The American Gastroenterological Association has released a new clinical practice update with recommendations about vaccinations and non–colorectal cancer screenings for people with inflammatory bowel disease.

The update includes 13 best-practice statements for gastroenterologists who treat people with IBD (Table). Recommendations for these patients include conducting age-appropriate cancer screening for all adults, including screening for cervical dysplasia in women; following the CDC’s adult immunization schedule; using inactivated vaccines when people are receiving immunosuppressant therapy; and screening adults for signs of latent hepatitis B infection and boosting protection, if needed.

“The best-practice statements summarize things that every gastroenterologist should be doing in a very concise way,” said update author Freddy Caldera, DO, PhD, a gastroenterologist at UW Health, in Madison, Wis., adding that revisions to the information are likely as new evidence develops related to vaccination strategies and non–colorectal cancer screening.

The goal of the practice update is to give actionable advice to gastroenterologists who may develop years-long relationships with their patients with IBD, he said.

Vaccination Recommendations

Addressing the recommendations related to vaccination, Dr. Caldera said, “patients with IBD trust their gastroenterologist,” often even around the sensitive topic of whether to receive a vaccine, and he underscored the need to educate patients about the data supporting vaccination. Specifically regarding the recommendation for recombinant herpes zoster vaccination for all IBD patients ages 19 years and older, even if they’ve had the vaccination previously, Dr. Caldera said, “When I educate patients about recent data showing IBD patients have higher risks of herpes zoster complications, including hospitalization and postherpetic neuralgia, compared to those without IBD, they better understand the importance of vaccination,” Dr. Caldera said.

For patients who need hepatitis B screening, Dr. Caldera said hepatitis B titers “below 10 mIU/mL suggest a lack of protection.” But he added that a single hepatitis B vaccine challenge dose can be given to previously vaccinated individuals to “test immune memory,” Dr. Caldera said. An antibody response greater than or equal to 10 mIU/mL four to eight weeks after the challenge dose indicates the person was protected through immune memory, but if no response occurs, the patient will need a complete revaccination series, he said. (For more information on HBV prevention, see “AGA Issues Updated Guideline On Preventing HBV Reactivation”.)

The Central Role of GI Providers

“As has been the case for many years, patients with IBD often identify their GI provider as their primary healthcare provider,” said Francis A. Farraye, MD, MSc, a professor of medicine and the director of the Inflammatory Bowel Disease Center at Mayo Clinic in Florida, Jacksonville.

Given the important role that GI providers play, Dr. Farraye told Gastroenterology & Endoscopy News that it is imperative for GI specialists to take a central role in counseling patients about age-appropriate vaccinations and cancer screenings. The AGA expert review supports this effort, he added.

“IBD is a systemic disorder with gastrointestinal, joint, skin, oral and liver manifestations. Our patients are at increased risk for infection and certain malignancies, regardless of immunosuppressive therapies,” he noted. “It is incumbent upon the GI team to be more proactive in managing the entire patient and not just their gastrointestinal issues. This means recommending specific vaccinations and cancer screenings, partnering with the patient’s primary care team.”

Looming large over discussion of vaccinations is distrust of vaccines fueled by misinformation. “More data is needed to understand barriers to administer vaccinations both in our healthcare system as well as how to combat misinformation so that patients are more comfortable receiving age-appropriate vaccinations,” Dr. Farraye said.

Ellen Scherl, MD, the Jill Roberts Professor of Inflammatory Bowel Disease at Weill Cornell Medicine, in New York City, agrees. Vaccinations have saved and continue to save lives, despite the rise of anti-vaccination sentiment during the COVID-19 pandemic, Dr. Scherl said. Rather than try to “debunk” misconceptions patients may have, providers should try to understand the patient’s perspective and concerns to balance the risks and benefits of vaccination, she suggested.

Noting that the practice update is not a systematic review, Dr. Scherl said it’s not possible to evaluate the strength of the evidence. She said she would like to see more data on the hepatitis B vaccination recommendation, in particular, noting that in her experience, the actual rate of hepatitis B reactivation is very rare.

Despite these caveats, Dr. Scherl said, “this practice update can serve as a playbook for having informed conversations about vaccination with our patients.” She also said she agrees with the thrust of the best-practice statements on topics beyond vaccination, such as performing a thorough perianal and anal examination at every colonoscopy and ordering bone densitometry exams for people with IBD at risk for osteopenia and osteoporosis.

Dr. Scherl told Gastroenterology & Endoscopy News that she also supports the practice update’s call for gastroenterologists to pay closer attention to the mental health of people with IBD. “I couldn’t agree more,” Dr. Scherl said. But she pointed to a severe shortage of mental health providers and called for action by professional groups and individual gastroenterologists to work to close these gaps.

—Marcus A. Banks

Dr. Caldera reported financial relationships with GSK, Janssen, Novavax and Takeda. Dr. Farraye reported financial relationships with Astellas, Avalo, Bausch, Braintree, BMS, Lilly, Fresenius Kabi, GI Reviewers, GSK, IBD Educational Group, Iterative Health, Janssen, Pharmacosmos, Pfizer, Sandoz and Viatris. Dr. Scherl is a member of the Gastroenterology & Endoscopy News editorial board.