What Do Influenza and COVID-19 Represent for Patients With Inflammatory Bowel Disease?

Abstract

Background Inflammatory bowel diseases (IBD) are a group of immune and inflammatory diseases; and patients seem to be more vulnerable to influenza and coronavirus disease 2019 (COVID-19). These conditions are characterized by the augmented release of inflammatory cytokines that have been suggested as potential triggers for the acute respiratory distress syndrome, which may favor severe and even fatal outcomes. For these reasons, this review aims to evaluate what influenza and COVID-19 may represent for patients with IBD. Methods The search was performed in MEDLINE/PubMed, EMBASE, and Cochrane databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to build the review. Results The conventional therapies used by IBD patients may also interfere in the outcomes of influenza and COVID-19. Immune-suppressors agents are associated with a higher risk of infections due to the inhibition of intracellular signals necessary to the host act against pathogens. On the other hand, drugs related to the suppression of the production of cytokines in IBD could bring benefits to reduce mucosal inflammation, and for preventing pneumonia. Moreover, coronaviruses can bind to the target cells through angiotensin-converting enzyme 2 (ACE-2) receptor that is expressed in epithelial cells of the lung and largely the colon and the terminal ileum suggesting that human intestinal tract could be an alternative route for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Conclusions Once the cytokine storm observed in influenza and COVID-19 is similar to the cytokine pattern observed in IBD patients during the disease flares, the advice is that avoiding the infections is still an optimal option for IBD subjects.

Protective role of flavonoids quercetin and silymarin in the viral-associated inflammatory bowel disease: an updated review

“…Therefore, etiopathologic aspects mainly include, impaired ACE-2, absorption loss and GIT inflammation. The cytokine storm induced by SARS-CoV-2 is similar to that of the IBD (such as IL-1, IL-6 and TNF-α) (Aziz et al 2020 ; Bezzio et al 2020 ; Bodini et al 2020 ; Barbalho et al 2021 ; Hanrahan et al 2021 ; Gray‐Rodriguez et al 2022 ). Notably, consumption of the anti-TNF drug possibly downregulates the anti-SARS-CoV-2 immune responses which increase the pathologic consequences of various agents such as SARS-CoV-2, hepatitis B virus (HBV) and human immunodeficiency virus (HIV) (Abdullah et al 2020 ; Neurath 2020 ; Wisniewski et al 2020 ; Lee et al 2022 ).…”

Vaccines in Children with Inflammatory Bowel Disease: Brief Review

“…Influenza is generally more severe in patients with a weakened immune system, including immunosuppression caused by medications. Regarding IBD patients, a retrospective cohort study including a total of 140,480 subjects revealed that these patients had an increased influenza risk (OR, 1.54; 95% CI, 1.49–1.63) and could suffer from a more severe disease (rate of hospitalizations 5.4% vs. 1.85%; p < 0.001) [ 77 ]. Systemic CSs were found to be independently associated with influenza occurrence (OR, 1.22; 95% CI, 1.08–1.38).…”

“…Although most countries have detailed recommendations for immunization of children with IBD, several studies showed that the incidence rate of incomplete immunization schedule was significantly higher in IBD patients than in healthy controls [ 77 , 78 , 79 , 80 ]. A French study carried out in outpatients followed in six tertiary centers and five local hospitals from May to November 2011 showed that only 24% and 4% of children with IBD were vaccinated in agreement with the national immunization schedule and the recommendations for IBD, respectively [ 81 ].…”

Effects of Medicinal Plants and Phytochemicals in Nrf2 Pathways during Inflammatory Bowel Diseases and Related Colorectal Cancer: A Comprehensive Review

“…Pathologically, the causes of IBDs are still not completely understood. Many authors highlight numerous genetic and environmental factors, including more than 100 genes and smoking, inadequate nutrition, or stress [ 8 , 9 ]. Among the included genetic factors, genes involved in regulating oxidative stress (OS), redox signaling, inflammation, and electrophilic stress are mainly studied [ 10 ].…”