Pediatric inflammatory bowel disease and the effect of COVID-19 pandemic on treatment adherence and patients’ behavior

Dorfman, Lev; Nassar, Raouf; Ohana, Dalit Binjamin; Oseran, Ilan; Matar, Michael A.; Shamir, Raanan; Assa, Amit

doi:10.1038/s41390-020-01312-6

Cited by 26 publications

(34 citation statements)

References 8 publications

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“…Unfortunately, the literature lacks data on the course of SARS-CoV-2 infection in this study group. Therefore, the researchers focused mainly on patients’ treatment adherence or changes to in-hospital care [ 20 , 21 ]. However, a cohort study from Sweden reports that among adults with Inflammatory Bowel Disease (IBD), despite the risk of hospital admission during infection being higher, the course of the disease is not more severe than in the general population [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Course of SARS-CoV-2 Infection among Immunocompromised Children Hospitalised in the Tertiary Referral Hospital in Poland

Kuczborska

Książyk

2021

JCM

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The aim of this retrospective study was the assessment of the prevalence, clinical characteristics, and the comparison of the course of SARS-CoV-2 infection in children with and without immunodeficiency that were admitted to the COVID-19 Subunit of the tertiary referral hospital in Warsaw, Poland. We analysed 313 children hospitalised in the COVID-19 Subunit. The analysis was performed on the total study group and subgroups of children with and without immunodeficiency. In each group, clinical data and laboratory test results were analysed. Of the 68 children with isolated fevers, only seven (11.76%) were diagnosed with COVID-19, whereas among those with the accompanying features of respiratory or gastrointestinal infection, only one (3.23%) and ten (16.95%) patients tested positive, respectively. In both groups, the course of the infection was mainly asymptomatic or mild. The children with immunodeficiencies had lower white blood cell and lymphocyte counts, lower haemoglobin levels, and higher urea levels but did not differ in other biochemical variables. To conclude, the most frequently reported symptoms of COVID-19 indicate that this disease among children is only a small percentage. In both groups, the responses to the infection were comparable in terms of the mild clinical symptoms and the laboratory test results. Therefore, SARS-CoV-2 infection should not alter the chronic treatment of underlying diseases.

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Section: Discussionmentioning

confidence: 99%

Prevalence and Course of SARS-CoV-2 Infection among Immunocompromised Children Hospitalised in the Tertiary Referral Hospital in Poland

Kuczborska

Książyk

2021

JCM

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“…A jelenlegi publikációk szerint jelenleg még nincs adat arra vonatkozóan, hogy a COVID-19-fertőzés önmagában okozhat-e relapsust, vagy következtében kialakulhat-e de novo IBD [22].…”

Section: A Covid-19-fertőzés Lefolyása a Gyulladásos Bélbeteg Gyermek...unclassified

A COVID–19-fertőzés gastrointestinalis hatásai gyermekkorban és a gyulladásos bélbeteg gyermekekben

