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Taxonera C, Sagastagoitia I, Alba C, Mañas N, Olivares D, Rey E. 2019 novel coronavirus disease (COVID-19) in patients with inflammatory bowel diseases. Aliment Pharmacol Ther 2020; 52:276-283. [PMID: 32359205 PMCID: PMC7267496 DOI: 10.1111/apt.15804] [Citation(s) in RCA: 129] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 04/29/2020] [Accepted: 05/01/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Data on patients with inflammatory bowel diseases (IBD) who have had 2019 novel coronavirus (SARS-CoV-2) disease (COVID-19) are needed. AIMS To report the clinical characteristics, including gastrointestinal symptoms, of COVID-19 in IBD patients, and to assess the risk of COVID-19 in IBD. METHODS This case series included consecutive IBD patients with laboratory-confirmed COVID-19. Age-adjusted cumulative incidences were compared with the general population in the Madrid region. RESULTS Through April 8, 12 of 1918 IBD patients were diagnosed with COVID-19. The average age was 52 years, 75% of the patients were female and 58.3% had Crohn's disease. Seven patients (58%) were on maintenance treatment with immunomodulators/biologics, of these four with combined therapy (33%). Eight patients (66%) required hospitalisation (one intensive care unit admission, and two deaths), and four patients were isolated at home. Nine patients had diarrhoea ranging between 4 and 10 loose stools per day (mean 5.4, SD 1.6). In five patients (42%) diarrhoea was a presenting symptom. In two patients, diarrhoea was the only symptom at debut. Cumulative incidence of COVID-19 was 6.2 per 1000 IBD patients. IBD patients had a lower adjusted incidence ratio of COVID-19 (OR 0.74, 95% CI 0.70-0.77; P < 0.001), and a similar associated mortality ratio (OR 0.95, 95% CI: 0.84-1.06; P = 0.36), compared with the general population. CONCLUSIONS IBD patients do not have an increased risk of COVID-19 and associated mortality compared with the general population. In many IBD patients, diarrhoea was a presenting symptom, and sometimes, was the only symptom at onset of COVID-19.
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Affiliation(s)
- Carlos Taxonera
- Inflammatory Bowel Disease UnitDepartment of GastroenterologyHospital Clínico San Carlos and Instituto de Investigación del Hospital Clínico San Carlos [IdISSC]MadridSpain
| | - Iñigo Sagastagoitia
- Department of Internal MedicineHospital Clínico San Carlos and Instituto de Investigación del Hospital Clínico San Carlos [IdISSC]MadridSpain
| | - Cristina Alba
- Inflammatory Bowel Disease UnitDepartment of GastroenterologyHospital Clínico San Carlos and Instituto de Investigación del Hospital Clínico San Carlos [IdISSC]MadridSpain
| | - Norberto Mañas
- Inflammatory Bowel Disease UnitDepartment of GastroenterologyHospital Clínico San Carlos and Instituto de Investigación del Hospital Clínico San Carlos [IdISSC]MadridSpain
| | - David Olivares
- Inflammatory Bowel Disease UnitDepartment of GastroenterologyHospital Clínico San Carlos and Instituto de Investigación del Hospital Clínico San Carlos [IdISSC]MadridSpain
| | - Enrique Rey
- Inflammatory Bowel Disease UnitDepartment of GastroenterologyHospital Clínico San Carlos and Instituto de Investigación del Hospital Clínico San Carlos [IdISSC]MadridSpain
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Pharmacologic management of patients with hepatic and pancreatic diseases that involve immunosuppressive therapies. Positioning within the framework of the SARS-CoV-2 (COVID-19) pandemic. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2020. [PMCID: PMC7832058 DOI: 10.1016/j.rgmxen.2020.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. COVID-19 affected close to 2 million persons worldwide in fewer than 4 months, after the report of the first cases in China in December 2019. The relation of the disease caused by SARS-Cov-2 to immunosuppressive treatment used in different gastrointestinal disorders is uncertain, resulting in debate with regard to suspending immunosuppressive therapy to improve infection outcome. Said suspension implies the inherent risk for graft rejection or autoimmune disease exacerbation that can potentially worsen the course of the infection. Based on the presently available evidence, a treatment stance has been established for patients with gastrointestinal diseases that require immunosuppressive therapy.
