Management of inflammatory bowel disease patients in the COVID-19 pandemic era: a Brazilian tertiary referral center guidance

Queiroz, Natália Sousa Freitas; Barros, Luísa Leite; Azevedo, Matheus Freitas Cardoso de; Oba, Jane; Sobrado, Carlos Walter; Carlos, Alexandre de Sousa; Milani, Luciane Reis; Sipahi, Aytan Miranda; Damião, Adérson Omar Mourão Cintra

doi:10.6061/clinics/2020/e1909

Cited by 29 publications

(40 citation statements)

References 32 publications

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“…Additional authors recommend vitamin D supplements to boost the immune systems of patients diagnosed with COVID-19 (2 p , 35, 69, 71, 74, 75, 118, 120, 125, 230-233). However, most authors recommend widespread daily vitamin D supplementation (most often with 1,000-5,000 IU per day) to prevent and decrease the severity of COVID-19, at least until the pandemic abates (1,5,12,28,34,36,42,64,65,107,109,113,114,116,121,124,127,165,171,172,178,190,192,197,198,210,214,219,222,(234)(235)(236)(237)(238)(239)(240)(241)(242)(243)(244)(245)(246)(247)(248) (Figure 8).…”

Section: Covid-19-specific Recommendations Of Expertsmentioning

confidence: 99%

A Basic Review of the Preliminary Evidence That COVID-19 Risk and Severity Is Increased in Vitamin D Deficiency

Benskin

2020

Front. Public Health

127

130

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As the world's attention has been riveted upon the growing COVID-19 pandemic, many researchers have written brief reports supporting the hypothesis that vitamin D deficiency is related to the incidence and severity of COVID-19. The clear common thread among the top risk groups-vitamin D deficiency-may be being overlooked because of previous overstated claims of vitamin D benefits. However, the need to decrease COVID-19 fatalities among high-risk populations is urgent. Early researchers reported three striking patterns. Firstly, the innate immune system is impaired by vitamin D deficiency, which would predispose sufferers to viral infections such as COVID-19. Vitamin D deficiency also increases the activity of the X-chromosome-linked "Renin-Angiotensin" System, making vitamin D deficient individuals (especially men) more susceptible to COVID-19's deadly "cytokine storm" (dramatic immune system overreaction). Secondly, the groups who are at highest risk for severe COVID-19 match those who are at highest risk for severe vitamin D deficiency. This includes the elderly, men, ethnic groups whose skin is naturally rich in melanin (if living outside the tropics), those who avoid sun exposure for cultural and health reasons, those who live in institutions, the obese, and/or those who suffer with hypertension, cardiovascular disease, or diabetes. And thirdly, the pattern of geographical spread of COVID-19 reflects higher population vitamin D deficiency. Both within the USA and throughout the world, COVID-19 fatality rates parallel vitamin D deficiency rates. A literature search was performed on PubMed, Google Scholar, and RSMLDS, with targeted Google searches providing additional sources. Although randomized controlled trial results may be available eventually, the correlational and causal study evidence supporting a link between vitamin D deficiency and COVID-19 risks is already so strong that it supports action. The 141 author groups writing primarily about biological plausibility detailed how vitamin D deficiency can explain every risk factor and every complication of COVID-19, but agreed that other factors are undoubtedly at work. COVID-19 was compared with dengue fever, for which oral vitamin D supplements of 4,000 IU for 10 days were significantly more effective than 1,000 IU in reducing virus replication and controlling the "cytokine storm" (dramatic immune system over-reaction) responsible for fatalities. Among the 47 original research studies summarized here, chart reviews found that serum vitamin D levels predicted COVID-19 mortality Benskin Evidence Linking Vitamin D, COVID-19 rates (16 studies) and linearly predicted COVID-19 illness severity (8 studies). Two causal modeling studies and several analyses of variance strongly supported the hypothesis that vitamin D deficiency is a causal, rather than a bystander, factor in COVID-19 outcomes. Three of the four studies whose findings opposed the hypothesis relied upon disproven assumptions. The literature review also found that prophylactically correcting possible ...

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Section: Covid-19-specific Recommendations Of Expertsmentioning

confidence: 99%

A Basic Review of the Preliminary Evidence That COVID-19 Risk and Severity Is Increased in Vitamin D Deficiency

Benskin

2020

Front. Public Health

127

130

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“…General and specific recommendations and therapeutic guidelines for pediatric IBD patients are listed in tables 1 and 2 , respectively. ( 26 - 29 )…”

Section: Inflammatory Bowel Disease and Liver Diseasementioning

confidence: 99%

Gastrointestinal manifestations and nutritional therapy during COVID-19 pandemic: a practical guide for pediatricians

Oba¹,

Carvalho²,

Silva³

et al. 2020

Einstein (São Paulo)

