Mistakes in opportunistic infections and vaccinations in IBD and how to avoid them

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Mistakes in opportunistic infections and vaccinations in IBD and how to avoid them

Paul McLellan, Julien Kirchgesner

Summary

AI Generated

This material discusses errors to avoid when managing the risk of opportunistic infections in inflammatory bowel disease patients treated with immunosuppressive agents, based on updated 2021 ECCO guidelines and clinical experience.

The use of new immunosuppressive agents, including biologic agents and small molecules, has revolutionised therapeutic management of inflammatory bowel disease but may expose patients to opportunistic infections that can be challenging to recognise.
Opportunistic infections are important due to their association with morbidity or mortality and the challenges regarding effective treatment.
New evidence on opportunistic infections and vaccination strategies for immunosuppressed IBD patients led to updated European Crohn's and Colitis Organization guidelines in 2021.
The discussion is based on available evidence and clinical experience to help clinicians avoid errors in managing infection risk.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10

Jiang H yin, Wang S yin, Deng M, Li Y chuan, Ling Z xin, Shao L, et al. Immune response to hepatitis B vaccination among people with inflammatory bowel diseases: A systematic review and meta-analysis. Vaccine. 2017 May 9; 35 (20): 2633–41 [Link]

Beaugerie L, Rahier JF, Kirchgesner J. Predicting, Preventing, and Managing Treatment-Related Complications in Patients With Inflammatory Bowel Diseases. Clin Gastroenterol Hepatol. 2020 May; 18 (6): 1324-1335.e2 [Link]

Taxonera C, Ponferrada Á, Bermejo F, Riestra S, Saro C, Martín-Arranz MD, et al. Early Tuberculin Skin Test for the Diagnosis of Latent Tuberculosis Infection in Patients with Inflammatory Bowel Disease. J Crohns Colitis. 2017 Jul 1 ;11 (7) : 792–800 [Link]

Winthrop KL, Melmed GY, Vermeire S, Long MD, Chan G, Pedersen RD, et al. Herpes Zoster Infection in Patients With Ulcerative Colitis Receiving Tofacitinib. Inflamm Bowel Dis. 2018 Sep 15; 24 (10): 2258–65. [Link]

Kucharzik T, Ellul P, Greuter T, Rahier JF, Verstockt B, Abreu C, et al. ECCO Guidelines on the Prevention, Diagnosis, and Management of Infections in Inflammatory Bowel Disease. J Crohns Colitis. 2021 Jun 22; 15 (6): 879–913 [Link]

Annese V, Beaugerie L, Egan L, Biancone L, Bolling C, Brandts C, et al. European Evidence-based Consensus: Inflammatory Bowel Disease and Malignancies. J Crohns Colitis. 2015 Nov; 9 (11): 945–65. [Link]

Griffin G, Shenoi S, Hughes GC. Hemophagocytic lymphohistiocytosis: An update on pathogenesis, diagnosis, and therapy. Best Pract Res Clin Rheumatol. 2020 Aug; 34 (4): 101515. [Link]

Rungoe C, Simonsen J, Riis L, Frisch M, Langholz E, Jess T. Inflammatory bowel disease and cervical neoplasia: a population-based nationwide cohort study. Clin Gastroenterol Hepatol. 2015 Apr; 13 (4): 693-700.e1 [Link]

Beaugerie L, Kirchgesner J. Balancing Benefit vs Risk of Immunosuppressive Therapy for Individual Patients With Inflammatory Bowel Diseases. Clin Gastroenterol Hepatol. 2019 Feb; 17 (3): 370–9. [Link]

10.

ACR. 2022 American College of Rheumatology (ACR) Guideline for Vaccinations in Patients with Rheumatic and Musculoskeletal Diseases [Internet]. 2022 [cited 2022 Aug 8]. Available from: https://www.rheumatology.org/Portals/0/Files/Vaccinations-Guidance-Summary.pdf [Link]

Abstract

The introduction and general use of new immunosuppressive agents, including biologic agents and small molecules, has revolutionised the therapeutic management of inflammatory bowel disease (IBD). Such immunosuppression may expose patients to opportunistic infections, which can be challenging to recognise. These infections are crucial due to their association with morbidity or mortality and the challenges regarding effective treatment. New evidence in this field and vaccination strategies for immunosuppressed IBD patients led to updated European Crohn’s and Colitis Organization (ECCO) guidelines in 2021. Here we discuss the errors to avoid when managing the risk of opportunistic infections in IBD patients. The discussion is based on evidence, whenever possible, and our clinical experience.

Topics

IBD

Citation

Kirchgesner J and McLellan P. Mistakes in opportunistic infections and vaccinations in IBD and how to avoid them. UEG Education 2022; 22: 26–28.

