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Benign Evolution of SARS-Cov2 Infections in Children With Inflammatory Bowel Disease: Results From Two International
Erica J Brenner1, Bénédicte Pigneur2, Gili Focht3
1Department of Pediatric Gastroenterology, University of North Carolina, Chapel Hill, North Carolina.
Insights
Pediatric inflammatory bowel disease (IBD) patients generally experience mild coronavirus disease 2019 (COVID-19). This study analyzed COVID-19 outcomes in young IBD patients, finding a low risk of severe illness.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Pediatrics
Background:
- The coronavirus disease 2019 (COVID-19) pandemic poses risks, particularly severe forms, despite most cases being mild.
- Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) utilizes the angiotensin-converting enzyme 2 (ACE2) receptor for cell entry, which is highly expressed in the gastrointestinal tract.
- Inflammatory bowel disease (IBD) involves chronic gastrointestinal inflammation, raising concerns about potential COVID-19 severity in affected individuals.
Purpose of the Study:
- To assess the clinical course and outcomes of COVID-19 in pediatric patients with inflammatory bowel disease (IBD).
- To determine if IBD patients, particularly children, are at increased risk for severe or complicated COVID-19.
- To expand upon existing data regarding COVID-19 in young IBD populations.
Main Methods:
- Analysis of COVID-19 disease course in an expanded cohort of pediatric IBD patients.
- Utilized data from two international databases to gather information on affected children.
- Compared outcomes with existing registry data on IBD patients and COVID-19.
Main Results:
- Pediatric IBD patients in this expanded sample exhibited predominantly mild clinical courses of COVID-19.
- Findings align with previous observations suggesting younger IBD patients (<20 years) have less severe disease.
- No significant risk factors for severe COVID-19 were identified in this pediatric cohort, unlike in adult IBD populations.
Conclusions:
- Pediatric patients with inflammatory bowel disease appear to have a favorable prognosis for COVID-19.
- The risk factors for severe COVID-19 identified in adults may not directly translate to pediatric IBD populations.
- Further longitudinal studies are warranted to fully understand the long-term implications of COVID-19 in pediatric IBD.
Abstract:
The coronavirus disease 2019 (COVID-19) pandemic caused by the highly infectious severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) presents most often with mild clinical symptoms, but the severe forms are of major concern.1 SARS-CoV-2 enters human cells via the angiotensin-converting enzyme 2 receptor, expressed on epithelial and endothelial cells.2 Because the highest angiotensin-converting enzyme 2 expression is in the terminal ileum and colon, and up-regulated further during inflammation, and many COVID-19 patients experience gastrointestinal symptoms, longitudinal data are necessary to determine whether inflammatory bowel disease (IBD) patients are at risk for severe or complicated COVID-19. A recent analysis in IBD patients from the Surveillance Epidemiology of Coronavirus Under Research Exclusion for Inflammatory Bowel Disease (SECURE-IBD) registry showed older age, steroid medication, and comorbidities as risk factors for severe evolution, and the same study showed that the 29 IBD patients younger than age 20 had only mild disease courses.3 This report describes the disease course of COVID-19 in an expanded sample of pediatric IBD patients from 2 international databases.
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