The new ECCO Guidelines on the Prevention, Diagnosis and Management of Infections in IBD provide an updated framework that builds on and extends the 2021 ECCO Guidelines. The document reflects the rapidly evolving therapeutic and infectious disease landscape and is designed as a practical tool for everyday clinical decision-making.
Coordinated by Javier Gisbert and Henit Yanai on behalf of the ECCO Guidelines Committee (GuiCom), the guideline was produced by expert gastroenterologists and infectious disease specialists using standard ECCO methodology: a structured PICO-based process, systematic literature searches, dual screening, Oxford evidence grading and electronic voting, followed by a final consensus meeting. The work was organised into four multidisciplinary Working Groups (WGs): WG1 – Viral infections; WG2 – TB, bacterial, parasitic and fungal infections; WG3 – Risk factors, degree of immunosuppression and special situations; and WG4 – Vaccination strategies. Each WG drafted statements and supporting text, which were then harmonised by the coordinators and GuiCom into a single, clinically ordered document offering clear, stepwise advice for the bedside and outpatient clinic.
As the therapeutic landscape in IBD has shifted markedly over the last half-decade, with rapid integration of small molecules and novel biologics, this guideline deliberately broadens its scope beyond anti-TNFs. It differentiates and profiles infection risk across anti-TNFs, anti-integrins, anti-IL-12/23 and selective anti-IL-23 agents, JAK inhibitors and S1P modulators, enabling more nuanced, drug-specific stratification of opportunistic infection risk. Compared with the 2021 ECCO Guidelines, the 2025 update incorporates robust new data on JAK inhibitors, selective IL-23 agents and S1P modulators and reframes the “degree of immunosuppression” into a more granular, drug- and host-specific framework that integrates age, comorbidities, polypharmacy and cumulative immunosuppressive load.
Prevention and vaccination strategies have also been substantially modernised. The guideline provides clearer vaccination pathways with treatment-tailored algorithms and practical advice on timing relative to starting immunosuppressive or biologic therapy, including for older adults and other high-risk groups. It offers critical clarity on JAK inhibitors, highlighting their dose-dependent association with herpes zoster and translating this into a strong recommendation for recombinant zoster vaccine for all adult IBD patients on immunosuppression. Pneumococcal schedules have been updated to incorporate newer conjugate vaccines, and for the first time the guideline includes recommendations on respiratory syncytial virus vaccination in patients aged ≥60 years and on COVID-19 booster strategies in IBD, reflecting post-pandemic evidence.
The main messages of the new ECCO Guidelines on Opportunistic Infections in IBD will be presented at the upcoming ECCO Congress in Stockholm and a full, peer-reviewed version of the guideline will subsequently be published in the Journal of Crohn’s and Colitis, supporting widespread implementation and helping clinicians balance therapeutic ambition with infection safety for people living with IBD.
