Extra-intestinal malignancies in inflammatory bowel disease: Results of the 3rd ECCO Pathogenesis Scientific Workshop (III)

Magro, Fernando; Peyrin–Biroulet, Laurent; Sokol, Harry; Aldeger, Xavier; Costa, Antónia; Higgins, Peter; Joyce, Joel C.; Κατσάνος, Κωνσταντίνος; Lopez, Anthony; Xaxars, Teresa Mas de; Toader, Elena; Beaugerie, Laurent

doi:10.1016/j.crohns.2013.04.006

Cited by 133 publications

(146 citation statements)

References 92 publications

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“…Similarly, in a Manitoba province study, 54% of women with IBD received Pap smear screening but having CD, as well as exposure to immunosuppressant medications were independent predictors of lower use of Pap testing ( 99 ). Th e European Crohn's and Colitis Organization states "given the excess risk demonstrated in various other contexts of immunosuppression, it is currently recommended that all women with IBD, particularly those receiving immunosuppressants, strictly adhere to a screening program of cervical surveillance and undergo vaccination against HPV, when appropriate" ( 100 ).…”

Section: Summary Of Evidencementioning

confidence: 99%

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

Farraye

Melmed

Lichtenstein

et al. 2017

American Journal of Gastroenterology

378

371

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Recent data suggest that infl ammatory bowel disease (IBD) patients do not receive preventive services at the same rate as general medical patients. Patients with IBD often consider their gastroenterologist to be the primary provider of care. To improve the care delivered to IBD patients, health maintenance issues need to be co-managed by both the gastroenterologist and primary care team. Gastroenterologists need to explicitly inform the primary care provider of the unique needs of the IBD patient, especially those on immunomodulators and biologics or being considered for such therapy. In particular, documentation of up to date vaccinations are crucial as IBD patients are often treated with long-term immune-suppressive therapies and may be at increased risk for infections, many of which are preventable with vaccinations. Health maintenance issues addressed in this guideline include identifi cation, safety and appropriate timing of vaccinations, screening for osteoporosis, cervical cancer, melanoma and non-melanoma skin cancer as well as identifi cation of depression and anxiety and smoking cessation. To accomplish these health maintenance goals, coordination between the primary care provider, gastroenterology team and other specialists is necessary. of evidence, we entered data from the papers of highest evidence into the GRADE program (accessible at http://www.gradepro.org ). Th e recommendation statements from this guideline are shown in Table 1 . Summary statements, when listed, are designed to be descriptive in nature without associated evidence-based ratings. VACCINATIONSRecent data suggest that IBD patients do not receive preventive services at the same rate as general medical patients ( 2 ). Members of the gastroenterology team are oft en the only clinicians that a patient with IBD will see. As such, it is incumbent upon gastroenterologists to take a proactive role in the health care needs of their IBD patients ( 3-5 ). It is crucial to clarify with the patient the limits of the specialist's responsibilities and delegate routine health care issues to the primary care clinician. 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. Although it appears that both primary care clinicians and gastroenterologists are hesitant to take ownership of vaccinations ( 6-8 ), it is reasonable ( 9 ) that vaccination recommendations be the responsibility of the treating gastroenterologist, but the actual delivery/administration of these vaccines may be a shared responsibility ( 10-13 ). Communicating specifi c recommendations to the primary care team in a concise fashion are needed. Consider empowering the patient by giving written recommendations to bring to their primary care physician. Clinicians sharing an electronic medical record should use this platform to send recommendations to the referring clinician.Patients with IBD are oft en treated with long-term immunesuppressive therapies and may t...

