Management of Inflammatory Bowel Disease during Coronavirus Disease 2019 Pandemic

Authors

  • Masrul Lubis Department of Internal Medicine

DOI:

https://doi.org/10.3889/oamjms.2021.6482

Keywords:

Coronavirus disease-2019, Immunosuppression, Inflammatory bowel disease, Management

Abstract

Inflammatory bowel disease (IBD) is a chronic inflammation consisted of ulcerative colitis and Crohn’s disease. IBD is a global disease with heavy economic burden. Coronavirus disease-2019 (COVID-19) is a novel disease which spread rapidly and becomes a pandemic. This pandemic situation affects the management of IBD. Severe acute respiratory syndrome coronavirus-2 as the etiology of COVID-19 requires angiotensin-converting enzyme (ACE2) as its receptor. ACE2 is found to be abundant in the gastrointestinal tract, particularly the small intestine and colon. This causes the presence of gastrointestinal symptoms in COVID-19 and interacts with gastrointestinal diseases including IBD. The diagnosis of IBD in patients with COVID-19 is similar with general population with precautions regarding endoscopic procedure. IBD does not increase the risk for contracting COVID-19 nor worsen the outcome of COVID-19. The first step in managing patients with IBD during pandemic is by implicating strict health protocol. There is still a controversy regarding surgery for IBD during pandemic. Medications for IBD are safe during pandemic except systemic corticosteroids. IBD patients without COVID-19 should continue their medications until the goal of disease remission is achieved. If asymptomatic COVID-19 is present, corticosteroid dose should be lowered, tapered, and stopped if available. Anti-tumor necrosis factor (TNF) administration should be postponed for 2 weeks. If COVID-19 manifestations exist, systemic corticosteroid, thiopurine, methotrexate, and anti-TNF should be discontinued. Supporting treatment for COVID-19 can be administered safely. In case of relapsing, the treatment of IBD must be started with the limitation of systemic corticosteroid.

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References

Malik TA. Inflammatory bowel disease historical perspective, epidemiology, and risk factors. Surg Clin North Am. 2015;95(6):1105-22. PMid:26596917

Kaplan GG. The global burden of IBD: From 2015 to 2025. Nat Rev Gastroenterol Hepatol. 2015;12(12):720-7. https://doi.org/10.1038/nrgastro.2015.150 PMid:26323879

Huang H, Fang M, Jostins L, Mirkov MU, Boucher G, Anderson CA, et al. Fine-mapping inflammatory bowel disease loci to single variant resolution. Nature. 2017;547(7662):173-8. PMid:28658209

Ng SC, Shi HY, Hamidi N, Underwood FE, Tang W, Benchimol EI, et al. Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: A systematic review of population-based studies. Lancet. 2017;390(10114):2769-78. https://doi.org/10.1016/s0140-6736(17)32448-0 PMid:29050646

Dalia T, Lahan S, Ranka S, Acharya P, Gautam A, Goyal A, et al. Impact on congestive heart failure and role of cardiac biomarkers in COVID-19 patients. A systematic review and meta-analysis. Indian Heart J. 2021;73(1):91-8. https://doi.org/10.1016/j.ihj.2020.12.002 PMid:33714416

Bader F, Mania Y, Atallah B, Starling RC. Heart failure and COVID-19. Heart Fail Rev. 2021;26(1):1-10. https://doi.org/10.1007/s10741-020-10008-2 PMid:32720082

Lazaridis C, Vlachogiannis NI, Bakogiannis C, Spyridopoulos I, Stamatelopoulos K, Kanakakis I, et al. Involvement of cardiovascular system as the critical point in coronavirus disease 2019 (COVID-19) prognosis and recovery. Hellenic J Cardiol. 2020;61(6):381-95. https://doi.org/10.1016/j.hjc.2020.05.004 PMid:32534109

Ruslie RH, Darmadi D. Coronavirus disease-19 and mental health. Open Access Maced J Med Sci. 2020;8:268-71. https://doi.org/10.3889/oamjms.2020.5304

