IBD HINTS for Preventive Care

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To the Editor:
We have read with interest new emerging guidelines on preventive care in patients with inflammatory bowel disease (IBD).1 These have set out an appropriately ambitious set of preventive services for our patients with IBD, but as many authors have pointed out, patients with IBD do not receive high rates of preventive care.2 We recognize that providers believe that they have less and less time with patients, and routine visits with nonflaring patients with IBD may believe like an easy break from other clinic appointments.
At our facility, our IBD clinic has 2 IBD specialists and an IBD-trained physician assistant. We developed a mnemonic to help us remember the health care maintenance checklist for patients with IBD, IBD-HINTS.
I—Immunizations. This includes vaccines for hepatitis B, hepatitis A, influenza, pneumonia, TDaP, and varicella.
B—Bone. Check bone densitometry for patients with Crohn's disease and patients with ulcerative colitis exposed to steroids.
D—Dysplasia. This includes both annual Pap smears for cervical dysplasia and annual to biennial colonoscopy for colonic dysplasia.3
H—Hepatic enzymes. Patients on thiopurines and biologics should have routine bloodwork to look for hepatoxicity.4
I—Infections. Patients starting on anti-tumor necrosis factor biologics should be screened for hepatitis B and tuberculosis before loading doses.
N—Nutrients. Patients should be screened for anemia5 and Vitamin D deficiency.6
T—Tobacco. We recommend nicotine cessation for all patients with IBD.
S—Skin cancer and Sadness. Patients on thiopurines should be screened annually for nonmelanoma skin cancer, and all patients with IBD should be screened for melanoma. We also screen our patients with IBD for depression and anxiety disorders during routine visits.
We found this mnemonic has helped us both maintain our patients and provide care in an efficient manner. We hope that this mnemonic will help other providers who take care of patients with IBD.

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