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How to manage inflammatory bowel disease during the COVID-19 pandemic: A guide for the practicing clinician
Júlio Maria Fonseca Chebli1, Natália Sousa Freitas Queiroz2, Adérson Omar Mourão Cintra Damião2
1Division of Gastroenterology, Department of Medicine, Inflammatory Bowel Disease Center, Federal University of Juiz de Fora, Juiz de Fora 36036-900, MG, Brazil.
Insights
Managing inflammatory bowel disease (IBD) during the COVID-19 pandemic requires careful consideration of biologics and immunosuppressants. This review addresses SARS-CoV-2 infection risks, treatment strategies, and telemedicine for IBD patients.
Area of Science:
- Gastroenterology and Hepatology
- Infectious Diseases
- Immunology
Background:
- The COVID-19 pandemic presented unique challenges for managing inflammatory bowel disease (IBD).
- Concerns existed regarding the impact of IBD medications (biologics, immunosuppressants) on SARS-CoV-2 infection risk and COVID-19 severity.
- Evolving knowledge necessitated a review of current data and management strategies.
Purpose of the Study:
- To review the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on IBD patients.
- To summarize pharmacologic and surgical management of IBD in the context of COVID-19.
- To discuss the influence of COVID-19 on patient psychology, endoscopy services, and the role of telemedicine.
Main Methods:
- Literature review of current data on SARS-CoV-2 and IBD.
- Analysis of medication impacts on infection risk and disease course.
- Synthesis of information on gastrointestinal manifestations, management, and psychological effects.
Main Results:
- Gastrointestinal involvement in SARS-CoV-2 infection is noted.
- Management strategies for IBD patients with COVID-19 depend on disease activity and COVID-19 severity.
- Telemedicine emerged as a crucial tool for patient care during the pandemic.
Conclusions:
- Careful management of IBD patients during the COVID-19 pandemic is essential.
- Understanding the interplay between IBD treatments and SARS-CoV-2 is critical.
- Telemedicine offers a valuable modality for ongoing patient support and monitoring.
Abstract:
Managing inflammatory bowel disease (IBD) during the coronavirus disease 2019 (COVID-19) pandemic has been a challenge faced by clinicians and their patients, especially concerning whether to proceed with biologics and immunosuppressive agents in the background of a global outbreak of a highly contagious new coronavirus (severe acute respiratory syndrome coronavirus 2, SARS-CoV-2). The knowledge about the impact of this virus on patients with IBD, although it is still scarce, is rapidly evolving. In particular, concerns surrounding medications' impact for IBD on the risk of acquiring SARS-CoV-2 infection or developing COVID-19, and potentially exacerbate viral replication and the COVID-19 course, are a current thinking of both practicing clinicians and providers caring for patients with IBD. Managing patients with IBD infected with SARS-CoV-2 depends on both the clinical activity of the IBD and the occasional development and severity of COVID-19. In this review, we summarize the current data regarding gastrointestinal involvement by SARS-CoV-2 and pharmacologic and surgical management for IBD concerning this infection, and the COVID-19 impact on both the patient's psychological functioning and endoscopy services, and we concisely summarize the telemedicine roles during the COVID-19 pandemic.
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