British Society of Gastroenterology guidance for management of inflammatory bowel disease during the COVID-19 pandemic

Kennedy, Nicholas A; Jones, G. R.; Lamb, Christopher A; Appleby, Richard; Arnott, Ian; Beattie, R Mark; Bloom, Stuart; Brooks, Alenka J; Cooney, Rachel; Dart, Robin; Edwards, Cathryn; Fraser, Aileen; Gaya, Daniel R.; Ghosh, Subrata; Greveson, Kay; Hansen, Richard; Hart, Ailsa; Hawthorne, A. B.; Hayee, Bu’Hussain; Limdi, Jimmy K.; Murray, Charles; Parkes, Gareth; Parkes, Miles; Patel, Kamal; Pollok, Richard; Powell, Nick; Probert, Chris; Raine, Tim; Scheer, Sebastian; Selinger, Christian P.; Smith, Philip J.; Stansfield, Catherine; Younge, Lisa; Lindsay, James O.; Irving, Peter M; Lees, Charlie W.

doi:10.1136/gutjnl-2020-321244

Cited by 236 publications

(290 citation statements)

References 17 publications

(19 reference statements)

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“…The SECURE-IBD database, which registers outcomes of IBD patients with COVID-19 worldwide, has similarly so far not indicated worse outcomes of patients under anti-TNF therapy [19]. In accordance, current recommendations by national and international organizations do not support preemptively stopping effective anti-TNF therapy, but rather recommend unchanged continuation if there are no signs of COVID-19 [20, 21]. In IBD patients with confirmed COVID-19, current recommendations advise to hold anti-TNF therapies during the viral illness [20].…”

Section: Resultsmentioning

confidence: 99%

Mild COVID-19 Symptoms in an Infliximab-Treated Ulcerative Colitis Patient: Can Ongoing Anti-TNF Therapy Protect against the Viral Hyperinflammatory Response and Avoid Aggravated Outcomes?

Abdullah

Atreya

2020

Visc Med

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The ongoing coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2, represents a potentially major challenge to patients with immune-mediated inflammatory diseases who are treated with immunomodulatory therapies. We report the case of an 18-year-old ulcerative colitis patient in sustained clinical remission who 4 days after application of her ongoing therapy with the anti-TNF antibody infliximab developed mild respiratory and abdominal symptoms. The patient was subsequently diagnosed with COVID-19 but did not need hospitalization. The clinical symptoms completely resolved within 1 week after onset and there was no change in ulcerative colitis activity. The recently applied anti-TNF therapy did not lead to exacerbation of the infectious symptoms. Current recommendations strongly favor continuation of effective maintenance anti-TNF therapy in inflammatory bowel disease patients, as there is no evidence for aggravated CO-VID-19 upon infection. It is unclear whether anti-TNF treatment might even have assisted in preventing worsening of COVID-19 and improving outcome. Further data in the group of immune-mediated inflammatory disease patients under anti-TNF therapy are urgently needed.

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Section: Resultsmentioning

confidence: 99%

Mild COVID-19 Symptoms in an Infliximab-Treated Ulcerative Colitis Patient: Can Ongoing Anti-TNF Therapy Protect against the Viral Hyperinflammatory Response and Avoid Aggravated Outcomes?

Abdullah

Atreya

2020

Visc Med

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“…5 6 Although there are, as yet, no specific data quantifying additional risk, specialist societies and expert groups have recommended heightened vigilance. [7][8][9] In the UK, patients categorised as high risk have been recommended for isolation ('shielding') by UK Department of Health and Social Care, 10 requiring individual IBD services to rapidly identify individuals in this group using hospital databases and registries.…”

Section: What This Study Addsmentioning

confidence: 99%

Organisational changes and challenges for inflammatory bowel disease services in the UK during the COVID-19 pandemic

Kennedy

Hansen

Younge

et al. 2020

Frontline Gastroenterol

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ObjectiveTo determine the challenges in diagnosis, monitoring, support provision in the management of inflammatory bowel disease (IBD) patients and explore the adaptations of IBD services.MethodsInternet-based survey by invitation of IBD services across the UK from 8 to 14 April 2020.ResultsRespondents from 125 IBD services completed the survey. The number of whole-time equivalent gastroenterologists and IBD nurses providing elective outpatient care decreased significantly between baseline (median 4, IQR 4–7.5 and median 3, IQR 2–4) to the point of survey (median 2, IQR 1–4.8 and median 2, IQR 1–3) in the 6-week period following the onset of the COVID-19 pandemic (p<0.001 for both comparisons). Almost all (94%; 112/119) services reported an increase in IBD helpline activity. Face-to-face clinics were substituted for telephone consultation by 86% and video consultation by 11% of services. A variation in the provision of laboratory faecal calprotectin testing was noted with 27% of services reporting no access to faecal calprotectin, and a further 32% reduced access. There was also significant curtailment of IBD-specific endoscopy and elective surgery.ConclusionsIBD services in the UK have implemented several adaptive strategies in order to continue to provide safe and high-quality care for patients. National Health Service organisations will need to consider the impact of these changes in current service delivery models and staffing levels when planning exit strategies for post-pandemic IBD care. Careful planning to manage the increased workload and to maintain IBD services is essential to ensure patient safety.

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“…The various society guidelines (Asian-Pacific Association of Gastroenterology IBD group [58], European Society for Pediatric Gastroenterology Hepatology and Nutrition [59], European Crohn's and Colitis Organization [60], Bristish Society of Gastroenterology [61], Crohn's and Colitis Foundation [62], American Gastroenterological Association [63], World Endoscopy Organization [64]) have been enlisted in Supplementary Table 2 and a summary of the recommendations for IBD management during the COVID-19 pandemic have been outlined in Appendix Panel 2.…”

Section: Covid-19 and Ibdmentioning

confidence: 99%

Corona Virus Disease-19 pandemic: The gastroenterologists’ perspective

Dhar

Samanta

Kochhar

2020

Indian J Gastroenterol

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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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British Society of Gastroenterology guidance for management of inflammatory bowel disease during the COVID-19 pandemic

Cited by 236 publications

References 17 publications

Mild COVID-19 Symptoms in an Infliximab-Treated Ulcerative Colitis Patient: Can Ongoing Anti-TNF Therapy Protect against the Viral Hyperinflammatory Response and Avoid Aggravated Outcomes?

Mild COVID-19 Symptoms in an Infliximab-Treated Ulcerative Colitis Patient: Can Ongoing Anti-TNF Therapy Protect against the Viral Hyperinflammatory Response and Avoid Aggravated Outcomes?

Organisational changes and challenges for inflammatory bowel disease services in the UK during the COVID-19 pandemic

Corona Virus Disease-19 pandemic: The gastroenterologists’ perspective

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