The inflammatory bowel diseases (IBD) are a group of chronic intestinal diseases characterized by inflammation of the gastrointestinal tract. The most common types of IBD are ulcerative colitis and disease. Biological and immunosuppression medications are often used to treat patients with moderate to severe disease. There is an increased risk for infections in patients taking these medications. Specifically, there is an increase for intracellular pathogens in patient's taking anti-TNF medications. We hypothesize that despite wide-spread use of these medications, physicians inadequately counsel patients regarding the risks of infections in regards to travel to endemic areas.Methods:
Electronic health records of patients seen in an urban, university-based gastroenterology practice were reviewed. A total of 275 IBD patients seen in the previous 6 month period were identified. Data collected was obtained from physician documentation pertaining to routine office visits. Patient demographics and results were collected and compiled in a protected database preserving patient confidentiality, complying with the universities standards for PHI. Statistical analysis was performed with a significance of P < 0.05. The study was approved by the university Institutional Review Board.Results:
Two hundred seventy-five IBD patient were identified, 163 with Crohn's disease and 112 with ulcerative colitis. There were 169 patient on either immunosuppression, biologic therapy or both. One hundred-six patient were not on either therapy. Travel history was documented in 4 patients on immunosuppression or biologic therapy and in 7 patients not on either therapy (P = 0.1). Specific documentation of the risks of travelling to or living in an area endemic for intracellular pathogens such as histoplasmosis was seen in 1 patient on immunosuppression or biologics and in 2 patients not on immunosuppression or biologics (P = 0.56).Conclusions:
IBD patients treated with immunosuppressive and biologic therapy are at increased risk for infections. Specifically, patient treated with anti-TNF therapy are at increased risk for intracellular pathogens. This study demonstrated that physicians are inadequately counselling patients regarding the infectious risks of these medications as it pertains to travel to endemic areas. The limitations of this study include the duration of review. While physician may have these discussions with their patients, there is inadequate documentation of these conversations. Further research is needed.