AGA Clinical Practice Update on Management of Inflammatory Bowel Disease During the COVID-19 Pandemic: Expert Commentary

Abstract

The purpose of this American Gastroenterological Association (AGA) Institute Clinical Practice Update was to rapidly review the emerging evidence and provide timely expert recommendations regarding the management of patients with inflammatory bowel disease during the coronavirus disease 2019 pandemic. This expert commentary was commissioned and approved by the AGA Institute Clinical Practice Updates Committee and the AGA Governing Board to provide timely perspective on a topic of high clinical importance to the AGA membership, and underwent internal peer review by the Clinical Practice Updates Committee and external peer review through standard procedures of Gastroenterology.

Persistent viral shedding of SARS-CoV-2 in faeces - a rapid review

“…5. Healthcare teams managing patients with gastrointestinal symptoms may need to consider the possibility of COVID-19 coexisting with or worsening symptoms of underlying conditions such as Inflammatory Bowel Disease [44].…”

Going Viral: Management of IBD in the Era of the COVID-19 Pandemic

“…Although data are sparse, the American Gastroenterological Association (AGA) recently released a useful paradigm for how to approach the management of IBD during the current COVID-19 pandemic based on the available evidence ACE2 is thought to function in amino acid transport. Permission for re-use obtained from Elsevier and expert opinion [27]. The authors divide the management into three categories based on presentation: IBD patients not infected with SARS-CoV-2, IBD patients infected with SARS-CoV-2 but without manifestations of COVID-19, and lastly IBD patients with confirmed COVID-19 with or without bowel inflammation (our patient).…”

“…Thiopurines, methotrexate, and tofacitinib should be temporarily held. Biologic therapies, including anti-TNF agents, ustekinumab and vedolizumab should have their dosing delayed for 2 weeks while monitoring for the development of COVID-19 [27].…”

“…Thiopurines, methotrexate and tofacitinib should be discontinued during the acute illness. Anti-TNF agents, vedolizumab, and ustekinumab should also be held during the acute illness [27].…”

Inflammatory Bowel Diseases and Biological Treatment in SARS-CoV-2 Era. Why Not?

“…2 Subsequent guidelines suggested for patients with IBD to continue all treatments to avoid relapse. 3 In an Italian observational study, among 522 IBD patients (89% adults), 16% under biological therapy, none was hospitalized for COVID-19. 4 We confirm this observation.…”