Epidemiologic Assessment of Pediatric Inflammatory Bowel Disease Presentation in NYC During COVID-19

Abstract

SARS-nCoV2 may have increased capacity to generate autoimmune disease; multiple reports suggest increased risk of Type 1 Diabetes, and case reports suggest other autoimmune linkages. Inflammatory Bowel Disease (IBD) pathogenesis appears to be a mix of genetic susceptibility, microbial populations, and immune triggers such as infections. Given the perceived role of infection in pathogenesis, decreased incidence of all infections during the pandemic secondary to non-pharmaceutical interventions should decrease IBD incidence rates. The aim of this study was to evaluate the association between the Covid-19 pandemic and IBD presentation in NYC using data from new diagnoses at a consortium of institutions. Using EMR systems all diagnoses at 4 collaborating institutions were retrieved from 2015-2021. We fit time series model (ARIMA) to the quarterly number of cases of each disease for January 2016-March 2020 and forecast the subsequent 21 months. We not only did not observe a decline in pediatric IBD secondary to absent viral illness, but noted a statistically significant increase in Crohn's Disease approximately 6 months after the initial 2020 COVID wave in NYC, and trends suggesting increases overall in IBD diagnoses above the existing trend towards increased disease presentation that pre-dated the pandemic. This data suggests that there may be a linkage between SARS-nCoV2 infection rates and subsequent pediatric IBD presentation, warranting further evaluation in the aftermath of the Omicron wave.

Older Age and Vaccination Protect Against Transaminase Elevation in Pediatric SARS-CoV2

“…As rates of fulminant liver injury have remained essentially unchanged over time, it is unlikely that acute SARS-CoV2 infections have led to an increased need for liver transplantation or frequently driven direct morbidity and mortality from hepatic injury. However, it remains a serious possibility that SARS-CoV2 may present an ongoing risk for severe liver injury, especially given evidence of increased capacity to drive autoimmunity, including liver specific disease [9][10][11] . There is an absence of confirmed findings for relatively rare events such as pediatric liver failure that is not exculpatory of possible linkage.…”

Identification of SARS-CoV-2 Persistent Intestinal Epithelial Syndrome (SPIES) as a Novel Disease Entity using Clinical, Histologic, and RNA Programmatic Data

“…The impact of gastrointestinal LC has been substantial, and to date is relatively poorly understood. Prior work has identified a trend towards increasing pediatric inflammatory bowel disease (IBD) since the emergence of COVID 1 , the ability of SARS-CoV-2 to persist in the gut 2,3 , as well as increased risk of liver disease, demonstrating capacity of this infection to induce durable gastrointestinal complications. Overall, 10-25% of patients report GI symptoms (nausea, anorexia, weight loss, diarrhea, hematochezia) 6 months following infection 4 .…”