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Continuing Medical Education Questions: February 2017

Veerappan,, Ganesh R, MD, FACG

American Journal of Gastroenterology: February 2017 - Volume 112 - Issue 2 - p 259
doi: 10.1038/ajg.2017.609
CLINICAL GUIDELINES
Free

1Digestive Health Center, Akron, OH

If you wish to receive credit for this activity, please refer to the Web site:http://acgjournalcme.gi.org/.Article

Artical Title: ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

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Questions:

  1. A 27-year-old woman with ileocolonic inflammatory Crohns disease presents to her gastroenterologist for a routine appointment. She is currently on infliximab 5 mg/kg monotherapy and has been in remission for 4 years. She is having 1-2 solid bowel movements daily. Patient denies abdominal pain, blood in stools, joint pain, rashes, and ocular symptoms. Patient has had routine labs that include normal quanterferon gold and hepatitis B markers. She has had a recent colonoscopy with no evidence of active disease. She asks if she should get any vaccinations as part of her preventive health. Which one of the following statements is correct regarding vaccinations in the setting of inflammatory bowel disease (IBD) patients?
    • A.IBD patients receive appropriate vaccinations at a similar rate to the general population.
    • B.Non-live vaccinations are not recommended in IBD patients due to concerns of immunosuppression.
    • C.Live vaccinations are not recommended in patients on anti-tumor necrosis factor (TNF) therapy.
    • D.Vaccinations have been shown to exacerbate IBD.
  2. A 22-year-old woman with ulcerative colitis presents to her gastroenterologist for a routine appointment. She is currently on azathioprine at 2.5 mg/kg monotherapy and has been in remission for the last 2 years. She is having formed stools and no blood. Patient denies abdominal pain. Routine lab monitoring is normal. She has had a recent colonoscopy with no evidence of active disease. Which one of the following statements is correct regarding risk of cervical cancer in IBD patients on immunosuppression?
    • A.IBD patients on immunosuppression are at increased risk of high-grade and low-grade cervical dysplasia.
    • B.Women with IBD on immunosuppressive therapy should undergo cervical cancer screening every 3 years.
    • C.HPV vaccination is a live vaccination and not indicated in this patient.
    • D.In a recent study, anti-TNF therapy was found to independently increase risk of dysplasia.
  3. A 55-year-old male smoker with ilecolonic fistulizing Crohns disease on combination therapy of adalimumab 40 mg every other week and 6-mercaptopurine 1.5 mg/kg presents to his gastroenterologist in clinical remission. Labs, colonoscopy, and MRI have all been stable for the last few years. He has had a long exposure (2 years) to steroids in the past prior to initiating anti-TNF therapy. Which one of the following health maintenance recommendations would you make for this patient?
  • A.This patient should undergo bone density screening at age 65 years, as with the general population.
  • B.There is no role for anxiety and depression screening in patients with IBD on immunosuppression.
  • C.There is no role for skin screening in patients with IBD on chronic immunosuppression.
  • D.This patient should be counselled to quit smoking.
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