Review article: prevention, diagnosis and management of COVID‐19 in the IBD patient

Abstract

Summary Background The current COVID‐19 pandemic, caused by SARS‐CoV‐2, has emerged as a public health emergency. All nations are seriously challenged as the virus spreads rapidly across the globe with no regard for borders. The primary management of IBD involves treating uncontrolled inflammation with most patients requiring immune‐based therapies. However, these therapies may weaken the immune system and potentially place IBD patients at increased risk of infections and infectious complications including those from COVID‐19. Aim To summarise the scale of the COVID‐19 pandemic, review unique concerns regarding IBD management and infection risk during the pandemic and assess COVID‐19 management options and drug interactions in the IBD population. Methods A literature review on IBD, SARS‐CoV‐2 and COVID‐19 was undertaken and relevant literature was summarised and critically examined. Results IBD patients do not appear to be more susceptible to SARS‐CoV‐2 infection and there is no evidence of an association between IBD therapies and increased risk of COVID‐19. IBD medication adherence should be encouraged to prevent disease flare but where possible high‐dose systemic corticosteroids should be avoided. Patients should exercise social distancing, optimise co‐morbidities and be up to date with influenza and pneumococcal vaccines. If a patient develops COVID‐19, immune suppressing medications should be withheld until infection resolution and if trial medications for COVID‐19 are being considered, potential drug interactions should be checked. Conclusions IBD patient management presents a challenge in the current COVID‐19 pandemic. The primary focus should remain on keeping bowel inflammation controlled and encouraging medication adherence.

Editorial: low population mortality from COVID‐19 in countries south of latitude 35 degrees North—supports vitamin D as a factor determining severity. Authors' reply

“…Apart from physical distancing and shutdown measures after identification of the first few cases of COVID‐19, there are likely to be multiple confounders to any potential relationship between vitamin D and severe outcomes from vitamin D. Age of population is the strongest determinant of severe outcomes 8,9 . The median age of the population tends to be substantially higher in countries with higher than lower CFRs 10…”

Practical Guidance for Dietary Management of Patients With Inflammatory Bowel Disease During the SARS-CoV2 Pandemic

“…Vitamin D is a nutrient of particular interest during this pandemic; deficiency has been associated with COVID-19 disease severity and higher mortality. 11,23 It is therefore reasonable to supplement low vitamin D levels and consider vitamin D supplementation for those IBD patients at risk of deficiency (eg, protracted periods of isolation, low sunlight exposure). 11 Similarly, a broad-spectrum multivitamin can be recommended where dietary intake is inadequate, and targeted individual nutrient supplements can be used to correct micronutrient deficiencies.…”

“…9 In contrast to corticosteroids, immunomodulators, and biologics, EEN poses no immunosuppressive risk of acquiring or becoming severely ill from the novel coronavirus, and thus may be a more suitable alternative to corticosteroids for certain patients with CD. 7,11 See Figure 3 for description of potential benefits and risks of EEN in the current COVID-19 pandemic.…”

“…8,9 Beyond dietary management of IBD, nutritional optimization and evaluation and treatment of both malnutrition and obesity-related illness are important to best equip patients to face COVID-19. 10,11 The need for dietary management of functional gut symptoms, already common in patients with IBD, is likely to increase during this period of enormous psychological stress. 12,13 In this article we discuss practical dietary considerations for patients with IBD during the SARS-CoV2 pandemic, including dietary recommendations to optimize nutritional status, manage weight gain, and use dietary therapies such as EEN and the potential for increased rates of functional gut symptoms needing dietary therapy.…”

Letter: IBD nurse—pivotal role in the time of the pandemic. Authors’ reply

“…We were pleased to read the letter by Khan et al . in response to our review on prevention and management of COVID‐19 in inflammatory bowel disease (IBD) patients, 1 highlighting the value of IBD nurses during the current pandemic 2 . We concur that the unprecedented challenges posed by this pandemic have led to innumerable patient queries and that the IBD nurse's role in handling these queries has been crucial.…”