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Sultan S, Altayar O, Siddique SM, Davitkov P, Feuerstein JD, Lim JK, Falck-Ytter Y, El-Serag HB. AGA Institute Rapid Review of the Gastrointestinal and Liver Manifestations of COVID-19, Meta-Analysis of International Data, and Recommendations for the Consultative Management of Patients with COVID-19. Gastroenterology 2020; 159:320-334.e27. [PMID: 32407808 PMCID: PMC7212965 DOI: 10.1053/j.gastro.2020.05.001] [Citation(s) in RCA: 276] [Impact Index Per Article: 69.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Multiple gastrointestinal (GI) symptoms, including diarrhea, nausea/vomiting, and abdominal pain, as well as liver enzyme abnormalities, have been variably reported in patients with coronavirus disease 2019 (COVID-19). This document provides best practice statements and recommendations for consultative management based on a systematic review and meta-analysis of international data on GI and liver manifestations of COVID-19. METHODS We performed a systematic literature search to identify published and unpublished studies using OVID Medline and preprint servers (medRxiv, LitCovid, and SSRN) up until April 5, 2020; major journal sites were monitored for US publications until April 19, 2020. We pooled the prevalence of diarrhea, nausea, vomiting, and abdominal pain, as well as liver function tests abnormalities, using a fixed-effect model and assessed the certainty of evidence using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework. RESULTS We identified 118 studies and used a hierarchal study selection process to identify unique cohorts. We performed a meta-analysis of 47 studies including 10,890 unique patients. Pooled prevalence estimates of GI symptoms were as follows: diarrhea 7.7% (95% confidence interval [CI], 7.2%-8.2%), nausea/vomiting 7.8% (95% CI, 7.1%-8.5%), and abdominal pain 2.7% (95% CI, 2.0%-3.4%). Most studies reported on hospitalized patients. The pooled prevalence estimates of elevated liver abnormalities were as follows: aspartate transaminase 15.0% (95% CI, 13.6%-16.5%) and alanine transaminase 15.0% (95% CI, 13.6%-16.4%). When we compared studies from China to studies from other countries in subgroup analyses, diarrhea, nausea/vomiting, and liver abnormalities were more prevalent outside of China, with diarrhea reported in 18.3% (95% CI, 16.6%-20.1%). Isolated GI symptoms were reported rarely. We also summarized the Gl and liver adverse effects of the most commonly utilized medications for COVID-19. CONCLUSIONS GI symptoms are associated with COVID-19 in <10% of patients. In studies outside of China, estimates are higher. Further studies are needed with standardized GI symptoms questionnaires and liver function test checks on admission to better quantify and qualify the association of these symptoms with COVID-19. Based on findings from our meta-analysis, we provide several Best Practice Statements for the consultative management of COVID-19.
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Affiliation(s)
- Shahnaz Sultan
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis Veterans Affairs Healthcare System, Minneapolis, Minnesota
| | - Osama Altayar
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri
| | - Shazia M Siddique
- Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Perica Davitkov
- Division of Gastroenterology, Northeast Ohio Veterans Affairs Healthcare System, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Joseph D Feuerstein
- Division of Gastroenterology and Center for Inflammatory Bowel Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Joseph K Lim
- Yale Liver Center and Section of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut
| | - Yngve Falck-Ytter
- Division of Gastroenterology, Northeast Ohio Veterans Affairs Healthcare System, Case Western Reserve University School of Medicine, Cleveland, Ohio
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Bezzio C, Saibeni S, Variola A, Allocca M, Massari A, Gerardi V, Casini V, Ricci C, Zingone F, Amato A, Caprioli F, Lenti MV, Viganò C, Ascolani M, Bossa F, Castiglione F, Cortelezzi C, Grossi L, Milla M, Morganti D, Pastorelli L, Ribaldone DG, Sartini A, Soriano A, Manes G, Danese S, Fantini MC, Armuzzi A, Daperno M, Fiorino G. Outcomes of COVID-19 in 79 patients with IBD in Italy: an IG-IBD study. Gut 2020; 69:1213-1217. [PMID: 32354990 PMCID: PMC7242872 DOI: 10.1136/gutjnl-2020-321411] [Citation(s) in RCA: 251] [Impact Index Per Article: 62.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 04/18/2020] [Accepted: 04/20/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES COVID-19 has rapidly become a major health emergency worldwide. Patients with IBD are at increased risk of infection, especially when they have active disease and are taking immunosuppressive therapy. The characteristics and outcomes of COVID-19 in patients with IBD remain unclear. DESIGN This Italian prospective observational cohort study enrolled consecutive patients with an established IBD diagnosis and confirmed COVID-19. Data regarding age, sex, IBD (type, treatments and clinical activity), other comorbidities (Charlson Comorbidity Index (CCI)), signs and symptoms of COVID-19 and therapies were compared with COVID-19 outcomes (pneumonia, hospitalisation, respiratory therapy and death). RESULTS Between 11 and 29 March 2020, 79 patients with IBD with COVID-19 were enrolled at 24 IBD referral units. Thirty-six patients had COVID-19-related pneumonia (46%), 22 (28%) were hospitalised, 7 (9%) required non-mechanical ventilation, 9 (11%) required continuous positive airway pressure therapy, 2 (3%) had endotracheal intubation and 6 (8%) died. Four patients (6%) were diagnosed with COVID-19 while they were being hospitalised for a severe flare of IBD. Age over 65 years (p=0.03), UC diagnosis (p=0.03), IBD activity (p=0.003) and a CCI score >1 (p=0.04) were significantly associated with COVID-19 pneumonia, whereas concomitant IBD treatments were not. Age over 65 years (p=0.002), active IBD (p=0.02) and higher CCI score were significantly associated with COVID-19-related death. CONCLUSIONS Active IBD, old age and comorbidities were associated with a negative COVID-19 outcome, whereas IBD treatments were not. Preventing acute IBD flares may avoid fatal COVID-19 in patients with IBD. Further research is needed.