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Coronavirus disease 2019 (COVID-19) is a disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which has spread globally in pandemic proportions. Accumulative evidence suggests SARS-CoV-2 can be transmitted through the digestive system, the so-called fecal-oral route of transmission, and may induce several gastrointestinal manifestations. MEDLINE ® and Embase databases were extensively searched for major clinical manifestations of gastrointestinal involvement in children and adolescents with COVID-19 reported in medical literature, and for nutritional therapy-related data. Findings and recommendations were pragmatically described to facilitate overall pediatric approach. A total of 196 studies addressing gastrointestinal or nutritional aspects associated with the global COVID-19 pandemic were found. Of these, only 17 focused specifically on pediatric patients with regard to aforementioned gastrointestinal or nutritional aspects. Most articles were descriptive and six addressed guidelines, established protocols, or expert opinions. Children and adolescents with gastrointestinal symptoms, such as nausea, vomiting and diarrhea, should be seriously suspected of COVID-19. Gastrointestinal signs and symptoms may occur in 3% to 79% of children, adolescents and adults with COVID-19, and are more common in severe cases. These include diarrhea (2% to 50%), anorexia (40% to 50%), vomiting (4% to 67%), nausea (1% to 30%), abdominal pain (2% to 6%) and gastrointestinal bleeding (4% to 14%). Patients with inflammatory bowel disease or chronic liver disease are not at greater risk of infection by SARS-CoV-2 relative to the general population. Nutritional support plays an important role in treatment of pediatric patients, particularly those with severe or critical forms of the disease. The digestive system may be a potential route of COVID-19 transmission. Further research is needed to determine whether the fecal-oral route may be involved in viral spread. Nutritional therapy is vital to prevent malnutrition and sarcopenia in severe cases.

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“…However, data reported so far did not recognize the use of immunomodulator as a risk factor for COVID-19 severity (Queiroz et al, 2020) despite the theoretical fact that decreased host immune surveillance increases virus burden (Estevinho and Magro, 2020). It was assumed that these patients are at higher risk of developing COVID-19 complications (Queiroz et al, 2020) as the ACE2 expression and activity of host cell trypsin-like proteases are increased in inflamed gut of IBD patients, thereby suggesting inflamed gut as a doorway for viral entry into host tissues (Monteleone and Ardizzone, 2020). But reports suggest that having IBD does not increase the risk of developing COVID-19 (Grossberg et al, 2020;Monteleone and Ardizzone, 2020;Estevinho and Magro, 2020) as neither inflammation nor IBD medication increases the gut expression of ACE2 and TMPRSS2 (Burgueño et al, 2020).…”

Section: Recommendatory Note On Ibd During Covid-19mentioning

confidence: 91%

“…The immunosuppressed patients often represent atypical presentations of viral diseases (Estevinho and Magro, 2020). However, data reported so far did not recognize the use of immunomodulator as a risk factor for COVID-19 severity (Queiroz et al, 2020) despite the theoretical fact that decreased host immune surveillance increases virus burden (Estevinho and Magro, 2020). It was assumed that these patients are at higher risk of developing COVID-19 complications (Queiroz et al, 2020) as the ACE2 expression and activity of host cell trypsin-like proteases are increased in inflamed gut of IBD patients, thereby suggesting inflamed gut as a doorway for viral entry into host tissues (Monteleone and Ardizzone, 2020).…”

Section: Recommendatory Note On Ibd During Covid-19mentioning

confidence: 99%

“…There is a further need to raise awareness regarding the management of patients with pre-existing digestive diseases such as IBD (Queiroz et al, 2020), which is characterized by the periods of remission and relapse that are triggered by an inappropriate chronic immune response, whose therapeutics involves immunosuppressive medications. Some COVID-19 manifestations may mimic an IBD exacerbation; therefore, it is suggested to test IBD patients for SARS-CoV-2 before assuming flare diagnosis as currently there is no evidence in support of SARS-CoV-2 infection as a cause of IBD flare.…”

Section: Recommendatory Note On Ibd During Covid-19mentioning

confidence: 99%

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Immunological co-ordination between gut and lungs in SARS-CoV-2 infection

2020

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has evolved into a major pandemic called coronavirus disease 2019 (COVID-19) that has created unprecedented global health emergencies, and emerged as a serious threat due to its strong ability for human-to-human transmission. The reports indicate the ability of SARS-CoV-2 to affect almost any organ due to the presence of a receptor known as angiotensin converting enzyme 2 (ACE2) across the body. ACE2 receptor is majorly expressed in the brush border of gut enterocytes along with the ciliated cells and alveolar epithelial type II cells in the lungs. The amino acid transport function of ACE2 has been linked to gut microbial ecology in gastrointestinal (GI) tract, thereby suggesting that COVID-19 may, to some level, be linked to the enteric microbiota. The significant number of COVID-19 patients shows extra-pulmonary symptoms in the GI tract. Many subsequent studies revealed viral RNA of SARS-CoV-2 in fecal samples of COVID-19 patients. This presents a new challenge in the diagnosis and control of COVID-19 infection with a caution for proper sanitation and hygiene. Here, we aim to discuss the immunological coordination between gut and lungs that facilitates SARS-CoV-2 to infect and multiply in the inflammatory bowel disease (IBD) and non-IBD patients.

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Management of inflammatory bowel disease patients in the COVID-19 pandemic era: a Brazilian tertiary referral center guidance

Cited by 29 publications

References 32 publications

A Basic Review of the Preliminary Evidence That COVID-19 Risk and Severity Is Increased in Vitamin D Deficiency

A Basic Review of the Preliminary Evidence That COVID-19 Risk and Severity Is Increased in Vitamin D Deficiency

Gastrointestinal manifestations and nutritional therapy during COVID-19 pandemic: a practical guide for pediatricians

Immunological co-ordination between gut and lungs in SARS-CoV-2 infection

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