Gastroenterology and Liver Services, Sydney Local Health District, Concord Hospital, Sydney, Australia.
Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore.
J Crohns Colitis. 2018 Nov 15;12(11):1261-1269. doi: 10.1093/ecco-jcc/jjy110.
With increasing use of biological therapies and immunosuppressive agents, patients with inflammatory bowel disease[IBD] have improved clinical outcome and international travel in this group is becoming common. Adequate pre-travel advice is important. We aim to determine the proportion of gastroenterologists who provided pre-travel advice, and to assess their management strategies for patients on biological therapies visiting tuberculosis[TB]-endemic areas.
A 57-question survey was distributed to IBD physicians in 23 countries. We collected physicians' demographics, and using a standardized Likert scale, assessed physicians' agreement with stated treatment choices.
A total of 305 gastroenterologists met inclusion criteria. Overall, 52% would discuss travel-related issues: travellers' diarrhoea [TD], travel-specific vaccines, medical care and health insurance abroad, and TB. They were more likely to advise patients not to travel to TB-endemic area if on both anti-tumour necrosis factor [TNF] and azathioprine, than if on vedolizumab and azathioprine [47% vs 17.6%, p < 0.01]. More IBD physicians agreed with vedolizumab monotherapy vs anti-TNF monotherapy [29.9% vs 23%, p < 0.01]. Two-thirds would continue all IBD treatments and not cease any medications. Chest X-ray and interferon-gamma-release assay were the preferred methods to assess for active and latent TB infection. Knowledge on vaccines among IBD physicians was inadequate (survey mean [SD] scores 10.76 [±6.8]). However, they were more familiar with the societal guidelines on management of venous thromboembolism and TD (mean scores 14.9 [±5.3] and 11.9 [±3.9] respectively).
Half of IBD specialists would provide pre-travel advice to IBD patients and two-thirds would advise continuing all IBD medications even when travelling to TB-endemic areas. More education on vaccinations would be particularly helpful for IBD physicians.
随着生物疗法和免疫抑制剂的应用日益增多，炎症性肠病（IBD）患者的临床转归得到改善，该人群的国际旅行也变得越来越常见。充分的旅行前咨询非常重要。我们旨在确定为 IBD 患者提供旅行前咨询的胃肠病学家的比例，并评估他们对前往结核病（TB）流行地区的接受生物治疗的患者的管理策略。
我们向 23 个国家的 IBD 医生发放了一份包含 57 个问题的调查问卷。我们收集了医生的人口统计学资料，并使用标准化的李克特量表评估了医生对既定治疗选择的认同程度。
共有 305 名胃肠病学家符合纳入标准。总体而言，52%的医生会讨论与旅行相关的问题，包括旅行者腹泻（TD）、旅行专用疫苗、国外的医疗保健和医疗保险，以及 TB。如果患者同时使用抗 TNF 和硫唑嘌呤，他们更有可能建议患者不要前往 TB 流行地区，而如果患者使用维得利珠单抗和硫唑嘌呤，则不太可能建议患者不要前往，分别为 47%和 17.6%，p < 0.01。更多的 IBD 医生认同维得利珠单抗单药治疗优于抗 TNF 单药治疗[29.9%比 23%，p < 0.01]。三分之二的医生会继续所有 IBD 治疗，而不会停止任何药物治疗。胸部 X 光和干扰素-γ释放试验是评估活动性和潜伏性 TB 感染的首选方法。IBD 医生对疫苗的了解不足（调查平均[标准差]评分 10.76[±6.8]）。然而，他们对静脉血栓栓塞和 TD 的管理社会指南更为熟悉（平均评分分别为 14.9[±5.3]和 11.9[±3.9]）。
一半的 IBD 专家会为 IBD 患者提供旅行前咨询，三分之二的专家会建议即使在前往 TB 流行地区时，也要继续所有 IBD 药物治疗。IBD 医生特别需要更多的疫苗接种教育。