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Affiliation(s)
- Cristina Bezzio
- Gastroenterology Unit, Rho Hospital, Rho (MI), ASST Rhodense, Garbagnate Milanese, Italy
| | - Simone Saibeni
- Gastroenterology Unit, Rho Hospital, Rho (MI), ASST Rhodense, Garbagnate Milanese, Italy
| | - Angela Variola
- IBD Unit, Don Calabria Sacred Heart Hospital, Negrar, Veneto, Italy
| | - Mariangela Allocca
- IBD Center, Gastroenterology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Alessandro Massari
- Gastroenterology Unit, ASST Fatebenefratelli Sacco, Milano, Lombardia, Italy
| | - Viviana Gerardi
- Medicine, Gastroenterology and Digestive Endoscopy Department, Poliambulanza Brescia Hospital, Brescia, Lombardia, Italy
| | - Valentina Casini
- UOC Gastroenterology and Digestive Endoscopy, ASST Bergamo Est, Seriate, Lombardia, Italy
| | - Chiara Ricci
- Gastroenterology Unit, ASST Spedali Civili di Brescia, Brescia, Lombardia, Italy
| | - Fabiana Zingone
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padova, Veneto, Italy
| | - Arnaldo Amato
- Division of Digestive Endoscopy and Gastroenterology, Valduce Hospital, Como, Italy
| | - Flavio Caprioli
- Gastroenterology and Endoscopy Unit, La Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano Policlinico, Milano, Lombardia, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milano, Lombardia, Italy
| | - Marco Vincenzo Lenti
- First Department of Internal Medicine, Università degli Studi di Pavia, Pavia, Lombardia, Italy
| | - Chiara Viganò
- Gastroenterology Unit, Azienda Ospedaliera San Gerardo, Monza, Lombardia, Italy
| | - Marta Ascolani
- Gastroenterology Unit, Ospedale Santa Maria di Ca Foncello, Treviso, Veneto, Italy
| | - Fabrizio Bossa
- Division of Gastroenterology, IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Puglia, Italy
| | | | | | - Laurino Grossi
- Department of Medicine and Aging Science, University Gabriele d'Annunzio of Chieti and Pescara, Chieti, Abruzzo, Italy
| | - Monica Milla
- Gastroenterology Unit, Azienda Ospedaliero Universitaria Careggi, Firenze, Toscana, Italy
| | - Daniela Morganti
- Gastreonterology Unit, ASST Rhodense, Garbagnate Milanese, Lombardia, Italy
| | - Luca Pastorelli
- Gastroenterology Unit, IRCCS Policlinico San Danato, San Donato Milanese, Lombardia, Italy
| | - Davide Giuseppe Ribaldone
- Division of Gastroenterology, Department of Medical Sciences, University of Turin, Torino, Piemonte, Italy
| | - Alessandro Sartini
- Internal Medicine, Gastroenterology Unit, Bufalini Hospital, AUSL della Romagna, Cesena, Italy
| | - Alessandra Soriano
- Gastroenterology Division, Arcispedale S Maria Nuova, Reggio Emilia, Emilia-Romagna, Italy
| | - Gianpiero Manes
- Gastroenterology Unit, ASST Rhodense, Garbagnate Milanese, Lombardia, Italy
| | - Silvio Danese
- IBD Center, Gastroenterology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Massimo Claudio Fantini
- Unit of Gastroenterology, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Sardegna, Italy
| | - Alessandro Armuzzi
- IBD Unit, Policlinico Universitario Agostino Gemelli, Roma, Lazio, Italy
- Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Roma, Lazio, Italy
| | - Marco Daperno
- Gastroenterology Unit, Azienda Ospedaliera Ordine Mauriziano di Torino, Torino, Piemonte, Italy
| | - Gionata Fiorino
- IBD Center, Gastroenterology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
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de León-Rendón J, Hurtado-Salazar C, Yamamoto-Furusho J. Aspects of inflammatory bowel disease during the COVID-19 pandemic and general considerations. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2020. [PMCID: PMC7321053 DOI: 10.1016/j.rgmxen.2020.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
So far, available evidence suggests that patients with inflammatory bowel disease (IBD) are not at greater risk for developing COVID-19 infection. In regard to patients with IBD remission: 5-aminosalycylates (5-ASAs) do not increase the risk for infection and should be continued. There is no need to suspend them or lower the dose. Immunomodulating drugs, such as thiopurines and methotrexate, should be continued, without modifying doses (even in patients with positive SARS-CoV-2 infection). No type of biologic therapy should be suspended, unless there are signs of COVID-19. Regarding patients with IBD activity: the oral and/or topical 5-ASA dose should be optimized in cases of disease relapse. Budesonide MMX should be considered in cases of mild-to-moderate activity, to avoid systemic steroid use. Systemic steroids should be avoided whenever possible because doses above 20 mg per day have an immunosuppressive effect, which could increase susceptibility to any type of infection, including COVID-19. The combined use of thiopurines with steroids and/or tumor necrosis factor (TNF) monoclonal antibodies should also be avoided because those combinations can increase the risk for infections, including COVID-19. Finally, biologic treatment with anti-TNF-alpha agents or any other mechanism of action, such as anti-integrins or anti-interleukins, should be suspended if patients become infected with SARS-CoV-2. The drugs can be restarted once the infectious process is resolved.
