an essential care gap. Coherence between evidence-based guidelines and clinical practice exist at several stages in this regard; low rates of colorectal cancer screening, suboptimal testing and treatment of Helicobacter pylori infection, inappropriate use of proton pump inhibitors are to name a few. Most PCPs still approach irritable bowel disease as a diagnosis of exclusion, this creates further problems.” “PCPs have a crucial and fundamental role in management of patients with IBD. Collaboration with PCPs can prompt knowledge on when to suspect and refer patients with IBD, how to screen and treat for bone loss, update all vaccinations, screen and treat for depression and anxiety, when to consider screening for self-image, and how to monitor and treat nutritional deficiencies. PCPs are critical to optimizing patient care and outcomes”, added Dr K K Aggarwal. With evolving strategies of therapy in the care of IBD patients, evidence now suggests that outcomes are dependent on the quality of management, particularly in early years of diagnosis. Early referral to a gastroenterologist for diagnosis and a structured management plan in collaboration with a primary care team therefore, is vital. The following tips should help manage the symptoms of IBD: 1. Try taking small but frequent meals, this will also help with low appetite issues. 2. Smoking can worsen the symptoms of IBD, now is the best time to quit. 3. Exercise regularly followed by a healthy diet and sleep, this will also help with fatigue and tiredness. 4. Avoid alcohol if you are taking antibiotics for managing your symptoms. 5. IBD differs from person to person; your diet and treatment schedule needs to be tailored to suit your personal needs. Talk to your healthcare provider. 6. IBD can put you at high risk of dehydration, especially in summer months. Make sure you stay optimally hydrated at all times. 7. Maintain a food diary to track which food products trigger your symptoms. 8. Ask your doctor about vitaminB12, calcium and folate supplements. 9. Those taking steroid based medications for managing IBD also need to be vigilant.

New guideline for preventive care in inflammatory bowel disease

New guideline for preventive care in inflammatory bowel disease A new clinical guideline from the American College of Gastroenterology has said that the primary care physician should also be involved in the management of a patient with inflammatory bowel disease (IBD), especially with regard to preventive health maintenance such as vaccinations. The guideline published in the February 2017 issue of the American Journal of Gastroenterology says, “To improve the care delivered to IBD patients, health maintenance issues need to be co-managed by both the gastroenterologist and primary care team. It is equally important to educate the primary care clinician to the unique health maintenance needs of the IBD patient, especially those on immunomodulators and biologic agents.” The guideline includes 14 recommendations to address the preventive care needs of these patients. • Guideline recommends appropriate vaccinations including influenza, pneumococcal, herpes zoster, varicella, Tdap (tetanus toxoid, reduced diphtheria toxoid and acellular pertussis), hepatitis A and B and HPV, as per guidelines. • Consult an infectious disease specialist prior to travel to endemic areas for yellow fever. • Household members of immunosuppressed patients can receive live vaccines with certain precautions. • Women on immunosuppressive therapy should be evaluated for cervical cancer annually. • All patients should be screened for depression and anxiety. • Evaluate these patients for melanoma independent of the use of biologic therapy; patients on immunomodulators should be screened for non-melanoma squamous cell cancer. • Screen for osteoporosis at the time of diagnosis as well as at regular intervals in at-risk patients. • Crohn’s disease patients who smoke should be counselled to quit. (Source: Am J Gastroenterol. 2017;112:241-58)