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Section: Summary Of Evidencementioning

confidence: 99%

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

Farraye

Melmed

Lichtenstein

et al. 2017

American Journal of Gastroenterology

378

371

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“…El desarrollo de neoplasia en pacientes con EII puede ser secundario a las alteraciones inmunológicas y al estado inflamatorio crónico presente en este grupo de pacientes, a los eventos adversos de las estrategias terapéuticas utilizadas (inmunosupresores y terapia biológica) o al riesgo de neoplasia descrito en la población general 1,3,16,17 . En nuestro conocimiento, este es el primer estudio nacional que evalúa la presencia de neoplasia en una cohorte de paciente chilenos con EII, donde sólo un número pequeño de pacientes (10/437), equivalente a 2,3%, han desarrollado algún tipo de neoplasia.…”

Section: Discussionunclassified

“…Es posible que alteraciones inmunológicas presentes en la EII o el tratamiento con inmunosupresores puedan llevar a un mayor riesgo de neoplasia cervical dado el deterioro en la capacidad de eliminar el virus papiloma 30 . Esto sugiere que pacientes con EII deben mantener un control de pesquisa de neoplasia cervical periódico y que el equipo médico debiera sugerir la vacuna para virus papiloma en mujeres entre los 9 y 26 años previo al inicio de la actividad sexual 17 . El objetivo del tratamiento farmacológico en la EII es lograr la remisión de la enfermedad, junto con la curación de la mucosa intestinal.…”

Section: Discussionunclassified

“…En nuestro registro, la paciente que desarrolló un CPNM estuvo con AZT en dosis adecuadas por 12 años debido a una CU de diagnóstico temprano (16 años), el cual fue suspendido y reemplazado por mesalazina al momento del diagnóstico de la neoplasia. Dada la clara asociación entre exposición a tiopurínicos y aumento en el riesgo de desarrollar CPNM es fundamental que estos pacientes tengan una disminución a la exposición al sol, uso de protector solar diario y control en dermatología 17 . Dentro de las limitaciones de nuestro estudio consideramos que la frecuencia de neoplasias fue baja, por lo que no es posible estratificar según edad, tipo de neoplasia o terapia farmacológica.…”

Section: Discussionunclassified

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Desarrollo de neoplasia en pacientes con enfermedad inflamatoria intestinal

et al. 2015

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“…To reduce of the risk of developing hepatosplenic T-cell lymphoma, the ECCO guidelines on extraintestinal malignancies recommend that young IBD patients avoid prolonged combination therapy of anti-TNF therapy and thiopurines for more than 2 years. 60 In addition, biologics can increase the risk of melanoma. Although regular dermatological screening and protection against UV radiation are recommended in Caucasians, no such guideline exists for Asian patients with IBD.…”

Section: Biologics Therapy In East Asiamentioning

confidence: 99%

Understanding the complications of anti‐tumor necrosis factor therapy in East Asian patients with inflammatory bowel disease

Cheon

2017

J of Gastro and Hepatol

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Remarkable advances have been made in the treatment of inflammatory bowel disease since the introduction of anti‐tumor necrosis factor‐α agents, especially for patients who are refractory to or cannot tolerate conventional therapies. Currently, infliximab, adalimumab, and golimumab are available in the East Asian medical market, and these agents have been shown to be effective for inducing and maintaining long‐term remission of inflammatory bowel disease. Despite their clinical benefits, anti‐tumor necrosis factor therapy can also lead to increased vulnerability to infections, development of autoimmune diseases and malignancy, and decreased immunogenicity of vaccinations. Because infectious diseases, such as tuberculosis, hepatitis, and influenza, remain major health problems in East Asia, more cautious use of biologics is needed. To further improve treatment efficacy and safety, close monitoring of inflammation, regular surveillance for malignancy, and regularly scheduled vaccinations are needed. Treatment strategies for biologics should be customized to meet the needs of different patients.

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Extra-intestinal malignancies in inflammatory bowel disease: Results of the 3rd ECCO Pathogenesis Scientific Workshop (III)

Cited by 133 publications

References 92 publications

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

Desarrollo de neoplasia en pacientes con enfermedad inflamatoria intestinal

Understanding the complications of anti‐tumor necrosis factor therapy in East Asian patients with inflammatory bowel disease

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