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Affiliation(s)
| | | | - J.K. Yamamoto-Furusho
- Corresponding author. Director de la Clínica de Enfermedad Inflamatoria Intestinal, departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Colonia Belisario Domínguez, Sección XVI, Delegación Tlalpan, CP 14080, Mexico City, Mexico. Tel.: 5555733418; Fax: 5556550942.
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106
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D’Amico F, Danese S, Peyrin-Biroulet L. Inflammatory Bowel Disease Management During the Coronavirus-19 Outbreak: A Survey From the European Crohn's and Colitis Organization. Gastroenterology 2020; 159:14-19.e3. [PMID: 32360567 PMCID: PMC7191276 DOI: 10.1053/j.gastro.2020.04.059] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 04/18/2020] [Accepted: 04/21/2020] [Indexed: 01/08/2023]
Affiliation(s)
| | - Silvio Danese
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; IBD center, Department of Gastroenterology, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France
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- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France
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Abstract
Coronavirus disease 2019 (COVID-19) is an infectious disease, caused by severe acute respiratory syndrome coronavirus 2, which predominantly affects the lungs and, under certain circumstances, leads to an excessive or uncontrolled immune activation and cytokine response in alveolar structures. The pattern of pro-inflammatory cytokines induced in COVID-19 has similarities to those targeted in the treatment of rheumatoid arthritis. Several clinical studies are underway that test the effects of inhibiting IL-6, IL-1β or TNF or targeting cytokine signalling via Janus kinase inhibition in the treatment of COVID-19. Despite these similarities, COVID-19 and other zoonotic coronavirus-mediated diseases do not induce clinical arthritis, suggesting that a local inflammatory niche develops in alveolar structures and drives the disease process. COVID-19 constitutes a challenge for patients with inflammatory arthritis for several reasons, in particular, the safety of immune interventions during the pandemic. Preliminary data, however, do not suggest that patients with inflammatory arthritis are at increased risk of COVID-19. This Perspective article explores similarities in the inflammatory processes underlying coronavirus disease 2019 (COVID-19) and rheumatoid arthritis, including the role of pro-inflammatory cytokines and the potential of anti-cytokine therapies to treat COVID-19, as well as the effect of the COVID-19 pandemic on rheumatology.
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108
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Miranda-Zazueta G, González-Regueiro JA, García-Juárez I, Moctezuma-Velázquez C, López-Díaz FJ, Pérez-González B, Uscanga-Domínguez LF, Peláez-Luna M. Pharmacologic management of patients with hepatic and pancreatic diseases that involve immunosuppressive therapies. Position statement within the framework of the SARS-CoV-2 (COVID-19) pandemic. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2020; 85:312-320. [PMID: 32620315 PMCID: PMC7298481 DOI: 10.1016/j.rgmx.2020.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/31/2020] [Accepted: 06/11/2020] [Indexed: 12/13/2022]
Abstract
La enfermedad por coronavirus 2019 (COVID-19) es causada por el virus del síndrome respiratorio agudo grave-coronavirus 2 (SARS-CoV-2). La COVID-19 ha afectado a unos 6 millones de personas en todo el mundo en menos de 4 meses posterior al reporte de los primeros casos en China en diciembre de 2019. La relación que guarda la enfermedad por SARS-CoV-2 con el tratamiento inmunosupresor utilizado en diversos trastornos gastrointestinales es incierta, y esto genera el debate sobre suspender el tratamiento inmunosupresor para mejorar el pronóstico de la infección, lo cual incluye el riesgo inherente de rechazo de injerto o agudización de enfermedades autoinmunes que potencialmente pudieran agravar el curso de la infección. En base a la evidencia disponible se logra establecer una postura de tratamiento en pacientes con enfermedades gastrointestinales que requieren terapia inmunosupresora.
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Affiliation(s)
- G Miranda-Zazueta
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán», Ciudad de México, México
| | - J A González-Regueiro
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán», Ciudad de México, México
| | - I García-Juárez
- Departamento de Gastroenterología, Unidad de Hepatología y Trasplante Hepático, Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán», Ciudad de México, México
| | - C Moctezuma-Velázquez
- Departamento de Gastroenterología, Unidad de Hepatología y Trasplante Hepático, Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán», Ciudad de México, México
| | - F J López-Díaz
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán», Ciudad de México, México
| | - B Pérez-González
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán», Ciudad de México, México
| | - L F Uscanga-Domínguez
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán», Ciudad de México, México
| | - M Peláez-Luna
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán», Ciudad de México, México.
