Recombinant Zoster Vaccine Benefits Older Patients with Inflammatory Bowel Disease or IBD

A study has revealed that older people with inflammatory bowel disease or IBD who receive the recombinant zoster vaccine or RZV are less likely to develop herpes zoster infection.

Recombinant Zoster Vaccine Benefits Older Patients with Inflammatory Bowel Disease or IBD
Photo: Inflammatory Bowel Disease | InStyleHealth


What Is Inflammatory Bowel Disease?

Inflammatory bowel disease or IBD is a medical condition that is used to describe disorders involving chronic inflammation of a person’s digestive tract. Types of Inflammatory Bowel Disease or IBD include:

  • Crohn's disease – This is a type of IBD that is characterized by the inflammation of the lining as well as it can involve the deeper layers of a person’s digestive tract.
  • Ulcerative Colitis – This is a medical condition that involves inflammation and sores (ulcers) along the superficial lining of the large intestine (colon) and the rectum.

Crohn’s disease and ulcerative colitis are usually characterized by diarrhea, rectal bleeding, abdominal pain and cramping, fatigue, fever, loss of appetite, and unintended weight loss.

Inflammatory bowel disease (IBD) can be devastating and the disease may even lead to life-threatening complications if not attended immediately.

What Are The Symptoms of Inflammatory Bowel Disease?

Inflammatory bowel disease symptoms may vary, it depends on the severity of inflammation and where it occurs in your digestive system or digestive tract. Symptoms may range from mild to severe. A person may likely to have periods of active illness followed by periods of remission.

The symptoms that are very common to both Crohn’s disease and Ulcerative colitis include:

  • Abdominal pain and cramping
  • Blood in your stool or Mucus
  • Diarrhea (sometimes alternating with constipation and the urgency to defecate)
  • Fatigue
  • Fever
  • Gas or Bloating
  • Itchy, Red, and Painful Eyes
  • Joint Pain
  • Nausea and Vomiting
  • Reduced appetite
  • Skin Rashes and Sores
  • Unintended weight loss
  • Upset Stomach
  • Vision Problems

What Are The Causes of Inflammatory Bowel Disease?

Experts are still working on to establish why some people develop inflammatory bowel disease (IBD). There are 3 factors that play a role in IBD:

  • Environmental triggers – Individuals with a family history of inflammatory bowel disease or IBD may develop the disease after being exposed to an environmental trigger. These environmental triggers include smoking, stress, medication use, and depression.
  • Genetics or Hereditary – 1 in 4 people with IBD have a family history of the disease. Although, there are cases where people with IBD who don’t have family history with the disease.
  • Immune system malfunction – The immune system in our body ideally fights off invading virus or bacteria. However, for people with IBD, the immune system attacks the cells in the digestive tracts. It releases antibodies (proteins) to fight off this threat in the body, causing IBD symptoms.

 

What Are The Risk Factors of Inflammatory Bowel Disease?

The following are the risk factors of inflammatory bowel disease or IBD:

  • Age – People who have IBD are diagnosed before they are 30 years old; however, some individuals are diagnosed with the disease in their 50’s and up.
  • Race or ethnicity – Caucasians or white individuals appear to have the highest risk of developing IBD, but the disease can develop in any race or ethnicity.
  • Family history – A person is at high risk if a close relative such as a parent or siblings have IBD. Although there are some people who develop IBD without family history.
  • Cigarette smoking – The most significant yet controllable risk factor for developing Crohn’s disease. Quitting smoking can improve the general health of your digestive system, and it will also yield many other health benefits.
  • Non-steroidal anti-inflammatory drugs or NSAIDs – These medications or medical drugs include ibuprofen (e.g., Advil, Motrin IB, others), naproxen sodium (e.g., Aleve), diclofenac sodium, and others. These medicines may elevate the risk of developing inflammatory bowel disease or worsen the disease in people already with IBD.

What Are The Complications of Inflammatory Bowel Disease?