Published

2022

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Endoscopic ultrasound-guided tissue sampling: European Society of Gastrointestinal Endoscopy (ESGE) Technical and Technology Review

Antonio Facciorusso

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Guideline

Abstract

This Technical and Technology Review from the European Society of Gastrointestinal Endoscopy (ESGE) represents an update of the previous document on the technical aspects of endoscopic ultrasound (EUS)-guided sampling in gastroenterology, including the available types of needle, technical aspects of tissue sampling, new devices, and specimen handling and processing. Among the most important new recommendations are:

ESGE recommends end-cutting fine-needle biopsy (FNB) needles over reverse-bevel FNB or fine-needle aspiration (FNA) needles for tissue sampling of solid pancreatic lesions; FNA may still have a role when rapid on-site evaluation (ROSE) is available.

ESGE recommends EUS-FNB or mucosal incision-assisted biopsy (MIAB) equally for tissue sampling of subepithelial lesions ≥20 mm in size. MIAB could represent the first choice for smaller lesions (<20 mm) if proper expertise is available.

ESGE does not recommend the use of antibiotic prophylaxis before EUS-guided tissue sampling of solid masses and EUS-FNA of pancreatic cystic lesions.

Publisher

European Society of Gastrointestinal Endoscopy

Guideline

Clinical Practice Guideline

Topics

Endoscopy

Citation

Endoscopy 2025; 57(04): 390-418

Published

2025

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ECCO Guidelines on Therapeutics in Ulcerative Colitis: Medical Treatment

Javier P. Gisbert

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Guideline

Introduction

Ulcerative colitis [UC] is a chronic inflammatory bowel disease [IBD] characterised by colonic inflammation extending to a variable extent from the rectum. Care of the patient with UC requires appropriate input from across the multiprofessional team. These guidelines summarise the recommended medical treatment for adults with UC.

In 2022, the European Crohn’s and Colitis Organisation [ECCO] published new guidelines on the management of UC in two papers focused on the medical and surgical management of the disease.¹^,² For the 2022 UC guidelines, ECCO adopted the Grading of Recommendations Assessment, Development, and Evaluation [GRADE] approach, a systematic process for developing guidelines that addresses how to frame healthcare questions, summarise the evidence, formulate recommendations, and grade their strength and the quality of associated evidence.³ The present paper represents an update to the 2022 guidelines and focuses specifically on the medical management of UC, while a companion paper developed as part of the same process addresses optimal surgical management [ECCO Guidelines on Therapeutics in Ulcerative Colitis: Surgical Treatment].

For this iteration of the guidelines, we have introduced several new, clinically relevant questions selected by members of the guidelines group, alongside a systematic approach to reviewing and updating previous topics to incorporate new evidence and to reappraise all findings within the context of contemporary practice. We have also introduced several “practice points” to summarise evidence and provide expert recommendations in key areas where the evidence remains limited but clinical decisions are still required. In such instances, where application of the GRADE methodology may be impractical, we adopted an approach based on systematic literature review, expert discussion, and voting to reach consensus recommendations outside the formal GRADE process.

Patients living with UC can have a variable disease course.⁴ In this document, we discuss therapeutic approaches stratified by disease severity [mildly-to-moderately active and moderately-to-severely active disease]. Definitions of disease severity are commonly used to establish clinical trial inclusion criteria and may be based on several distinct assessment frameworks.⁵ It is also important to remember that these definitions capture severity at a given point in time and may not reflect the cumulative long-term burden of disease experienced by a patient.⁶

It is also important to consider disease extent when planning treatment in UC, as this may affect the optimal route of drug administration. This is typically defined according to disease involving the rectum only [proctitis], disease distal to the splenic flexure [left-sided or distal UC], or disease extending proximal to the splenic flexure [extensive UC].⁷ It should be noted that disease distribution can change⁴ and that proximal disease extension can be a negative prognostic marker.⁸

Publisher

European Crohn’s and Colitis Organisation

Guideline

Clinical Practice Guideline

Topics

IBD

Citation

Journal of Crohn's and Colitis, Volume 20, Issue 7, July 2026

Published

2026

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UEG Mistakes In Articles

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Mistakes in coagulation in liver disease and how to avoid them

Edoardo G. Giannini

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10

Griffin G, Shenoi S, Hughes GC. Hemophagocytic lymphohistiocytosis: An update on pathogenesis, diagnosis, and therapy. Best Pract Res Clin Rheumatol. 2020 Aug; 34 (4): 101515. [Link]

10.

