Impact of COVID-19 in Pediatric Patients and Young Adults with Inflammatory Bowel Disease

Abstract

<b><i>Introduction:</i></b> Acute COVID-19 in pediatric and young adult patients tends to be milder in severity compared to adult infection. Recent studies seem to show that inflammatory bowel disease (IBD) patients are at no greater risk than the general population. We aim to describe our experience in the follow-up of pediatric and young adult patients with IBD followed in our center and determine possible risk factors of said population for severe COVID-19. <b><i>Methods:</i></b> We performed a retrospective study of all patients aged under 25 years followed for IBD at the Unit of Pediatric Gastroenterology in a tertiary center between December 2019 and April 2021 evaluating the incidence of COVID-19 and characterization of positive cases. <b><i>Results:</i></b> Of the 268 participants, 24 had COVID-19: the mean age was 19 years old and gender had an equal distribution; 75% (<i>n</i> = 18) had Crohn’s disease, whereas only 25% (<i>n</i> = 6) had ulcerative colitis. Most patients were in clinical remission (<i>n</i> = 21). The majority of patients were under treatment with a tumor necrosis factor (TNF) antagonist (58%, <i>n</i> = 14), mainly infliximab, and most had no comorbidities other than IBD (83%). Regarding COVID-19, 17% of the patients were asymptomatic while the rest had only mild symptoms. There were no reported gastrointestinal complaints, no complications nor hospitalizations. Most patients did not require interruption of their IBD treatment. <b><i>Conclusions:</i></b> Our data suggest that pediatric and young adult IBD patients have a low risk for complications and hospitalization, regardless of IBD treatment. We believe that this experience is encouraging and allows for safe counseling regarding treatment options and school attendance in pediatric and young adult IBD patients.

SARS-CoV-2 Infection and Outcomes in Children with Inflammatory Bowel Diseases: A Systematic Review

“…Of the 14 studies included in our systematic review, 12 were observational studies [ 8 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ] (9 cohort studies, 2 cross-sectional studies, and 1 case-control study), while the other 2 were case report/series [ 23 , 24 ]. All studies included patients with PIBD with adequate data about SARS-CoV-2 infection.…”

“…All studies included patients with PIBD with adequate data about SARS-CoV-2 infection. In certain studies, the population included adults, children, and adolescents; however, specific and well-defined data regarding pediatric patients were provided [ 14 , 15 , 17 , 18 , 20 ]. Unfortunately, due to many plausible reasons for extreme heterogeneity such as different aims of the included studies (and consequently inclusion and exclusion criteria), different populations, and different medical treatment used for IBD across studies (but absence of individual patient data to take this important information into account), a meta-analysis was not deemed appropriate.…”

“…In a retrospective cohort study in an IBD referral center in Portugal, Μagalhaes et al [ 20 ] reported 11 pediatric patients who tested positive for COVID-19; a total of 7 of them had CD and 4 had UC. The clinical course was either mild or totally asymptomatic, with mean symptom duration not exceeding 4 days and without need for hospitalization.…”

“…Ιn the aforementioned study from Portugal [ 20 ], aminosalicylates were the most commonly used treatment agents ( n = 5, 45%). Other treatment regimens included anti-TNF ( n = 2) and thiopurines ( n = 2), either as monotherapy or combined ( n = 2).…”

“…Presenting symptoms include persistent fever, rash, abdominal pain, renal and cardiac dysfunction, conjunctivitis, coagulopathy, and, in some cases, shock requiring admission to the intensive care unit (ICU) [ 4 , 19 , 31 ]. The gastrointestinal tract is commonly affected, but the cause remains unknown, while a universal definition for MIS-C is still pending, and rapid evolution on the understanding of its pathophysiological mechanisms and treatment possibilities is gradually achieved [ 19 , 20 , 32 ]. Interestingly, there have been reported MIS-C cases where abdominal imaging reveals inflammation of the bowel wall in the distal ileum and mesenteric fat, a usual finding in IBD cases [ 33 ].…”