Siregar GA, Siregar GP, Darmadi D, Ruslie RH. Coronavirus disease-19 and liver injury. Open Access Maced J Med Sci. 2020;8:154-7. https://doi.org/10.3889/oamjms.2020.5028

Siregar GA, Siregar GP, Darmadi D. Gastrointestinal aspects of COVID-19: A review. Open Access Maced J Med Sci. 2020;8(1):52-4. https://doi.org/10.3889/oamjms.2020.4891

Ruslie RH, Darmadi D, Siregar GA. Pediatric immunization practice during coronavirus disease-2019 pandemic. Open Access Maced J Med Sci. 2020;8:258-60. https://doi. org/10.3889/oamjms.2020.5125

Ruslie RH, Darmadi D, Siregar GA. Susceptibility of coronavirus disease-19 in pediatric population. Open Access Maced J Med Sci. 2020;8(1):363-5. https://doi.org/10.3889/oamjms.2020.5240

Geng Y, Wei Z, Qian H, Huang J, Lodato R, Castriotta RJ. Pathophysiological characteristics and therapeutic approaches for pulmonary injury and cardiovascular complications of coronavirus disease 2019. Cardiovasc Pathol. 2020;47:107228. https://doi.org/10.1016/j.carpath.2020.107228 PMid:32375085

Ghoshal UC, Ghoshal U, Dhiman RK. Gastrointestinal and hepatic involvement in severe acute respiratory syndrome coronavirus 2 infection: A review. J Clin Exp Hepatol. 2020;10(6):622-8. https://doi.org/10.1016/j.jceh.2020.06.002 PMid:32837095

de Vries AA. SARS-CoV-2/COVID-19: A primer for cardiologists. Neth Heart J. 2020;28(7-8):366-83. https://doi.org/10.1007/s12471-020-01475-1 PMid:32671650

Driggin E, Madhavan MV, Bikdeli B, Chuich T, Laracy J, Biondi- Zoccai G, et al. Cardiovascular considerations for patients, health care workers, and health systems during the COVID-19 pandemic. J Am Coll Cardiol. 2020;75(18):2352-71. https://doi.org/10.1016/j.jacc.2020.03.031 PMid:32201335

Ge H, Wang X, Yuan X, Xiao G, Wang C, Deng T, et al. The epidemiology and clinical information about COVID-19. Eur J Clin Microbiol Infect Dis. 2020;39(6):1011-9. https://doi.org/10.1007/s10096-020-03874-z PMid:32291542

World Health Organization. Coronavirus Disease (COVID-19) Outbreak Situation. Available from: http://www.covid19.who.int. [Last accessed on 2021 May 20].

Satsangi J, Silverberg MS, Vermeire S, Colombel J. The Montreal classification of inflammatory bowel disease: Controversies, consensus, and implications. Gut. 2006;55(6):749-53. https://doi.org/10.1136/gut.2005.082909 PMid:16698746

Shafi AM, Shaikh SA, Shirke MM, Iddawela S, Harky A. Cardiac manifestations in COVID-19 patients-a systematic review. J Card Surg. 2020;35(8):1988-2008. https://doi.org/10.1111/jocs.14808 PMid:32652713

Oz M, Lorke DE, Kabbani N. A comprehensive guide to the pharmacologic regulation of angiotensin converting enzyme 2 (ACE2), the SARS-CoV-2 entry receptor. Pharmacol Ther. 2020;221:107750. https://doi.org/10.1016/j.pharmthera.2020.107750 PMid:33275999

Savarese G, Benson L, Sundstrom J, Lund LH. Association between rennin-angiotensin-aldosterone system inhibitor use and COVID-19 hospitalization and death: A 1.4 million patient nationwide registry analysis. Eur J Heart Fail. 2020;7:10. https://doi.org/10.1002/ejhf.2060

Ng SC, Tilg H. COVID-19 and the gastrointestinal tract: More than meets the eye. Gut. 2020;69(6):973-4. https://doi.org/10.1136/gutjnl-2020-321195 PMid:32273292