Crohn’s disease and ulcerative colitis have some complications in common and other complications that are specific to each medical condition. The complications in both IBD types include:

  • Blood clots – Inflammatory bowel disease or IBD elevates the risk of blood clots in veins and arteries in a person’s body.
  • Colorectal (colon) cancer – When a person is having ulcerative colitis or Crohn’s disease that affects most of the person’s colon can elevate the risk of developing colorectal carcinoma or colon cancer. A screening for cancer starts usually around 8 to 10 years following the IBD diagnosis is made. One needs to ask their healthcare professional about when and how frequent the screening has to be done.
  • Medication side effects – Some medications for IBD are correlated with small risk of developing certain cancers. Corticosteroids can be correlated with a risk of developing osteoporosis, hypertension, and other conditions.
  • Primary sclerosing cholangitis – This condition involves inflammation causes scarring within the bile ducts, which will make them narrow and gradually resulting to liver damage.
  • Skin, eyes, and joint inflammation – there are certain disorders may occur during IBD flare-ups, such as arthritis, eye inflammation or uveitis, and skin lesions.

Complications specific to Crohn's disease may include:

  • Anal fissure – This condition is a small tear in the tissue that lines the anus or in the skin around the anus where infections take place. It is often correlated with painful bowel movements and can sometimes lead to developing perianal fistula.
  • Bowel obstruction – Crohn’s disease affects the full thickness of the intestinal wall. In the long run, parts of the bowel will become thicken and narrow, that will eventually block the flow of digestive contents. A person may need a surgical procedure to remove the diseased portion of the bowel.
  • Fistulas – This is an abnormal connection between different body parts. Fistulas that are near or around the perianal or anal area are the most common. There are cases where a fistula may become infected resulting to abscess formation.
  • Malnutrition Having diarrhea, abdominal pain, and cramping may make it difficult for a person to eat or for the intestine to absorb enough nutrients to keep the body nourished. This is also prevalent to developing anemia due to low iron or vitamin B-12 caused by Crohn’s disease.

Complications specific to ulcerative colitis may include:

  • Toxic megacolon – A serious condition that is caused by ulcerative colitis where colon rapidly widens and swells.
  • Perforated colon – A hole in the colon that is most commonly is caused by toxic megacolon, but it may also occur on its own.
  • Severe dehydration – Having diarrhea may result in severe dehydration.

How Is Inflammatory Bowel Disease Diagnosed?

Crohn’s disease and ulcerative colitis cause similar symptoms. There is no single test, however, that can diagnose either condition.

A healthcare provider will ask about the symptoms in order to make a diagnosis. The workup may start with a complete blood count (CBC) and stool test to look for signs of intestinal inflammation.

A person may also get one or more of these diagnostic tests:

  • Capsule endoscopy – which is using a small camera device that a person has to swallow. The camera captures images as it travels through the digestive tract.
  • Colonoscopy which is to evaluate the large and small intestines.
  • EUS (endoscopic ultrasound) to check the digestive tract for swelling and ulcers.
  • Flexible sigmoidoscopy to evaluate the inside of the rectum and anus.
  • Imaging scan, such as a Computerized Tomography (CT) scan or Magnetic Resonance Imaging (MRI), to check for signs of inflammation or an abscess.
  • Upper endoscopy to check the digestive tract from the mouth to the start of the small intestine.

Research analyzed the data from the national Veterans Affairs Healthcare System or VAHS and covered 33,300 IBD patients. Experts then grouped these patients into two according to age, with 7,008 patients aged 50-60 years and 26,292 >60 years.

Over 70% of the population were White, and most had comorbidities. Moreover, each group had a greater proportion of patients with ulcerative colitis than Crohn’s disease.

By utilizing cox regression with time varying analysis, it revealed that comparing with non-vaccination, full-dose vaccination with RZV generated a significant reduction in the crude incidence rate of herpes zoster infection. It was true for both the 50-60-year age group (from 3.93 to 0.0 per thousand person-years) and the >60-year age group (from 4.57 to 1.87 per thousand person-years).

Outcomes were consistent despite multivariate adjustment, with RZV cutting the risk of the herpes zoster infection in both groups.

Research findings suggest that RZV vaccination is beneficial to older adults with IBD due to its correlation with the decreased risk of herpes zoster infection in both age groups. Thus, greater efforts should be made to vaccinate all IBD patients with RZV.

 

Source: Clin Gastroenterol Hepatol 2021;doi:10.1016/j.cgh.2021.07.023

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