Implications of COVID-19 for inflammatory bowel disease: Opportunities and challenges amidst the pandemic

Abstract

Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic various measures have been taken to mitigate the effects of the global health crisis in this unprecedented time. According to the World Health Organization, more than 5 million people have been infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and with more than 300000 deaths attributed to COVID-19 worldwide. There is emerging evidence that SARS-CoV-2 utilizes angiotensin-converting enzyme 2 receptors to enter human cells which are found in abundance in the alveoli and intestines. In addition, the infection is noted to be more severe in patients with co-morbid conditions, those who are malnourished, immunosuppressed and immunocompromised. Inflammatory bowel disease (IBD) which includes ulcerative colitis and Crohn’s disease is chronic remitting and relapsing disorders with intestinal and extraintestinal manifestation. IBD patients are often malnourished and on immunosuppressive medications and there is a hypothetical concern that IBD patients are at substantial risk of COVID-19 infection. The management of IBD patients is often complex and poses unique challenges for gastroenterologists during the pandemic. The purpose of this review article is to summarize the growing level of evidence and understanding of the management of IBD during the COVID-19 pandemic, in the light of international and national gastroenterology society guidelines. We performed a thorough literature search on IBD, SARS-CoV-2 and COVID-19 on PubMed, EMBASE, OVID Medline and Google Scholar and pertaining literature was critically examined and summarized. Per national and international society guidelines and recommendations, IBD is not a risk factor for SARS-CoV-2 infection. IBD patients should continue with their medications and they should follow universal precautions i.e. masks, hand and respiratory hygiene and avoidance of health care facilities and public toilets as general population. Among IBD patients older age, having active disease, and co-morbid conditions are risk factors for a severe SARS-CoV-2 infection. Furthermore, elective endoscopic and surgical procedures can be delayed or deferred until discussing the risks and benefits with patients.

Keywords: SARS-CoV-2, COVID-19, Inflammatory bowel disease, Crohn’s disease, Ulcerative colitis, Pandemic

Core Tip: The current pandemic caused by coronavirus disease 2019 (COVID-19) has resulted in devastating consequences worldwide. This viral infection affecting the respiratory and gastrointestinal systems is the most severe in patients with co-morbid conditions, including the immunocompromised. Patients with inflammatory bowel disease are often malnourished and on immunosuppressive medications; management of this population poses unique challenges during this time. In this review, we summarize the current evidence and understanding of the management of inflammatory bowel disease during the COVID-19 pandemic. We further outline the current guidelines for treatment of those with inflammatory bowel disease and offer education for measures to prevent infections, including COVID-19.