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Crespo J, Andrade R, Alberca de Las Parras F, Balaguer F, Barreiro-de Acosta M, Bujanda L, Gutiérrez A, Jorquera F, Iglesias-García J, Sánchez-Yagüe A, Calleja JL. Resumption of activity in gastroenterology departments. Recommendations by SEPD, AEEH, GETECCU and AEG. GASTROENTEROLOGIA Y HEPATOLOGIA 2020; 43:332-347. [PMID: 32409107 PMCID: PMC7183290 DOI: 10.1016/j.gastrohep.2020.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 02/07/2023]
Abstract
The set of measures proposed by SEPD, AEEH, GETECCU and AEG are aimed to help departments in their resumption of usual activity. We have prepared a number of practical recommendations regarding patient management and the stepwise resumption of healthcare activity. These recommendations are based on the sparse, changing evidence available, and will be updated in the future according to daily needs and the availability of expendable materials to suit them; in each department they will be implemented depending upon the cumulative incidence of SARS-CoV-2 infection in each region, and the burden the pandemic has represented for each hospital. The general objectives of these recommendations include: (a)To protect our patients against the risks of infection with SARS-CoV-2 and to provide them with high-quality care. (b)To protect all healthcare professionals against the risks of infection with SARS-CoV-2. (c)To resume normal functioning of our departments in a setting of ongoing risk for infection with SARS-CoV-2.
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Affiliation(s)
- Javier Crespo
- Presidente de la SEPD. Jefe del Servicio de Aparato Digestivo, Hospital Universitario Marqués de Valdecilla. Instituto de Investigación Valdecilla (IDIVAL). Facultad de Medicina, Universidad de Cantabria, Santander, España.
| | - Raúl Andrade
- Presidente de la AEEH. Jefe del Servicio de Aparato Digestivo, Hospital Universitario Virgen de la Victoria, Málaga, España
| | | | - Francesc Balaguer
- Secretario de la Asociación Española de Gastroenterología (AEG). Servicio de Gastroenterología, Hospital Clínic, Barcelona, España
| | - Manuel Barreiro-de Acosta
- Presidente de GETECCU. Unidad EII. Servicio de Aparato Digestivo, Hospital Clínico Universitario de Santiago, Santiago de Compostela, La Coruña, España
| | - Luís Bujanda
- Presidente de la Asociación Española de Gastroenterología (AEG). Instituto Biodonostia. CIBERehd. Universidad del País Vasco (UPV/EHU), San Sebastián, España
| | - Ana Gutiérrez
- Vicepresidenta de GETECCU. Servicio de Medicina Digestiva, Hospital General Universitario de Alicante. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd). Instituto de Salud Carlos III, Alicante, España
| | - Francisco Jorquera
- Jefe del Servicio de Aparato Digestivo, Complejo Asistencial Universitario de León. IBIOMED. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd). Instituto de Salud Carlos III, León, España
| | - Julio Iglesias-García
- Jefe de la Sección de Endoscopia, Servicio de Aparato Digestivo, Hospital Clínico Universitario de Santiago, Santiago de Compostela, La Coruña, España
| | - Andrés Sánchez-Yagüe
- Facultativo Especialista de Área, Servicio de Aparato Digestivo, Hospital Costa del Sol, Marbella. Jefe del Servicio de Aparato Digestivo, Hospital Vithas Xanit Internacional, Benalmádena, Málaga, España
| | - José Luis Calleja
- Vicepresidente de la AEEH. Jefe del Servicio de Gastroenterología y Hepatología, Hospital Universitario Puerta de Hierro Majadahonda. Instituto de Investigación Biomédica IDIPHIM. Universidad Autónoma de Madrid, Majadahonda, Madrid, España
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110
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Dhar J, Samanta J, Kochhar R. Corona Virus Disease-19 pandemic: The gastroenterologists' perspective. Indian J Gastroenterol 2020. [PMID: 32783168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The world is witnessing a serious public health threat in the wake of the third corona virus pandemic, a novel corona virus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]). The Corona Virus Disease-19 (COVID-19) is not limited to the respiratory system but has widespread involvement including the gastrointestinal (GI) tract and liver, with evidence of prolonged fecal shedding and feco-oral transmission. This finding has stirred up a hornet's nest of not only a newer modality of the spread of the virus but also a risk of the unpredictable duration of the infective potential of the shedders. We reviewed the literature on fecal shedding and possible implications on prevention and surveillance strategies. The pandemic is changing the management of underlying chronic diseases such as inflammatory bowel disease (IBD) and other diseases. Moreover, for the gastroenterologist, doing endoscopic procedures in this COVID-19 era poses a high risk of contamination, as it is an aerosol-generating procedure. There is a daily influx of data on this disease, and multiple societies are coming up with various recommendations. We provide a comprehensive review of all the reported GI manifestations of COVID-19 infection and the side effects of confounding drugs. We have summarized the management recommendations for diseases such as IBD with COVID-19 and nutritional recommendations and provided a concise review of the endoscopy guidelines by the various societies. This review provides a comprehensive account and a lucid guide covering various aspects of gastroenterology practice during this COVID-19 pandemic.
