Inflammatory bowel update. Of note, inflammatory bowel includes Crohn’s disease and ulcerative colitis. Inflammatory bowel disease is not irritable bowel. I recently attended a lecture by a local gastroenterologist Here are some of the “pearls” from that talk…
- Patients with ulcerative colitis flares are at increased risk of blood clots, especially when ill and are sedentary (like when in bed in the hospital). DVT prophylaxis needed.
- IBD patients may be more at risk for skin, lymphoma, cervical and anal cancer. Additionally, colon cancer risk is 2 times higher than the general population.
- A routine patient (without inflammatory bowel) is at lifetime-risk of colon cancer is 5-6%.
- If a patient has pancolitis, colonoscopy should be done after 7 years. Then a colonoscopy every 2 years.
- Primary sclerosing cholangitis patients get a colonoscopy every one year because their risk of colon cancer can be as high as 20 times the routine population’s risk.
Biologic medicines (that are often used to control inflammatory bowel disease) decrease immune strength and therefore increases the risk of many different kinds of cancers:
- Melanomas. These patients should be more sun-aware (sunscreen and spf clothing) and have skin cancer screenings yearly.
- Lymphoma risk increases with patients on azathioprine.
- Cervical cancer screening: Consider HPV vaccine, decrease tobacco exposure, get routine pap screenings.
- Anal cancers are usually squamous cell carcinoma and are more at risk with patients with long standing anorectal colitis or men who have sex with men or HIV patients. Anal strictures should be biopsied by colorectal surgeon to rule out anal cancer.
What vaccines do inflammatory bowel disease patients need? Varicella (live vaccine) , Zoster, MMR (live), Tetanus, flu, HPV, hepatitis B, hepatitis A, meningococcal, and pneumococcal (pneumovax). It is important that patients receive live vaccines before biologic medicines (which can cause immune suppression) are started. If immunosuppressed, it is suggested that pneumonia vaccines be given before the rest of the population is due (at age 65). The American College of Gastroenterology (statement offered in 2018) suggests Prevnar followed by Pneumovax 8 weeks later. Then Pneumovax booster is suggested 5 years later.
Your GI doctor will recheck labs depending on what therapy you are on. You may need renal function labs, DEXA (bone density) scans, vitamin D or calcium level, comprehensive metabolic panel, tuberculosis test
When to start colon cancer screening in routine-risk patients? New data shows that first screening should be at age 45, but insurers are not following this yet. African Americans should get their first screening colonoscopy at age 45.
http://www.cornerstonehealth.org is a great website.