[Infections in inflammatory bowel disease]

Area of Science:

• Gastroenterology and Immunology
• Infectious Disease Epidemiology

Context:

• Inflammatory bowel diseases (IBD), including Crohn's disease and ulcerative colitis, are associated with significant morbidity and mortality, largely driven by infections.
• Key risk factors for opportunistic infections in IBD patients encompass malnutrition, comorbidities, advanced age, and iatrogenic immunosuppression.
• While infection risks associated with traditional immunosuppressants like corticosteroids, thiopurines, and TNFα inhibitors are well-documented, data on newer gut-selective integrin antibodies remain limited.

Purpose:

• To review and synthesize current knowledge on infection risks in IBD patients undergoing immunosuppressive therapy.
• To highlight the need for further research into the infectious complications associated with novel therapeutic agents targeting gut-selective integrins.
• To emphasize the clinical importance of pre-treatment infectious disease screening and accurate differentiation between disease flares and infectious complications in IBD management.

Summary:

• Infections represent a substantial contributor to morbidity and mortality in patients with inflammatory bowel diseases (IBD).
• Established risk factors for opportunistic infections include malnutrition, comorbidities, age, and immunosuppression.
• While risks for corticosteroids, thiopurines, and TNFα antibodies are known, data on gut-selective integrin antibodies and combined immunosuppression are less clear.
• Clinical vigilance in screening for infections before immunosuppression and distinguishing flares from infections is paramount.

Impact:

• Informing clinical practice regarding the selection and monitoring of immunosuppressive therapies in IBD to minimize infection risk.
• Guiding future research directions to better characterize the safety profiles of emerging IBD treatments, particularly gut-selective agents.
• Improving patient outcomes by enabling timely diagnosis and management of infectious complications, thereby reducing IBD-related morbidity and mortality.