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Affiliation(s)
- Jahnvi Dhar
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, Sector - 12, Chandigarh, 160 012, India
| | - Jayanta Samanta
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, Sector - 12, Chandigarh, 160 012, India.
| | - Rakesh Kochhar
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, Sector - 12, Chandigarh, 160 012, India
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111
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Crespo J, Andrade R, Alberca de las Parras F, Balaguer F, Barreiro-de Acosta M, Bujanda L, Gutiérrez A, Jorquera F, Iglesias-García J, Sánchez-Yagüe A, Calleja JL. Resumption of activity in gastroenterology departments. Recommendations by SEPD, AEEH, GETECCU and AEG. GASTROENTEROLOGÍA Y HEPATOLOGÍA (ENGLISH EDITION) 2020. [PMCID: PMC7186212 DOI: 10.1016/j.gastre.2020.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The set of measures proposed by SEPD, AEEH, GETECCU and AEG are aimed to help departments in their resumption of usual activity. We have prepared a number of practical recommendations regarding patient management and the stepwise resumption of healthcare activity. These recommendations are based on the sparse, changing evidence available, and will be updated in the future according to daily needs and the availability of expendable materials to suit them; in each department they will be implemented depending upon the cumulative incidence of SARS-CoV-2 infection in each region, and the burden the pandemic has represented for each hospital. The general objectives of these recommendations include: • To protect our patients against the risks of infection with SARS-CoV-2 and to provide them with high-quality care. • To protect all healthcare professionals against the risks of infection with SARS-CoV-2. • To resume normal functioning of our departments in a setting of ongoing risk for infection with SARS-CoV-2.
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112
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Grassia R, Soro S, Conti CB. Inflammatory Bowel Diseases and Biological Treatment in SARS-CoV-2 Era. Why Not? Inflamm Bowel Dis 2020; 26:e71. [PMID: 32386056 PMCID: PMC7239122 DOI: 10.1093/ibd/izaa110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Roberto Grassia
- Gastroenterology and Digestive Endoscopy Unit, ASST Cremona, Cremona, Italy,Address correspondience to: Roberto Grassia, MD, Viale Concordia,1, 26100 Cremona, Italy ()
| | - Sara Soro
- Gastroenterology and Digestive Endoscopy Unit, ASST Cremona, Cremona, Italy
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113
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Garcia KS, Moutinho BD, de Azevedo MFC, Queiroz NSF, Milani LR, Sanches LN, Barros LL, Oba J, Carlos ADS, Damião AOMC, Sipahi AM. Recovery from COVID-19 Pneumonia in a Patient with Acute Severe Colitis. Inflamm Intest Dis 2020; 5:93-97. [PMID: 32984404 PMCID: PMC7493790 DOI: 10.1159/000508161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/23/2020] [Indexed: 12/26/2022] Open
Abstract
Introduction The coronavirus disease 2019 (COVID-19) pandemic has increased concern regarding SARS-CoV-2 infection in inflammatory bowel disease (IBD) patients, especially those on immunosuppressive therapies or with active disease. There are limited reports describing the clinical features of COVID-19 in an IBD population, and the impact of immunosuppression on the severity of the infection remains unclear. Case Report A 33-year-old female patient with a long history of ulcerative colitis, poorly controlled, was admitted with COVID-19 a few days after being discharged from the hospital for treatment of acute severe ulcerative colitis. High-risk factors for COVID-19 complications, i.e., high-dose steroids (40 mg prednisone) and severe active disease, were present at admission. Despite the development of extensive pulmonary involvement, the patient had a favorable outcome. Discussion Management of IBD patients during the COVID-19 pandemic has been challenging. Measures to minimize the potential risk of SARS-CoV-2 infection, including strict social distancing and self-isolation, in the IBD population have been recommended, especially for high-risk patients. Although steroid tapering and persistence of biologics are advised by professional groups, the best treatment strategy for IBD patients presenting a flare during the outbreak has yet to be defined.
