Canadian IBD Today

Deprescribing Advanced Therapies in Inflammatory Bowel Diseas

2025-09-23T20:22:00+00:00

Key Takeaways:

• Deprescribing advanced therapies is a viable option for carefully-selected patients living with IBD.

• We propose a systematic approach for deprescribing advanced therapies in IBD, which comprises strategic patient selection, comprehensive risk assessment, shared decision-making, rigorous monitoring, and a pre-defined rescue strategy.

• Further research is needed to improve patient selection tools, optimize monitoring techniques, and clarify deprescribing strategies for newer agents.

Travelling with Inflammatory Bowel Disease: Clinical Considerations

2025-09-23T20:21:52+00:00

Key Takeaways:

• Pre-travel consultation is essential for safe and enjoyable travel. IBD patients and physicians should discuss necessary vaccinations and action plans as soon as possible.

• Preparing for travel by packing a medical kit, necessary medications and obtaining adequate travel insurance can reduce stress and mitigate problems.

• Pre-travel vaccination is an important part of the preparations for many IBD patients. Live vaccines are contraindicated in patients taking immunosuppressant medications. Expert advice from a travel medicine specialist can identify individual patient vaccinations needs.

• There are several resources available to physicians and patients alike, to empower our patients and remove many of the barriers they face when travelling.

Cytomegalovirus Colitis in Inflammatory Bowel Disease The Eternal Debate: Foe or Innocent Bystander?

2025-09-23T20:21:45+00:00

Key Takeaways:

• The prevalence of CMV infection among patients with IBD ranges from 2 to 29%, with a higher prevalence in those with UC compared to CD.

• Immunohistochemistry and tissue PCR, or both, are the recommended tests for diagnosing active CMV colitis.

• CMV may be an active pathogenic participant in cases with a high density of CMV and severe disease activity. Thus, we recommend testing for CMV colitis in patients with a severe inflammatory burden who are not responding to conventional IBD therapy.

• Patients with low CMV viral burden can likely be treated with immunosuppression alone, while patients with high viral density or medically refractory disease should be treated with antiviral therapy.

Isolated Perianal Fistulas: When and How Should I Investigate for Inflammatory Bowel Disease?

2025-09-23T20:21:38+00:00

Key Takeaways:

• Approximately, 5–10% of all perianal fistulizing Crohn’s disease (PFCD) patients will have isolated PFCD. High or complex tracts, multiple internal openings, chronicity, and refractoriness to treatment—along with patient factors—should raise suspicion for PFCD (isolated or not).

• A negative initial luminal evaluation does not exclude CD — surveillance is key. Up to 25% of patients presenting initially with isolated complex fistulas develop luminal CD over time (median 2.5 years). Periodic reassessment with imaging, endoscopy, and symptom monitoring is critical to avoid missed or delayed diagnosis.

• Diagnosis and management of isolated PFCD requires a multidisciplinary, patient‑centered approach. TOpClass criteria offer practical diagnostic guidance using clinical, radiologic, and histologic features. For patients with significant symptoms and complex isolated PFCD, anti-TNF therapy may be considered, though evidence is limited and optimal duration remains unclear.

Prevention of Venous Thromboembolism in Patients with Inflammatory Bowel Disease

2025-09-23T20:21:30+00:00

Key Takeaways:

• When reviewing inflammatory bowel disease (IBD) patients in the clinical setting, remember to review their medical history and screen for venous thromboembolism (VTE) risk factors. This will help to risk stratify them for future decision-making.

• IBD patients admitted to hospital are at the highest risk of VTE. All IBD patients, regardless of reason for admission and disease activity, should receive VTE prophylaxis.

• In the post-operative and post-discharge setting, all IBD patients should be classified as low, intermediate, or high risk of VTE. After carefully weighing the risks and benefits, high risk patients should be considered for extended VTE prophylaxis beyond hospital discharge.