Tóbi

Prehoda

Balogh

et al. 2022

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Összefoglaló. A SARS-CoV-2-infekció változatos kórlefolyású, a gyermekpopulációban növekvő incidenciát mutató fertőzés. Ebben a korcsoportban a felnőttekkel szemben sokkal gyakrabban tapasztalhatók gasztroenterológiai tünetek a betegség során, 18–32%-ban jelentkezik legalább egy szimptóma. Ezek nem specifikusak, gyakran megegyezhetnek a virális enteritisek, a gyulladásos bélbetegségek vagy a vakbélgyulladás tüneteivel. A gyermekkori SARS-CoV-2-infekciónak egy viszonylag ritkán megjelenő, de súlyos, akár életveszélyes szövődménye a gyermekkori sokszervi gyulladásos szindróma (multisystem inflammatory syndrome in children, MIS-C). Ilyenkor a gastrointestinalis tünetek gyakorisága 60–100%-ra nő, sok esetben akut has benyomását keltve. A jelenlegi kutatások eredményei alapján a gyulladásos bélbeteg gyerekek az alapbetegségük miatt nincsenek nagyobb veszélynek kitéve az átlagpopulációhoz képest a COVID–19-fertőzés szempontjából. A terápiájukban alkalmazott gyógyszereik közül a nagy dózisú szteroidkezelés okoz nagyobb kockázatot a megfertőződésre, illetve ebben az esetben a súlyosabb kórlefolyásra. Az éppen remisszióban lévő gyulladásos bélbetegek fenntartó terápiájának módosítások nélküli folytatása javasolt, kiemelt figyelmet fordítva a biológiai terápiák időben történő, megszakítás nélküli alkalmazására. Törekedni kell a személyes vizitek számának csökkentésére a pandémia idején, ezek telemedicinával történő helyettesítése javasolt. A halasztható endoszkópos vizsgálatok noninvazív vizsgálómódszerekkel történő átmeneti kiváltása részesítendő előnyben a betegség aktivitásának, a terápia hatékonyságának megítélésére. A gyulladásos bélbetegségben szenvedő gyermekek COVID–19 elleni védőoltása javasolt, jelenleg minden elérhető oltóanyag alkalmazható náluk (az élő ágenst tartalmazó vakcinák ellenjavalltak). Immunmoduláns, szteroid- vagy anti-tumornekrózisfaktor (TNF)-alfa-terápia esetén az oltás lehetséges csökkent hatékonyságával kell számolni. Orv Hetil. 2022; 163(6): 214–221. Summary. The SARS-CoV-2 infection is showing high variety in the disease course, with a constantly increasing incidence among the pediatric population. In this age group, at least one gastrointestinal symptom appears in 18–32% of the cases, showing a significant difference compared to the adult population. The gastrointestinal signs of COVID–19 are not specific, can mimic the symptoms of viral enteritis, inflammatory bowel diseases or acute appendicitis. The multisystem inflammatory syndrome in children (MIS-C) is a rather rare, but serious complication of the pediatric COVID–19 disease: in these cases, the incidence of the gastrointestinal symptoms is increased up to 60–100%, often observed as acute abdomen. Based on recent researches, patients with inflammatory bowel diseases (IBD) are shown to have the same risk in developing COVID–19 infection compared to the normal population: in their medications, the high dose steroid treatment is proved to increase the risk of infection or to make the disease course more serious. The treatment of patients with IBD should be continued without any changes (when the disease is in remission). The use of biologics should be done with special care, with more attention keeping the schedule and the continuity. It is advised to minimise the number of personal visits during the pandemic, they should be substituted with telemedicine. The postponable endoscopic examinations should be temporarily redeemed by non-invasive methods for screening the disease activity and the efficacy of the treatment. The vaccination against COVID–19 is advised in the population with IBD. All vaccines currently available are usable in this patient group (the use of vaccines containing live agents are contraindicated). In the case of patients treated with immunmodulators, steroids or anti-tumor necrosis factor (TNF) alpha, a possible lower efficacy can be expected after the vaccination. Orv Hetil. 2022; 163(6): 214–221.

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“…In fact, over half of those newly diagnosed with IBD in that month were presumed diagnoses due to lack of access to endoscopy ( 17 ). A cross-sectional study from Israel surveyed families of children with IBD and found the majority did not perceive any major changes to their health care in the first wave of the pandemic ( 18 ). For the people with IBD in Canada, non-urgent endoscopic services were severely affected by the first wave of the pandemic, with follow-up procedures to assess therapeutic response cancelled until May to June 2020.…”

Section: Health System Impact Of Covid-19 In Children With Ibdmentioning

confidence: 99%

“…These findings suggest that the increased levels of fear were more related to the pandemic than to ongoing health concerns. Further, in a cross-sectional telephone survey in Israel, Dorfman et al found that youth with IBD (mainly adolescents) were very worried about COVID-19 because of their belief that they had an increased susceptibility to contracting the virus ( 18 ). This fear resulted in these people voluntarily increasing their avoidance of attending school beyond the ministry requirements of their country.…”

Section: Mental Health Impact Of Covid-19 In Children and Youth With Ibdmentioning

confidence: 99%

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

Benchimol

Carroll

Geist

et al. 2021

Journal of the Canadian Association of Gastroenterology

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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.

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Pediatric inflammatory bowel disease and the effect of COVID-19 pandemic on treatment adherence and patients’ behavior

Cited by 26 publications

References 8 publications

Prevalence and Course of SARS-CoV-2 Infection among Immunocompromised Children Hospitalised in the Tertiary Referral Hospital in Poland

Prevalence and Course of SARS-CoV-2 Infection among Immunocompromised Children Hospitalised in the Tertiary Referral Hospital in Poland

A COVID–19-fertőzés gastrointestinalis hatásai gyermekkorban és a gyulladásos bélbeteg gyermekekben

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

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