Management of paediatric IBD after the peak of COVID-19 pandemic in Italy: A position paper on behalf of the SIGENP IBD working group

Abstract

Coronavirus Disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2, spreading in Italy during the first months of 2020, abruptly changed the way of practicing medicine in this country. As a consequence of the lockdown, the diagnostic and therapeutic management of paediatric chronic conditions, such as inflammatory bowel disease (IBD) has been affected. During the peak of COVID-19 pandemic, elective visits, endoscopies and infusions have been postponed, with potential clinical and psychological impact on disease course and a high likelihood of increasing waiting lists. While slowly moving back towards normality, clinicians need to recognize the best ways to care for patients with IBD, carefully avoiding risk factors for new potential epidemic outbreaks. In this uncertain scenario until the development and spread of COVID-19 vaccine, it is necessary to continue to operate with caution. Hereby we provide useful indications for a safer and gradual restarting of routine clinical activities after COVID-19 peak in Italy.

Impact of COVID-19 pandemic on the management of paediatric inflammatory bowel disease: An Italian multicentre study on behalf of the SIGENP IBD Group

“…Together with a great impact on healthcare costs, it has been proven to increase patients’ quality of life and to decrease the rates of hospitalization [22 , 23] . The sudden SARS CoV-2 pandemic represents an obvious opportunity to test and implement telemedicine services for the management of paediatric IBD [24] , [25] , [26] . The results of our study demonstrate that specific telemedicine services for children with IBD were activated in 52.3% of the participating centres with an overall number of 343 visits performed during the lockdown.…”

Implications of SARS-COV-2 infection in the diagnosis and management of the pediatric gastrointestinal disease

“…Telemedicine services are strongly recommended, particularly for those IBD patients with stable disease on maintenance therapy in order to minimize hospitalizations, outpatient gastroenterology visits and, consequently, SARS-CoV-2 exposure risk [27,28].…”

“…Psychological issues have been mostly found among subjects with preexisting chronic diseases [45,46]. Therefore, psychological assistance in all children with IBD and their parents with the aid of online video-psychotherapy sessions should be ensured [21].…”

“…Multiple national and international gastroenterology and endoscopic scientific societies agree with the need to perform endoscopy in the following urgent cases: acute gastrointestinal bleeding, upper gastrointestinal foreign bodies requiring removal, nutrient support (application of percutaneous endoscopic gastrostomy/jejunostomy), obstructing upper or lower gastrointestinal lesion that requires stenting/therapy. Regarding IBD patients, endoscopic procedures should not be deferred in cases of confirmation of new diagnoses, severe acute flares, or occurrence of complications [21,[54][55][56]. If available, negative pressure rooms should be used, especially for patients infected by SARS-CoV-2 [57,58].…”

“…In this context, the use of corticosteroids has been widely debated. Although steroids are currently being used to treat patients with moderate-to-severe COVID-19 in order to counteract the super inflammation state in the later phases of the disease, their use may increase viral burden in the early stages of the infection [ 21 ]. This hypothesis has been confirmed by a recent analysis including 525 patients with IBD, which revealed that steroid therapy was the most significant factor for the development of severe COVID-19 [ 22 ].…”