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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UEG Podcast Episode

Journal Podcast

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Abstract

Topics

Endoscopy Hepatobiliary IBD Pancreas

Published

2025

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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 eosinophilic oesophagitis and how to avoid them

Alfredo J. Lucendo, Javier Molina-Infante

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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

Eosinophilic oesophagitis (EoE) is a chronic immune-mediated inflammatory condition that is confined to the oesophagus. Clinically, EoE is characterized by symptoms of oesophageal dysfunction; histologically, by eosinophil-predominant inflammation.1,2 At present, EoE is the second-most frequent cause of chronic oesophagitis (gastro-oesophageal reflux disease [GORD] is the primary cause) and the foremost cause of dysphagia and food impaction in young adults and children.

Topics

Oesophagus

Citation

Molina-Infante J and Lucendo AJ. Mistakes in eosinophilic oesophagitis and how to avoid them. UEG Education 2017: 17; 6–9.

Published

2024

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UEG Mistakes In Articles

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Mistakes in metabolic dysfunction associated steatotic liver disease and how to avoid them

Sarah Townsend, Philip Newsome

Summary

AI Generated

Summary is not available for this content yet.

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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

Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is a subclassification of steatotic liver disease (SLD), defined as the presence of excess triglyceride storage in the liver in conjunction with at least one cardiometabolic risk factor and no other discernible cause.1 Cirrhosis secondary to MASH is the most common cause of liver disease in the world and is the fastest-growing indication for liver transplantation, but it also has a >50% recurrence rate post-transplantation.

Topics

Hepatobiliary

Citation

Townsend SA and Newsome PN. Mistakes in nonalcoholic fatty liver disease and how to avoid them. UEG Education 2017; 17: 39–41.

Published

2024

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Episode 6: UEG Journal October Spotlight

Maria Manuela Estevinho

Mistakes in coagulation in liver disease and how to avoid them

Edoardo G. Giannini

Mistakes in eosinophilic oesophagitis and how to avoid them

Alfredo J. Lucendo

Mistakes in metabolic dysfunction associated steatotic liver disease and how to avoid them

Sarah Townsend

European guidelines from the EHTG and ESCP for Lynch syndrome: an updated third edition of the Mallorca guidelines based on gene and gender

Toni Seppala

Revised Guidelines for the Treatment and Follow-Up of Gallbladder Polyps Do Not Reduce Unwarranted Cholecystectomies: Results of the POLYP Study

Elise A.J. de Savornin Lohman

UEG Standards and Guidelines

Clinical Practice Guideline

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European guidelines from the EHTG and ESCP for Lynch syndrome: an updated third edition of the Mallorca guidelines based on gene and gender

Toni Seppala

Summary

AI Generated

Summary is not available for this content yet.

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Guideline

Abstract

Background

Lynch syndrome is the most common genetic predisposition for hereditary cancer but remains underdiagnosed. Large prospective observational studies have recently increased understanding of the effectiveness of colonoscopic surveillance and the heterogeneity of cancer risk between genotypes. The need for gene‐ and gender‐specific guidelines has been acknowledged.

Methods

The European Hereditary Tumour Group (EHTG) and European Society of Coloproctology (ESCP) developed a multidisciplinary working group consisting of surgeons, clinical and molecular geneticists, pathologists, epidemiologists, gastroenterologists, and patient representation to conduct a graded evidence review. The previous Mallorca guideline format was used to revise the clinical guidance. Consensus for the guidance statements was acquired by three Delphi voting rounds.

Results

Recommendations for clinical and molecular identification of Lynch syndrome, surgical and endoscopic management of Lynch syndrome‐associated colorectal cancer, and preventive measures for cancer were produced. The emphasis was on surgical and gastroenterological aspects of the cancer spectrum. Manchester consensus guidelines for gynaecological management were endorsed. Executive and layperson summaries were provided.

Conclusion

The recommendations from the EHTG and ESCP for identification of patients with Lynch syndrome, colorectal surveillance, surgical management of colorectal cancer, lifestyle and chemoprevention in Lynch syndrome that reached a consensus (at least 80 per cent) are presented.