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Affiliation(s)
- Karoline Soares Garcia
- Division of Gastroenterology and Hepatology, Department of Gastroenterology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Bruna Damásio Moutinho
- Division of Gastroenterology and Hepatology, Department of Gastroenterology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Matheus Freitas Cardoso de Azevedo
- Division of Gastroenterology and Hepatology, Department of Gastroenterology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Natalia Sousa Freitas Queiroz
- Department of Gastroenterology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Luciane Reis Milani
- Division of Gastroenterology and Hepatology, Department of Gastroenterology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Lucas Navarro Sanches
- Division of Gastroenterology and Hepatology, Department of Gastroenterology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Luisa Leite Barros
- Division of Gastroenterology and Hepatology, Department of Gastroenterology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Jane Oba
- Division of Gastroenterology and Hepatology, Department of Gastroenterology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil.,Instituto da Criança e do Adolescente, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Alexandre de Sousa Carlos
- Division of Gastroenterology and Hepatology, Department of Gastroenterology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Aderson Omar Mourão Cintra Damião
- Division of Gastroenterology and Hepatology, Department of Gastroenterology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Aytan Miranda Sipahi
- Division of Gastroenterology and Hepatology, Department of Gastroenterology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil.,Laboratory of Clinical and Experimental Gastroenterology (LIM-07), Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
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114
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Del Papa N, Sambataro G, Minniti A, Pignataro F, Caporali R. Novel COronaVirus Disease 2019 (COVID-19) epidemic: What are the risks for systemic sclerosis patients? Autoimmun Rev 2020; 19:102558. [PMID: 32380317 PMCID: PMC7198424 DOI: 10.1016/j.autrev.2020.102558] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/18/2020] [Indexed: 01/16/2023]
Affiliation(s)
| | - Gianluca Sambataro
- Regional Referral Center for Rare Lung Diseases, Department of Clinical and Experimental Medicine, University of Catania, Italy
| | | | | | - Roberto Caporali
- Department of Rheumatology, Gaetano Pini Hospital, Milan, Italy; University of Milan, Dept. of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Milan, Italy
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115
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Cosset JM, Deutsch É, Bazire L, Mazeron JJ, Chargari C. [Low dose lung radiotherapy for COVID-19-related cytokine storm syndrome: Why not?]. Cancer Radiother 2020; 24:179-181. [PMID: 32389579 PMCID: PMC7252150 DOI: 10.1016/j.canrad.2020.04.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 12/21/2022]
Affiliation(s)
- J-M Cosset
- Centre de radiothérapie Charlebourg, groupe Amethyst, 65, avenue Foch, 92250 La Garenne-Colombes, France
| | - É Deutsch
- Département d'oncologie radiothérapie, Gustave-Roussy Cancer Campus, 114, rue Édouard-Vaillant, 94600 Villejuif, France; Inserm, U1030 radiothérapie moléculaire et innovations thérapeutiques, 114, rue Édouard-Vaillant, 94805 Villejuif, France; Université Paris-Saclay, 114, rue Édouard-Vaillant, 94805 Villejuif, France.
| | - L Bazire
- Centre de radiothérapie Charlebourg, groupe Amethyst, 65, avenue Foch, 92250 La Garenne-Colombes, France
| | - J-J Mazeron
- Centre Antoine-Béclère, 47, rue de la Colonie, 75013 Paris, France
| | - C Chargari
- Département d'oncologie radiothérapie, Gustave-Roussy Cancer Campus, 114, rue Édouard-Vaillant, 94600 Villejuif, France; Inserm, U1030 radiothérapie moléculaire et innovations thérapeutiques, 114, rue Édouard-Vaillant, 94805 Villejuif, France; Université Paris-Saclay, 114, rue Édouard-Vaillant, 94805 Villejuif, France; Service de santé des armées, école du Val-de-Grâce, 74, boulevard de Port-Royal, 75005 Paris, France; Institut de recherche biomédicale des armées, D19, 91220 Bretigny-sur-Orge, France
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116
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Beattie RM, Ashton JJ, Penman ID. COVID-19 and the gastrointestinal tract: emerging clinical data. Frontline Gastroenterol 2020; 11:290-292. [PMID: 32582421 PMCID: PMC7307047 DOI: 10.1136/flgastro-2020-101507] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 04/20/2020] [Indexed: 02/04/2023] Open
Affiliation(s)
- R Mark Beattie
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
| | - James J Ashton
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK,Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
| | - Ian D Penman
- Centre for Liver & Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK
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117
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Filocamo G, Minoia F, Carbogno S, Costi S, Romano M, Cimaz R. Absence of Severe Complications From SARS-CoV-2 Infection in Children With Rheumatic Diseases Treated With Biologic Drugs. J Rheumatol 2020; 48:1343-1344. [DOI: 10.3899/jrheum.200483] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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118
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Peyrin-Biroulet C, D’Amico F, Peyrin-Biroulet L. Will COVID-19 Infection be Less Severe in Ulcerative Colitis Than in Crohn's Patients, Due to a Lower Rate of Smokers? J Crohns Colitis 2020; 14:1648. [PMID: 32303741 PMCID: PMC7188171 DOI: 10.1093/ecco-jcc/jjaa077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
| | - Ferdinando D’Amico
- Department of Biomedical Sciences, Humanitas University, Milan, Italy,Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France,Corresponding author: Prof. Laurent Peyrin-Biroulet, MD, PhD, Inserm NGERE and Department of Gastroenterology, Nancy University Hospital, Lorraine University, Vandoeuvre-les-Nancy, France. Tel.: +33383153661; fax: +33383153633;
