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Systematic Review on Inflammatory Bowel Disease Patients With Coronavirus Disease 2019: It Is Time to Take Stock
Ferdinando D'Amico1, Silvio Danese2, Laurent Peyrin-Biroulet3
1Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Department of Gastroenterology, Inserm Nutrition - Genetics and exposure to environmental risks U1256, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France.
Insights
This systematic review analyzed 1028 inflammatory bowel disease (IBD) patients with coronavirus disease 2019 (COVID-19). Diarrhea was more common in IBD patients with COVID-19 compared to the general population.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Epidemiology
Background:
- Limited data exists on clinical characteristics of patients with inflammatory bowel diseases (IBD) and coronavirus disease 2019 (COVID-19).
- Understanding the interplay between IBD and COVID-19 is crucial for patient management.
Purpose of the Study:
- To systematically review and investigate the symptoms and diagnostic-therapeutic management of IBD patients diagnosed with COVID-19.
- To consolidate existing knowledge on clinical presentations and outcomes in this patient cohort.
Main Methods:
- A comprehensive literature search was conducted across PubMed, Embase, Web of Science, and MedRxiv up to July 29, 2020.
- Inclusion criteria focused on studies reporting clinical information on adult and pediatric IBD patients with confirmed COVID-19.
Main Results:
- The review included 23 studies encompassing 243,760 IBD patients, with 1028 diagnosed with COVID-19 (cumulative prevalence of 0.4%).
- Common symptoms included fever (48.3%), cough (46.5%), and diarrhea (20.5%). Hospitalization rates were 30.6%, with 11.4% requiring ICU admission.
- COVID-19-related deaths were reported in 3.8% of cases, with older age and comorbidities identified as risk factors for adverse outcomes.
Conclusions:
- Diarrhea was observed more frequently in IBD patients with COVID-19 compared to the non-IBD population.
- Further research is necessary to establish optimal diagnostic and therapeutic strategies for IBD patients co-infected with COVID-19.
Background & Aims:
Data on the clinical characteristics of patients with inflammatory bowel diseases (IBDs) with coronavirus disease 2019 (COVID-19) are scarce. The aim of our systematic review was to investigate symptoms and diagnostic-therapeutic management of IBD patients with COVID-19.
Methods:
We searched PubMed, Embase, Web of Science, and MedRxiv up to July 29, 2020, to identify all studies reporting clinical information on adult and pediatric IBD patients with confirmed COVID-19.
Results:
Twenty-three studies met our inclusion criteria, including 243,760 IBD patients. COVID-19 was diagnosed in 1028 patients (509 with Crohn's disease [49.5%], 428 with ulcerative colitis [41.6%], 49 with indeterminate colitis [4.8%], and 42 with missing data [4.1%]), accounting for a cumulative prevalence of 0.4%. Viral infection occurred more frequently in males than in females (56.5% vs 39.7%), and the mean age ranged from 14 to 85 years. The most common symptoms were fever (48.3%), cough (46.5%), and diarrhea (20.5%), and a COVID-19 diagnosis was achieved mainly through polymerase chain reaction analysis of nasopharyngeal swabs (94.4%) and chest computed tomography scans (38.9%). Hydroxychloroquine (23.9%), lopinavir/ritonavir (8.2%), steroids (3.2%), and antibiotics (3.1%) were the most used drugs. Overall, approximately a third of patients were hospitalized (30.6%), and 11.4% of them required admission to the intensive care unit. In total, 29 COVID-19-related deaths were reported (3.8%), and increasing age and the presence of comorbidities were recognized as risk factors for COVID-19 and negative outcomes.
Conclusions:
Diarrhea occurs more frequently in IBD patients with COVID-19 than in the non-IBD population. Further studies are needed to define the optimal diagnostic-therapeutic approach in IBD patients with COVID-19.
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