Abstract

Alteration of common coagulation tests and thrombocytopenia represent an integral part of the clinical picture of patients with advanced chronic liver disease. As such, the International Normalised Ratio (INR) for prothrombin time is part of the Model for End-stage Liver Disease (MELD) score, which is commonly used to assess prognosis and the need for liver transplantation in patients with cirrhosis. Thrombocytopenia—being mainly related to hypersplenism and decreased synthesis of thrombopoietin by the liver—can also be used to identify the presence of portal hypertension and decreased liver function in patients with chronic liver disease.

Topics

Hepatobiliary

Citation

Giannini EG and Caldwell SH. Mistakes in coagulation in liver disease and how to avoid them. UEG Education 2021; 21: 29–34.

Published

2021

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UEG Mistakes In Articles

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Mistakes in jejunal feeding and how to avoid them

Ashley Bond, Simon Lal

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10

Griffin G, Shenoi S, Hughes GC. Hemophagocytic lymphohistiocytosis: An update on pathogenesis, diagnosis, and therapy. Best Pract Res Clin Rheumatol. 2020 Aug; 34 (4): 101515. [Link]

10.

Abstract

Topics

Small Intestine & Nutrition

Citation

Bond A and Lal S. Mistakes in jejunal feeding and how to avoid them. UEG Education 2020; 20: 17–19.

Published

2020

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Mistakes in hepatitis C and how to avoid them

Ana Catarina Garcia, Gonçalo Alexandrino

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10

Griffin G, Shenoi S, Hughes GC. Hemophagocytic lymphohistiocytosis: An update on pathogenesis, diagnosis, and therapy. Best Pract Res Clin Rheumatol. 2020 Aug; 34 (4): 101515. [Link]

10.

Abstract

Hepatitis C virus (HCV) infection remains an important global health concern. It is estimated that there are approximately 50 million people infected with HCV globally, with around 1 million new infections each year and about 242,000 deaths annually attributed to HCV-related complications. Most acute HCV infections (55–85%) become chronic due to the virus’s effective evasion strategies, with spontaneous clearance being rare once chronicity is established. This condition often progresses silently, with many individuals unaware of their infection until advanced liver damage has occurred. If left untreated, HCV can lead to severe complications, including liver cirrhosis and hepatocellular carcinoma (HCC). HCV transmission occurs mainly through percutaneous exposure to infected blood. HCV can also spread from mother to infant (vertical transmission) and, less frequently, via sexual contact.1,2 In recent years, the introduction of oral direct-acting antivirals (DAAs), with remarkable safety and effectiveness profiles, has led to a sustained virological response (SVR) in virtually all (>97%) HCV-infected patients, regardless of HCV genotype or disease stage. However, significant barriers remain, such as issues with diagnosis, access to treatment and awareness of the disease.

Here, we discuss some of the misconceptions in HCV management and provide a practical management approach grounded in evidence and clinical experience.

Topics

Hepatobiliary

Citation

Garcia A.C and Alexandrino G. Mistakes in hepatits C and how to avoid them. UEG Education 2025; 25: 14-17.

Published

2025

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European Society of Coloproctology: guidelines for the management of diverticular disease of the colon

Johannes Kurt Schultz

Summary

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Guideline

Abstract

Aim

The goal of this European Society of Coloproctology (ESCP) guideline project is to give an overview of the existing evidence on the management of diverticular disease, primarily as a guidance to surgeons.

Methods

The guideline was developed during several working phases including three voting rounds and one consensus meeting. The two project leads (JKS and EA) appointed by the ESCP guideline committee together with one member of the guideline committee (WB) agreed on the methodology, decided on six themes for working groups (WGs) and drafted a list of research questions. Senior WG members, mostly colorectal surgeons within the ESCP, were invited based on publication records and geographical aspects. Other specialties were included in the WGs where relevant. In addition, one trainee or PhD fellow was invited in each WG. All six WGs revised the research questions if necessary, did a literature search, created evidence tables where feasible, and drafted supporting text to each research question and statement. The text and statement proposals from each WG were arranged as one document by the first and last authors before online voting by all authors in two rounds. For the second voting ESCP national representatives were also invited. More than 90% agreement was considered a consensus. The final phrasing of the statements with < 90% agreement was discussed in a consensus meeting at the ESCP annual meeting in Vienna in September 2019. Thereafter, the first and the last author drafted the final text of the guideline and circulated it for final approval and for a third and final online voting of rephrased statements.

Results

This guideline contains 38 evidence based consensus statements on the management of diverticular disease.

Conclusion

This international, multidisciplinary guideline provides an up to date summary of the current knowledge of the management of diverticular disease as a guidance for clinicians and patients.

Publisher

European Society for Coloproctology

Guideline

Clinical Practice Guideline

Topics

Endoscopy Radiology & Imaging Surgery Colorectal

Citation

Colorectal Dis, 22: 5-28

Published

2020

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