Inflammatory bowel disease amid the COVID-19 pandemic: impact, management strategies, and lessons learned

Abstract

The current outbreak of COVID-19 pandemic caused by SARS-CoV-2 has affected nearly 188 countries. Patients with severe COVID-19 are more commonly elderly and suffer from comorbidities such as hypertension, diabetes mellitus, coronary artery disease, chronic pulmonary disease, obesity, and cancer. Inflammatory bowel disease (IBD) affects as many as 6.8 million people globally, and a significant proportion of them are treated with immunosuppressants. Hence, there is an ongoing concern over the impact of COVID-19 on IBD patients and their susceptibility to it. So far, there are about 1439 IBD patients in the Surveillance Epidemiology of Coronavirus under Research Exclusion (SECURE-IBD) registry reported to be infected with SARS-CoV-2. There are many unique challenges and dilemmas that need to be taken into account when managing an IBD patient with COVID-19. The management of each patient should be individualized. The IBD societies and experts have strongly recommended that patients should not discontinue their IBD medications. If the patients have symptoms of COVID-19 or IBD flare-up, they are recommended to call their IBD physician first to discuss their medication. In addition, IBD patients are urged to practice social distancing strictly to minimize the chances of infection. As COVID-19 is rapidly evolving, our experience and understanding of its impact on the IBD population may potentially change in the near future.

Successful Distancing: Telemedicine in Gastroenterology and Hepatology During the COVID-19 Pandemic

“…Multiple institutions have development platforms such as IBD Qorus™ program centers [ 44 ], HealthPROMISE [ 45 ], IBD LIVE™ (Liver Interinstitutional and interdisciplinary Video conference Education) [ 46 ], and myIBDcoach [ 47 ] in order to provide high-quality care, improve adherence to the treatment regimens, and identify disease progression at early stages facilitating the timely institution of therapies. There is no better time for increased telemedicine utilization in IBD care than now [ 48 , 49 ]. Although IBD patients may be at higher risk for acquiring SARS-CoV-2 infection due to a dysregulated immune system, biological therapy continuation in IBD is essential.…”

Impact of the COVID-19 pandemic on inflammatory bowel disease patients: A review of the current evidence

“…Considering the differences in the initial clinical presentation, although in concordance with the non-IBD population, fever and cough were the most common clinical findings. Further, COVID-19 positive IBD patients presented with diarrhea significantly more often than the general population[ 54 - 57 ]. This disparity could be associated with the influence of the underlying disease on the number of evacuations, justifying the greater percentage of diarrhea in IBD patients than in the general population.…”

Evaluating IBD Patient-Initiated Electronic Communication During the SARS-CoV-2 Pandemic: A Single-Center Study

“…COVID-19 has posed numerous unique challenges and dilemmas for managing IBD patients, especially due to similarities between COVID-19 intestinal symptoms and IBD flare [2,3]. The use of telemedicine among IBD patients has been on the rise during the pandemic.…”