Crohn’s and Colitis Canada’s 2021 Impact of COVID-19 and Inflammatory Bowel Disease in Canada: Children and Expectant Mothers With Inflammatory Bowel Disease

Abstract

Coronavirus disease 2019 (COVID-19) in children with inflammatory bowel disease (IBD) typically results in a mild infection, similar to those without IBD. Children and adolescents have less severe manifestations of COVID-19 compared to older people, whether or not they have IBD. However, some IBD medications (in particular, corticosteroids) are associated with more severe COVID-19. During the first year of the global pandemic, more IBD care was provided with online technology, necessitated by efforts to reduce hospital and clinic visits. Additionally, non-endoscopic monitoring of inflammation has been required due to the cancellation of non-urgent procedures, resulting in longer endoscopy wait-times. In contrast, pregnant people (with and without IBD) who contract COVID-19 are at increased risk of severe manifestations, death and preterm delivery, making them a priority for severe acute respiratory syndrome coronavirus 2 protective measures and vaccination. Few studies have examined effect of COVID-19 on IBD-related disease activity in pregnant people with IBD. The pandemic has significantly affected the mental health and sense of well-being of children and their families, as well as pregnant people with IBD. These groups were much more likely to experience anxiety and depression compared with prior to the pandemic, even while concern has mostly abated regarding the effect of IBD medications and COVID-19 severity. Unfortunately, the availability of mental health care providers who specialize in people with IBD has not kept pace with the increasing demand.

Recent advances in clinical practice: management of inflammatory bowel disease during the COVID-19 pandemic

“…Children with IBD receiving immunosuppression, like adults, are considered to be vulnerable and of potentially higher risk of developing adverse outcomes with COVID-19 98. Reassuringly, they have not experienced higher rates of COVID-19, or related morbidity and mortality compared with adults with IBD 99–101. Compared with adults, COVID-19 in children, including those with IBD, followed a milder disease course, and children had less adverse outcomes to COVID-19 99.…”

“…Similarly, pregnant women with IBD receiving immunosuppression are a concern for risk of developing adverse outcomes with COVID-19 107. However, throughout the pandemic, this cohort has not yet demonstrated higher rates of COVID-19, or related morbidity and mortality, and adverse pregnancy-related outcomes have been infrequent 100 108. Limited studies have reported pregnancy outcomes in patients with IBD and COVID-19 109 110.…”

“… 107 However, throughout the pandemic, this cohort has not yet demonstrated higher rates of COVID-19, or related morbidity and mortality, and adverse pregnancy-related outcomes have been infrequent. 100 108 Limited studies have reported pregnancy outcomes in patients with IBD and COVID-19. 109 110 In the first case, 110 a woman presenting with acute ASUC in her first trimester subsequently tested positive for SARS-CoV-2 and had a spontaneous abortion.…”

Coronavirus disease 2019 and gastrointestinal disorders in children

“… 162 For example, the pandemic necessitated a rapid adaptation to remote care delivery, 163 , 164 and a rise in virtual care for chronic GI conditions (e.g. IBD 165 and CeD 166 ). While patient satisfaction with virtual care is typically reported to be high, 164 and its use has been linked to reduced travel costs and school absences, the effectiveness of virtual GI clinics has not been thoroughly studied.…”

A qualitative evaluation of treatment fidelity alongside a pilot trial of a novel therapy for pediatric IBD

“…People living with IBD face diminished quality of life, through financial burden, physical impairment, and psychological distress (4). The incidence and prevalence of IBD is increasing worldwide (5), as is the economic burden of the disease (6).…”