I’d like to draw your attention to an important Clinical Practice Update recently published in Clinical Gastroenterology and Hepatology, titled “Non-colorectal Cancer Screening and Vaccinations in Patients with Inflammatory Bowel Disease: Expert Review“.
The update highlights new Best Practice Advice for managing inflammatory bowel disease (IBD).
While the full document is worth reading, I’d like to focus on Best Practice Advice statements 3, 12, and 13, which are most relevant for dietitians.
Best Practice Advice 3:
All adult patients with IBD should follow skin cancer primary prevention practices by avoiding excessive exposure to the sun’s ultraviolet radiation. Patients on immunomodulators, anti-tumor necrosis factor (anti-TNF) biologic agents, or small molecules should undergo yearly total body skin exams (TBSE). Patients with any history of thiopurine use should continue with yearly TBSE even after cessation.
👉 What this means for us:
IBD puts people at a higher risk for skin cancer, so prevention is key.
We play two key roles here.
- We can encourage yearly skin cancer screenings and remind our patients to use sunscreen.
- We can monitor vitamin D status, knowing how critical it is for IBD management. While sunlight is the best natural source of vitamin D, it’s often not a safe option for our patients. As a result, most patients will need a vitamin D supplement.
Best Practice Advice 12:
Bone densitometry should be considered in patients with IBD, regardless of age, when risk factors for osteopenia and osteoporosis are present. These risk factors include low body mass index (BMI; <20), greater than 3 months of cumulative corticosteroid exposure, current smoking, post-menopausal status, or hypogonadism. In the absence of other factors, bone densitometry should be considered for post-menopausal women and men 65 years or older.
👉 What this means for us:
IBD patients are at increased risk for osteopenia, osteoporosis, and related fractures.
Despite this, bone health is often overlooked in clinical practice.
When I ask my at-risk patients, including those who’ve been on steroids for over three months, if they’ve had a bone density scan, the answer is almost always “no”—it’s often the first time they’ve even heard about it.
This is significant because so many patients I see are deeply concerned about their calcium intake and bone loss—improving bone health is frequently a top goal.
As dietitians, we’re uniquely positioned to lead conversations about diet, exercise, supplements, and the importance of regular screenings when it comes to bone health.
Early detection and intervention can reverse bone loss and prevent fractures.
Best Practice Advice 13:
All adult patients with IBD should be screened for depression and anxiety annually. Patients who screen positive should be referred to the appropriate specialist.
👉 What this means for us:
Chronic stress and anxiety can worsen IBD symptoms and disease progression.
Dietitians, especially those of us in the outpatient setting, often spend significant time with patients, building rapport and gaining insight into their mental health.
We can share our observations with the healthcare team, refer patients to mental health specialists when necessary, and educate them on the connection between stress, anxiety, and disease activity.
As dietitians, we play a key role in executing these best practices, particularly when it comes to preventing skin cancer, promoting bone health, and supporting mental well-being.