Recommendations for clinical and molecular identification of LS, surgical and endoscopic management of LS‐associated colorectal cancer and preventive measures for cancer were produced. The emphasis was on surgical and gastroenterological aspects of the cancer spectrum.

Publisher

European Society for Coloproctology

Guideline

Clinical Practice Guideline

Topics

Digestive Oncology Endoscopy Surgery

Citation

British Journal of Surgery, Volume 108, Issue 5, May 2021, Pages 484–498

Published

2021

More Like This:

Episode 6: UEG Journal October Spotlight

Maria Manuela Estevinho

Mistakes in coagulation in liver disease and how to avoid them

Edoardo G. Giannini

Mistakes in eosinophilic oesophagitis and how to avoid them

Alfredo J. Lucendo

Mistakes in metabolic dysfunction associated steatotic liver disease and how to avoid them

Sarah Townsend

European guidelines from the EHTG and ESCP for Lynch syndrome: an updated third edition of the Mallorca guidelines based on gene and gender

Toni Seppala

Revised Guidelines for the Treatment and Follow-Up of Gallbladder Polyps Do Not Reduce Unwarranted Cholecystectomies: Results of the POLYP Study

Elise A.J. de Savornin Lohman

UEG Standards and Guidelines

Clinical Practice Guideline

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This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

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Revised Guidelines for the Treatment and Follow-Up of Gallbladder Polyps Do Not Reduce Unwarranted Cholecystectomies: Results of the POLYP Study

Mike van Dooren, Elise A.J. de Savornin Lohman

Summary

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Guideline

ABSTRACT

Background

Gallbladder polyps are seen in up to 7% of adults and carry a low malignancy risk. Guidelines on indication for surgery and follow-up remain controversial because of regional differences in the development of malignancy. This study compares European practice guidelines for gallbladder polyps and assesses the percentage of patients in whom cholecystectomy was indicated according to the guidelines with a true adenoma postoperatively.

Methods

Dutch patients with active follow-up or surgery for gallbladder polyps between 2018 and 2020 in 26 participating centres were included. Data on demographics, imaging characteristics, surgery and histopathology were assessed. Indications for cholecystectomy were examined for all patients comparing 2017 and 2022 European guidelines.

Results

A cohort of 302 patients was included. Patients in follow-up underwent imaging three times (median) and were followed up during a median of 23.2 months (IQR 10.9–47.4). In total, 88 patients (29%) underwent cholecystectomy after a median period of 23 months and a median of two instances of imaging. In 71 of 88 patients (81%) who underwent cholecystectomy, the gallbladder polyps was a valid indication for cholecystectomy according to 2017 guidelines, compared to 68 of 88 (77%) according to 2022 guidelines. The difference only occurred due to age as a risk factor which changed from 50 to 60 years of age. Of 71 operated patients, non-neoplastic polyps were found in 49 (69%), no gallbladder wall abnormality was found in 23 (32%). An adenoma was found in six patients (9%), of which three had low grade dysplasia and one had high grade dysplasia.

Discussion

Despite revision of guidelines in 2022, a significant number of patients still undergo follow-up and cholecystectomy for non-neoplastic gallbladder polyps, indicating the need for a more comprehensive risk assessment algorithm in the management of gallbladder polyps.

Guideline

Clinical Practice Guideline

Topics

Hepatobiliary Surgery

Citation

United European Gastroenterology Journal, 2025; 13:1133–1140

Published

2025

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Episode 6: UEG Journal October Spotlight

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Mistakes in coagulation in liver disease and how to avoid them

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Mistakes in eosinophilic oesophagitis and how to avoid them

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Mistakes in metabolic dysfunction associated steatotic liver disease and how to avoid them

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European guidelines from the EHTG and ESCP for Lynch syndrome: an updated third edition of the Mallorca guidelines based on gene and gender

Toni Seppala

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Elise A.J. de Savornin Lohman