Health Maintenance
|
Objective: Prevent development of other diseases and monitor for adverse effects of therapy |
|
Patient population: Individuals diagnosed with inflammatory bowel disease |
Highlight BoxIBD patients are at increased risk of infections, metabolic bone disease, certain malignancies, and mental health disorders secondary to their illness while on immunomodulatory therapy. Many of the infections can be prevented if patients are routinely monitored. |
Introduction
This CCP aims to guide clinicians attending to the health of IBD patients in supporting and optimizing their health maintenance strategies.
Maintenance Strategies
1. Annual routine review by family physician
2. Annual routine review by an IBD specialist if the patient is NOT on any treatment. The frequency of the evaluation will change depending on disease trajectory and medication.
3. Colon cancer/dysplasia screening: Patients with colonic disease for > 8 years should undergo colonoscopy every 1-3 years—see Surveillance protocol Colonic Dysplasia/Cancer surveillance | IBD Clinic
4. Provide smoking cessation counselling, especially in patients with Crohn’s disease
a. discuss at every visit
b. provide the patient with educational materials
c. refer to Smoking Action Plan
5. Diet and Nutritional assessment
a. Provide with educational materials
b. If ileal disease or post-surgery, monitor vitamin B12 and iron annually
c. Assess vitamin D 25-OH level. If deficient or insufficient, refer to Vitamin D protocol.
d. Referral to the IBD dietician
6. Vaccination
a. Ensure vaccinations are up-to-date. Refer to the vaccination guide
b. Annual inactivated influenza vaccine
7. Annual screening
a. Skin examination for melanoma
b. Oral Health
c. Ophthalmologic examination
d. PAP smears in immunocompromised women for cervical cancer
e. Routine breast examinations
8. Behavioral Health
a. Screen and address mental health co-morbidities
b. Offer patients with high depression/anxiety scores referral to their primary care physician, psychiatrist, or other mental health professional.
References
Farraye, F.A. et al. ACG Clinical Guideline: Preventive care in inflammatory bowel disease. American Journal of Gastroenterology 2017; 112:241-258. https://doi.org/10.1038/ajg.2016.537
Mir, F. et al. Health maintenance in inflammatory bowel disease. Current Gastroenterology Reports 2018; 20(23): 22-28. https://doi.org/10.1007/s11894-018-0621-1
Chhaparia A, Odufalu F, Edwards M, Patel K, Christopher K, Schroeder K, Prather C, Hammami MB. Cervical Cancer Screening in Inflammatory Bowel Disease: Who Should Be Screening? Gastroenterology Res. 2020 Oct;13(5):208-216. doi: 10.14740/gr1287. Epub 2020 Oct 8. https://doi.org/10.14740%2Fgr1287
Hashash JG, Picco MF, Farraye FA. Health Maintenance for Adult Patients with Inflammatory Bowel Disease. Curr Treat Options Gastroenterol. 2021;19(4):583-596. 10.1007/s11938-021-00364-9
