Aliment Pharmacol Ther. 2020 Apr 29.doi: 10.1111/apt.15779. Online ahead of print.

Aysha Al-Ani ¹, Ralley Prentice ¹, Clarissa Rentsch ¹, Doug Johnson ², Zaid Ardalan ¹, Neel Heerasing ¹, Mayur Garg ¹, Sian Campbell ², Joe Sasadeusz ², Fin Macrae ¹, Siew C Ng ³, David T Rubin ⁴, Britt Christensen ¹

Author information

¹Department of Gastroenterology, The Royal Melbourne Hospital, Melbourne, Australia.

²Victorian Infectious Diseases Unit, The Royal Melbourne Hospital, Melbourne, Australia.

³Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.

⁴Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, Il, USA.

Abstract

Background: The current COVID-19 pandemic, caused by SARS-CoV-2, has emerged as a public health emergency. All nations are seriously challenged as the virus spreads rapidly across the globe with no regard for borders. The primary management of inflammatory bowel disease (IBD) involves treating uncontrolled inflammation with most patients requiring immune based therapies. However, these therapies may weaken the immune system and potentially place IBD patients at increased risk of infections and infectious complications including those from COVID-19.

Aim: To summarise the scale of the COVID-19 pandemic, review unique concerns regarding IBD management and infection risk during the pandemic and assess COVID-19 management options and drug interactions in the IBD population.

Methods: A literature review on IBD, SARS-CoV-2 and COVID-19 was undertaken and relevant literature was summarized and critically examined.

Results: IBD patients do not appear to be more susceptible to SARS-CoV-2 infection and there is no evidence of an association between IBD therapies and increased risk of COVID-19. IBD medication adherence should be encouraged to prevent disease flare but where possible high dose systemic corticosteroids should be avoided. Patients should exercise social distancing, optimise co-morbidities and be up to date with influenza and pneumococcal vaccine. If a patient develops COVID-19, immune suppressing medications should be withheld until infection resolution and if trial medications for COVID-19 are being considered, potential drug interactions should be checked.

Conclusion: IBD patient management presents a challenge in the current COVID-19 pandemic. The primary focus should remain on keeping bowel inflammation controlled and encouraging medication adherence.