The American College of Gastroenterology (ACG) recently updated its original 2017 guidelines, Preventive Care in Inflammatory Bowel Disease. Literature and research released through 2024 was considered for the 2025 ACG inflammatory bowel disease guidelines update. The result is a list of 12 recommendations (condensed from 2017’s 14 recommendations) that provide guidance on vaccinations, cancer screenings, and more.

Regarding vaccinations, the 2025 update takes into consideration many advances in treatment that came as a result of the development of tumor necrosis factor inhibitors, interleukin (IL)-12/23 antibodies, IL-23 antibodies, anti-integrin antibodies and novel small molecules sphingosine-1 phosphate receptor modulators, and Janus kinase inhibitors.

Updated Recommendations for 2025:
  1. In all adult patients with IBD aged 50 and older and no prior pneumococcal vaccination, we suggest pneumococcal vaccination with PCV20 or PCV21.
  2. In adult patients with IBD between 19 and 49 years receiving immune-modifying therapy and with no prior pneumococcal vaccination, we suggest pneumococcal vaccination with PCV20 or PCV21.
  3. In patients with IBD who have previously received pneumococcal vaccination and are either age 19–64 on immune-modifying therapy, or who are age 65 and older, should follow Centers for Disease Control and Prevention (CDC) guidance for whether to receive additional pneumococcal vaccination with PCV20 or PCV21.
  4. In all adults 50 and older with IBD, we suggest vaccination against HZ with the 2-dose inactive recombinant HZ vaccine.
  5. In adults 19 and above with IBD on immune-modifying therapy or planning to start therapy, we suggest vaccination against HZ with the 2-dose inactive recombinant HZ vaccine.
  6. In adults with IBD, we suggest vaccination against SARS-CoV-2 in accordance with national guidelines.
  7. We suggest that a live rotavirus vaccine may be offered in children with in-utero exposure to biologic therapy.
  8. In women with IBD on immune-modifying therapies, we suggest annual cervical cancer screening within a year of the onset of sexual activity and if younger than 30 years should continue for 3 consecutive years before increasing to every 3 years.
  9. In patients with IBD (both UC and CD), we suggest annual screening for melanoma independent of the use of biologic therapy.
  10. In patients with IBD on immune-modifying therapies (6-mercaptopurine, azathioprine, methotrexate, JAK inhibitors, or S1P receptor modulators), we suggest annual screening for NMSC while using these agents, particularly older than the age of 50.
  11. In adults with IBD and conventional risk factors for abnormal bone mineral density, we suggest screening for osteoporosis with bone mineral density testing at the time of diagnosis and periodically after diagnosis.
  12. In adults with IBD who smoke, we suggest that they should be counseled to quit.

The former recommendation that IBD patients be screened for depression and anxiety was shifted out of a recommendation and to a key concept (11). These key concept sections are new to the guidelines and include statements that the GRADE process wasn’t applied to and can include expert recommendations and/or epidemiological statements or definitions.

Key Concepts Outlined in the 2025 Update:
  1. Adults with IBD should follow the Advisory Committee on Immunization Practices (ACIP). recommendation and should not receive a live vaccine if on immune-modifying therapy.
  2. Adults with IBD should receive age-appropriate vaccinations before initiation of immune-modifying therapy when possible.
  3. All adult patients with IBD should receive annual influenza vaccine.
  4. Adult patients with IBD receiving immune-modifying therapies and their household contacts should receive the nonlive trivalent inactivated influenza vaccine but not the live inhaled influenza vaccine.
  5. All adult patients with IBD 75 years of age and older should receive a RSV vaccine.
  6. All adult patients with IBD aged 50–74 years with certain chronic medical conditions or other risk factors for severe RSV disease should receive a RSV vaccine.
  7. Adults with IBD should be evaluated for varicella immunity before initiating immune-modifying therapy, through either a documented history of chickenpox infection or completion of a 2-dose varicella vaccine series. Serologic testing is not recommended in previously vaccinated individuals because of the high false-negative rates. If nonimmune status is confirmed, vaccination should be completed before initiating immune-modifying therapy when possible.
  8. Household members of patients receiving immune-modifying therapies can receive live vaccines with certain precautions.
  9. Vaccinations against Tdap, hepatitis A virus (HAV), HPV, and meningococcus should be administered according to the ACIP Recommendations.
  10. Adults with IBD should receive vaccination against hepatitis B if not immune.
  11. All patients with CD and UC should be screened for depression and anxiety at baseline and annually. Patients who screen positive for anxiety and/or depression should be referred for counseling/therapy.

Click here for a look at the full-text version of the ACG's updated guidelines for Preventive Care in Inflammatory Bowel Disease.

Updated clinical guidelines help optimize patient health, as they use the latest evidence and research to inform best practices. Updating older guidelines helps support consistent, high-quality care, reduce variability in clinical decision-making, and improve patient outcomes.

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