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France
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119
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Affiliation(s)
- Liat S. Gutin
- grid.280062.e0000 0000 9957 7758Department of Gastroenterology and Hepatology, Kaiser Permanente, San Francisco, USA
| | - Angela Y. Lam
- grid.280062.e0000 0000 9957 7758Department of Gastroenterology and Hepatology, Kaiser Permanente, San Francisco, USA
| | - Fernando S. Velayos
- grid.280062.e0000 0000 9957 7758Department of Gastroenterology and Hepatology, Kaiser Permanente, San Francisco, USA
| | - Stephanie A. Santos
- grid.280062.e0000 0000 9957 7758Department of Gastroenterology and Hepatology, Kaiser Permanente, 3600 Broadway, 2nd Floor, Oakland, CA 94611 USA
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120
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Corona Virus Disease-19 pandemic: The gastroenterologists' perspective. Indian J Gastroenterol 2020; 39:220-231. [PMID: 32783168 PMCID: PMC8852322 DOI: 10.1007/s12664-020-01075-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 07/08/2020] [Indexed: 02/06/2023]
Abstract
The world is witnessing a serious public health threat in the wake of the third corona virus pandemic, a novel corona virus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]). The Corona Virus Disease-19 (COVID-19) is not limited to the respiratory system but has widespread involvement including the gastrointestinal (GI) tract and liver, with evidence of prolonged fecal shedding and feco-oral transmission. This finding has stirred up a hornet's nest of not only a newer modality of the spread of the virus but also a risk of the unpredictable duration of the infective potential of the shedders. We reviewed the literature on fecal shedding and possible implications on prevention and surveillance strategies. The pandemic is changing the management of underlying chronic diseases such as inflammatory bowel disease (IBD) and other diseases. Moreover, for the gastroenterologist, doing endoscopic procedures in this COVID-19 era poses a high risk of contamination, as it is an aerosol-generating procedure. There is a daily influx of data on this disease, and multiple societies are coming up with various recommendations. We provide a comprehensive review of all the reported GI manifestations of COVID-19 infection and the side effects of confounding drugs. We have summarized the management recommendations for diseases such as IBD with COVID-19 and nutritional recommendations and provided a concise review of the endoscopy guidelines by the various societies. This review provides a comprehensive account and a lucid guide covering various aspects of gastroenterology practice during this COVID-19 pandemic.
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121
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Maclean A, Ashton JJ, Garrick V, Beattie RM, Hansen R. Impact of COVID-19 on the diagnosis, assessment and management of children with inflammatory bowel disease in the UK: implications for practice. BMJ Paediatr Open 2020; 4:e000786. [PMID: 34192173 PMCID: PMC7549416 DOI: 10.1136/bmjpo-2020-000786] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/07/2020] [Accepted: 09/27/2020] [Indexed: 12/16/2022] Open
Abstract
The assessment and management of patients with known, or suspected, paediatric inflammatory bowel disease (PIBD) has been hugely impacted by the COVID-19 pandemic. Although current evidence of the impact of COVID-19 infection in children with PIBD has provided a degree of reassurance, there continues to be the potential for significant secondary harm caused by the changes to normal working practices and reorganisation of services. Disruption to the normal running of diagnostic and assessment procedures, such as endoscopy, has resulted in the potential for secondary harm to patients including delayed diagnosis and delay in treatment. Difficult management decisions have been made in order to minimise COVID-19 risk for this patient group while avoiding harm. Initiating and continuing immunosuppressive and biological therapies in the absence of normal surveillance and diagnostic procedures have posed many challenges. Despite this, changes to working practices, including virtual clinic appointments, home faecal calprotectin testing kits and continued intensive support from clinical nurse specialists and other members of the multidisciplinary team, have resulted in patients still receiving a high standard of care, with those who require face-to-face intervention being highlighted. These changes have the potential to revolutionise the way in which patients receive routine care in the future, with the inclusion of telemedicine increasingly attractive for stable patients. There is also the need to use lessons learnt from this pandemic to plan for a possible second wave, or future pandemics as well as implementing some permanent changes to normal working practices. In this review, we describe the diagnosis, management and direct impact of COVID-19 in paediatric patients with IBD. We summarise the guidance and describe the implemented changes, evolving evidence and the implications of this virus on paediatric patients with IBD and working practices.
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Affiliation(s)
- Abbie Maclean
- School of Medicine, Dentistry and Nursing, University of Glasgow College of Medical, Veterinary and Life Sciences, Glasgow, UK
| | - James J Ashton
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK.,Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
| | - Vikki Garrick
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Royal Hospital for Children, Glasgow, UK
| | - R Mark Beattie
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
| | - Richard Hansen
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Royal Hospital for Children, Glasgow, UK
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