Ambulatory management of perianal Crohn’s disease during the COVID‐19 pandemic

Coronavirus disease 2019 (COVID-19), a respiratory viral infection, has affected more than 78 million individuals worldwide as of the end of December 2020. Previous studies reported that severe acute respiratory syndrome coronavirus 1 and Middle East respiratory syndrome–related coronavirus infections may affect the gastrointestinal (GI) system. In this review we outline the important GI manifestations of COVID-19 and discuss the possible underlying pathophysiological mechanisms and their diagnosis and management. GI manifestations are reported in 11.4–61.1% of individuals with COVID-19, with variable onset and severity. The majority of COVID-19-associated GI symptoms are mild and self-limiting and include anorexia, diarrhoea, nausea, vomiting and abdominal pain/discomfort. A minority of patients present with an acute abdomen with aetiologies such as acute pancreatitis, acute appendicitis, intestinal obstruction, bowel ischaemia, haemoperitoneum or abdominal compartment syndrome. Severe acute respiratory syndrome coronavirus 2 RNA has been found in biopsies from all parts of the alimentary canal. Involvement of the GI tract may be due to direct viral injury and/or an inflammatory immune response and may lead to malabsorption, an imbalance in intestinal secretions and gut mucosal integrity and activation of the enteric nervous system. Supportive and symptomatic care is the mainstay of therapy. However, a minority may require surgical or endoscopic treatment for acute abdomen and GI bleeding.

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“…This would minimize the number of medical personnel required and avoid higher-risk anaesthetic procedures. 144 …”

Section: Covid-19 In Patients With Diagnosed Gi Disordersmentioning

confidence: 99%

Gastrointestinal manifestations in COVID-19

Kariyawasam

Jayarajah

Riza

et al. 2021

Transactions of the Royal Society of Tropical Medicine and Hygiene

114

105

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“…Active surveillance for an early diagnosis is considered mandatory. Rutgeerts endoscopic index is possibly the most widely used scoring system to detect recurrent lesions [ 62 , 63 ]. Previous studies demonstrated that the lesions are located more often in or near the area of anastomosis, usually reproducing the same initial pattern of the disease, though it has been suggested that post-resection lesions should be considered new.…”

Section: Surgical Management and CD Recurrencementioning

confidence: 99%

Pathophysiology of Crohn’s disease inflammation and recurrence

et al. 2020

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Chron’s Disease is a chronic inflammatory intestinal disease, first described at the beginning of the last century. The disease is characterized by the alternation of periods of flares and remissions influenced by a complex pathogenesis in which inflammation plays a key role. Crohn’s disease evolution is mediated by a complex alteration of the inflammatory response which is characterized by alterations of the innate immunity of the intestinal mucosa barrier together with a remodeling of the extracellular matrix through the expression of metalloproteins and increased adhesion molecules expression, such as MAcCAM-1. This reshaped microenvironment enhances leucocytes migration in the sites of inflammation, promoting a TH1 response, through the production of cytokines such as IL-12 and TNF-α. IL-12 itself and IL-23 have been targeted for the medical treatment of CD. Giving the limited success of medical therapies, the treatment of the disease is invariably surgical. This review will highlight the role of inflammation in CD and describe the surgical approaches for the prevention of the almost inevitable recurrence.

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“…Setons prevent fistula closure while in place, therefore they are used as bridging therapy to optimal medical management or definitive surgical therapy after resolution of inflammation [20]. During the COVID-19 pandemic, outpatient exploration has emerged in Italy without requiring anesthesia [29 ▪▪ ].…”

Section: Initial Evaluation and Classification Of Perianal Crohn's Di...mentioning

confidence: 99%

Multidisciplinary management of perianal Crohn's disease

Abushamma¹,

Ballard²,

Smith

et al. 2021

Current Opinion in Gastroenterology

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Purpose of reviewMultiple new medications with novel mechanisms of action are now available to treat Crohn's disease (CD). However, they have varying effectiveness in the management of perianal CD. Identifying the most appropriate therapy and optimizing it is essential to maximize effectiveness of therapy. Additionally, the management of perianal CD requires imaging of the perianal area to identify the fistula anatomy and local complications such as abscesses that require surgical drainage. Initial surgical assessment is key to drain abscesses and allow fistula healing with medical therapy. Recent findingsAlthough anti-tumor necrosis factor (TNFs) remain the most effective medications to treat perianal CD, realworld data suggests that ustekinumab may be a 2 nd -line option in patients nonresponsive to an anti-TNF or having contraindications. Mesenchymal stem cells are an emerging therapeutic approach that is currently in Phase 3 trials in the United States and poised to play a major role in the treatment algorithm.

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Ambulatory management of perianal Crohn’s disease during the COVID‐19 pandemic

Cited by 9 publications

References 5 publications

Gastrointestinal manifestations in COVID-19

Gastrointestinal manifestations in COVID-19

Pathophysiology of Crohn’s disease inflammation and recurrence

Multidisciplinary management of perianal Crohn's disease

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