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Children With Inflammatory Bowel Disease in the COVID-19 Main Endemic Focus: The Lombardy Experience
Naire Sansotta1, Lorenzo Norsa1, Giovanna Zuin2
1Paediatric Hepatology Gastroenterology and Transplantation, Papa Giovanni XXIII Hospital, Bergamo, Italy.
Insights
Children with inflammatory bowel diseases (IBD) in Lombardy experienced mild COVID-19 symptoms, with no hospitalizations or treatment changes needed. Standard IBD therapies, including biologics, remained safe during the pandemic.
Area of Science:
- Pediatric gastroenterology
- Infectious disease epidemiology
- Immunology
Background:
- The Coronavirus Disease 2019 (COVID-19) pandemic raised concerns for pediatric patients with inflammatory bowel diseases (IBD) due to their potential immunosuppression.
- Assessing the impact of SARS-CoV-2 infection on this vulnerable population is crucial for guiding clinical management.
Purpose of the Study:
- To evaluate the incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and its impact on pediatric inflammatory bowel disease (IBD) patients in Lombardy, a high-prevalence region.
- To assess changes in IBD disease activity, including flares and new diagnoses, during and after the COVID-19 lockdown period.
Main Methods:
- A cross-sectional survey was administered to 290 pediatric IBD patients across seven major IBD centers in Lombardy during the COVID-19 lockdown.
- Clinical data, including symptoms suggestive of SARS-CoV-2 infection and adherence to IBD treatment, were collected.
- Medical records were reviewed for IBD flares and new diagnoses before and after the lockdown, comparing data to the previous year.
Main Results:
- During lockdown, 8% of surveyed pediatric IBD patients reported mild symptoms consistent with SARS-CoV-2 infection; none required hospitalization or IBD treatment modification.
- One patient experienced an IBD flare and one had infectious colitis during lockdown; no new IBD cases were diagnosed.
- Post-lockdown, 4% of patients relapsed, and 15 new IBD diagnoses were made. These rates were not statistically different from the previous year's non-pandemic period.
Conclusions:
- The study provides reassuring data for pediatric IBD patients in a high COVID-19 prevalence area, indicating that standard treatments, including biologics, can be safely continued.
- A small proportion of children with IBD experienced mild SARS-CoV-2 symptoms without significant impact on their disease management or requiring hospitalization.
- While IBD flares and new diagnoses occurred post-lockdown, their incidence did not significantly differ from the preceding year, suggesting the pandemic had a limited direct impact on IBD onset or exacerbation in this cohort.
Abstract:
Objectives: In the era of Coronavirus 2019 (COVID-19), concern has been raised for immunosuppressed patients, including children with inflammatory bowel diseases (IBD). We aimed to collect data from IBD tertiary centers of Lombardy during pandemic. Methods: A cross-sectional survey enrolling IBD children has been completed by seven major IBD centers in Lombardy during lockdown. The clinical form included questions on any symptom consistent with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the IBD adherence treatment. Furthermore, we have reviewed all IBD medical records including new IBD diagnoses and flares in known IBD patients after the lockdown. Results: Questionnaires of 290 IBD children were returned during lockdown. Out of them, 24 children (8%) complained of mild symptoms suspicious of SARS-CoV-2 infection without needing hospitalization or changing IBD treatment. During the lockdown, one patient presented with IBD flare and one had infectious colitis, with no new IBD cases. Conversely, after lockdown, 12/290 (4%) children relapsed and 15 children were newly diagnosed with IBD. Last year, in the same timeframe, 20/300 (7%) children presented with IBD flare, while 17 children had IBD onset with no statistical difference. Conclusions: Our data on children with IBD in a high COVID-19 prevalence region are reassuring. Only a minority of IBD children had mild symptoms, and no hospitalization or treatment modification was needed. Standard IBD treatments including biologics were safely continued. New IBD diagnoses and flares in known IBD children occurred after the lockdown phase, although no significant difference was found compared with the previous year.
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