Xiao F, Tang M, Zheng X, Liu Y, Li X, Shan H. Evidence for gastrointestinal infection of SARS-CoV-2. Gastroenterology. 2020;158(6):1831-3. https://doi.org/10.1053/j.gastro.2020.02.055 PMid:32142773

Monteleone G, Franze E, Laudisi F. Expression of receptors for SARS-CoV-2 in the gut of patients with inflammatory bowel disease. Gut Liver. 2020;14(4):530-1. https://doi.org/10.5009/gnl20112 PMid:32482915

Agarwal A, Chen A, Ravindran N, To C, Thuluvath PJ. Gastrointestinal and liver manifestations of COVID-19. J Clin Exp Hepatol. 2020;10(3):263-5. https://doi.org/10.1016/j.jceh.2020.03.001 PMid:32405183

Hashimoto T, Perlot T, Rehman A, Trichereau J, Ishiguro H, Paolino M, et al. ACE2 links amino acid malnutrition to microbial ecology and intestinal inflammation. Nature. 2012;487:477-81. https://doi.org/10.1038/nature11228

Guerra I, Algaba A, Jimenez L, Aller M, Garza D, Bonillo D, et al. Incidence, clinical characteristics, and evolution of SARS-CoV-2 infection in patients with inflammatory bowel disease: A single-center study in Madrid, Spain. Inflamm Bowel Dis. 2020;27(1):izaa221. https://doi.org/10.1093/ibd/izaa221

Rubin DT, Feuerstein JD, Wang AY, Cohen RD. AGA clinical practice update on management of inflammatory bowel disease during the COVID-19 pandemic: Expert commentary. Gastroenterology. 2020;159(1):350-7. https://doi.org/10.1053/j.gastro.2020.04.012 PMid:32283100

Kennedy NA, Jones G, Lamb CA, Appleby R, Arnott I, Beattie RM, et al. British society of gastroenterology guidance for management of inflammatory bowel disease during the COVID-19 pandemic. Gut. 2020;69(6):984-90. PMid:32303607

Macaluso FS, Orlando A. COVID-19 patients with inflammatory bowel disease: A systematic review of clinical data. Dig Liver Dis. 2020;52(11):1222-7. https://doi.org/10.1016/j.dld.2020.09.002 PMid:32928672

Brenner EJ, Ungaro RC, Gearry RB, Kaplan GG, Kissous- Hunt M, Lewis JD, et al. Corticosteroid, but not TNF antagonists, are associated with adverse COVID-19 outcomes in patients with inflammatory bowel diseases: Results from an international registry. Gastroenterology. 2020;159(2):481-91. https://doi.org/10.1053/j.gastro.2020.05.032 PMid:32425234

Verstockt B, Verstockt S, Rahiman SA, Ke B, Amauts K, Cleynen I, et al. Intestinal receptor of SARS-CoV-2 in inflamed IBD tissue seems downregulated by HNF4A in ileum and upregulated by interferon regulating factors in colon. J Crohns Colitis. 2021;15:485-98. https://doi.org/10.1093/ecco-jcc/jjaa185 PMid:32915959

Danese S, Cecconi M, Spinelli A. Management of IBD during the COVID-19 outbreak: Resetting clinical priorities. Nat Rev Gastroenterol Hepatol. 2020;25:1-3. https://doi.org/10.1038/s41575-020-0294-8

Zingone F, Savarino EV. Viral screening before initiation of biologics in patients with inflammatory bowel disease during the COVID-19 outbreak. Lancet Gastroenterol Hepatol. 2020;5(6):525. https://doi.org/10.1016/s2468-1253(20)30085-6 PMid:32220656

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Published

2021-07-20

How to Cite

1.
Lubis M. Management of Inflammatory Bowel Disease during Coronavirus Disease 2019 Pandemic. Open Access Maced J Med Sci [Internet]. 2021 Jul. 20 [cited 2022 Aug. 13];9(F):219-23. Available from: https://oamjms.eu/index.php/mjms/article/view/6482

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Narrative Review Article

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