Covid-19 and the management of patients with inflammatory bowel disease: a practical decalogue for the post-pandemic phase

Abstract

The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has raised several concerns for patients with chronic immune-mediated diseases, including inflammatory bowel disease (IBD). As the outbreak appears to be in the descending phase, at least in some part of the world, as in most European countries, guidance is urgently needed to provide optimal care for our IBD patients in order to gradually and safely reduce the gap in care that has been accumulated in the months of lockdown and to face all the backlogs. Therefore, we have provided a decalogue of practical recommendations for gastroenterologists to manage patients with IBD in the post-peak phase of the COVID-19 pandemic. They include all the aspects of IBD care, not only pharmacological ones but also endoscopy, surgery, psychological treatment, telemedicine, diagnostics and educational tasks provided by doctors and patient associations.

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“…These symptomatology rates are higher than those found in previous research on the general population in the same region of Spain during the pandemic (Ozamiz-Etxebarria et al, 2020). This is consistent with the other research indicating that teachers are experiencing stress, anxiety, and other psychological and physical symptoms during lockdown [16] for the pandemic. On the other hand, this study demonstrates that this symptomatology is not limited to times of lockdown.…”

“…The academic research indicates that reducing mental health problems and supporting vulnerable populations should be the urgent focus of the scientific community during this unusual period. As a result, the COVID-19 pandemic may have the long-term effects on educators and classroom activities, potentially spreading to students and adolescents [16]. As this epidemic continues, we can better understand how teachers are coping with returning to school and the necessary support mechanisms, as well [17].…”

How to Face the Advent of SARS-CoV-2 Vaccination in IBD Patients: Another Task for Gastroenterologists

“…Interestingly, the risk factors associated to a worse prognosis of COVID-19 in IBD patients are the same as the general population (i.e., advanced age and the presence of comorbidities) with the addition of active disease at the time of infection [ 14 ]. However, these reassuring findings are largely due to the health agencies recommendations for reducing COVID-19 spread, to the IBD treatments adequately prescribed by gastroenterologists as well as to the cautious preventive measures adopted by the patients [ 15 ]. In fact, especially during the first months of the pandemic, access to diagnostic exams (i.e., endoscopy), hospital admissions or outpatient visits with the sole exception of infusion therapy and emergencies have been deferred or canceled [ 16 , 17 ].…”

Impact of COVID-19 in individuals with and without pre-existent digestive disorders with a particular focus on elderly patients

“…In addition, combination therapy with TNF-α antagonists plus thiopurines was correlated with an augmented risk of hospitalization or death, but not the combination with methotrexate. Moreover, biologics were not associated with worse COVID-19 outcomes and could have a protective effect without differences when comparing biologic classes such as TNF-α, IL-12/23, or integrin antagonists[ 56 ]. Therefore, the correct management of IBD therapy is relevant because SARS-CoV-2 is not correlated with the risk of IBD relapse.…”

“…Therefore, the correct management of IBD therapy is relevant because SARS-CoV-2 is not correlated with the risk of IBD relapse. Conversely, the discontinuation or delay of the IBD therapy, regardless of SARS-CoV-2 infection, is significantly associated with the disease activity[ 55 , 56 ] (Table 2 ).…”