Impact of the COVID-19 pandemic on inflammatory bowel disease patients: A review of the current evidence

Since the initial coronavirus disease 2019 (COVID-19) outbreak in China in December 2019, the infection has now become the biggest medical issue of modern medicine. Two major contributors that amplified the impact of the disease and subsequently increased the burden on health care systems were high mortality among patients with multiple co-morbidities and overcapacity of intensive care units. Within the gastroenterology-related community, particular concern was raised with respect to patients with inflammatory bowel disease (IBD), as those patients are prone to opportunistic infections mainly owing to their immunosuppressive-based therapies. Hence, we sought to summarize current knowledge regarding COVID-19 infection in patients with IBD. Overall, it seems that IBD is not a comorbidity that poses an increased risk for COVID-19 acquisition, except in patients treated with 5-aminosalicylates. Furthermore, outcomes of the infected patients are largely dependent on therapeutic modality by which they are treated, as some worsen the clinical course of COVID-19 infection, whereas others seem to dampen the detrimental effects of COVID-19. Finally, we discussed the present and the future impact of COVID-19 pandemic and concomitantly increased health care burden on IBD-management.     

Review of inflammatory bowel disease and COVID-19

The first cases of a novel corona virus infection were reported in Wuhan China in December of 2019, followed by the declaration of an international pandemic by the World Health Organization in March 2020. Early reports of the virus, now known as severe acute respiratory syndrome coronavirus 2, and its clinical disease coronavirus disease 2019(COVID-19), has shown higher rates of morbidity and mortality in the elderly and those with pre-existing medical conditions. Of particular concern is the safety of those with compromised immune systems. Inflammatory Bowel disease(IBD) is itself caused by a disordered immune response, with the most effective medical therapies being immune suppressing or modifying. As such, the risk of COVID-19, virus related outcomes, and appropriate management of IBD patients during the global pandemic is of immediate concern to gastroenterologists worldwide. There has been a rapid accumulation of clinical data and expert opinion on the topic. This review will highlight the latest source information on clinical observation/outcomes of the IBD population and provide a concise summary of the most up to date perspectives on IBD management in the age of COVID-19.     

How to manage inflammatory bowel disease during the COVID-19 pandemic: A guide for the practicing clinician

Managing inflammatory bowel disease (IBD) during the coronavirus disease 2019 (COVID-19) pandemic has been a challenge faced by clinicians and their patients, especially concerning whether to proceed with biologics and immunosuppressive agents in the background of a global outbreak of a highly contagious new coronavirus (severe acute respiratory syndrome coronavirus 2, SARS-CoV-2). The knowledge about the impact of this virus on patients with IBD, although it is still scarce, is rapidly evolving. In particular, concerns surrounding medications’ impact for IBD on the risk of acquiring SARS-CoV-2 infection or developing COVID-19, and potentially exacerbate viral replication and the COVID-19 course, are a current thinking of both practicing clinicians and providers caring for patients with IBD. Managing patients with IBD infected with SARS-CoV-2 depends on both the clinical activity of the IBD and the occasional development and severity of COVID-19. In this review, we summarize the current data regarding gastrointestinal involvement by SARS-CoV-2 and pharmacologic and surgical management for IBD concerning this infection, and the COVID-19 impact on both the patient's psychological functioning and endoscopy services, and we concisely summarize the telemedicine roles during the COVID-19 pandemic.     

肠易激综合征与炎症性肠病

近年发现,炎症性肠病(IBD)患者发病早期或缓解期时常表现为肠易激综合征(IBs)症状,且IBD与IBS的临床表现具有一定的相似性。因而IBS与IBD的相关性受到广泛的重视。此文就IBS与IBD的发病机制及临床相关性予以阐述,以期为临床个体化治疗提供借鉴。     

营养与炎症性肠病

营养和炎症性肠病的发病机制及治疗有密切的关系,深入研究两者的关系对临床有重要的意义。此文对饮食中的营养成分是否和发病有关、如何营养支持等问题作一简要概述。     

Risk stratification and geographical mapping of Brazilian inflammatory bowel disease patients during the COVID-19 outbreak: Results from a nationwide survey

BACKGROUNDCoronavirus disease 2019 (COVID-19) pandemic is still evolving globally, and Brazil is currently one of the most affected countries. It is still debated whether patients with inflammatory bowel disease (IBD) are at a higher risk for developing COVID-19 or its complications.AIMTo assess geographical distribution of IBD patients at the highest risk and correlate these data with COVID-19 mortality rates in Brazil.METHODSThe Brazilian IBD Study Group (Grupo de Estudos da Doença Inflamatória Intestinal do Brasil) developed a web-based survey adapted from the British Society of Gastroenterology guidelines. The included categories were demographic data and inquiries related to risk factors for complications from COVID-19. Patients were categorized as highest, moderate or lowest individual risk. The Spearman correlation test was used to identify any association between highest risk and mortality rates for each state of the country.RESULTSA total of 3568 patients (65.3% females) were included. Most participants were from the southeastern and southern regions of Brazil, and 84.1% were using immunomodulators and/or biologics. Most patients (55.1%) were at moderate risk, 23.4% were at highest risk and 21.5% were at lowest risk of COVID-19 complications. No association between the proportion of IBD patients at highest risk for COVID-19 complications and higher mortality rates was identified in different Brazilian states (r = 0.146, P = 0.467).CONCLUSIONThis study indicates a distinct geographical distribution of IBD patients at highest risk for COVID-19 complications in different states of the country, which may reflect contrasting socioeconomic, educational and healthcare aspects. No association between high risk of IBD and COVID-related mortality rates was identified.     

当前炎症性肠病诊治中需注意的若干问题

我国炎症性肠病患者逐年增多,但目前临床对其认识或重视仍显不足,亟待规范化地开展诊疗。根据同济大学附属同济医院消化科临床实践体会和文献报道,对当前炎症性肠病诊治中需注意的诊断、鉴别诊断、规范化个体化治疗的若干问题进行了分析,以期引起消化专科医师的重视。     

肠道蠕虫与炎症性肠病的治疗

炎症性肠病(IBD)是一种病因不明,反复发作性的肠道特异性疾病。随着遗传因素、环境因素与免疫反应异常等发病机制方面研究的不断进展,IBD的治疗发生了重大的变化,其中直接改善肠道微环境逐渐受到重视。在动物模型和人体寄生虫感染研究中,有丰富的资料支持寄生虫感染有免疫调节作用,近来这个概念已经用来治疗IBD,不断有肠道蠕虫治疗IBD的报道。现就肠道蠕虫治疗IBD的研究作一综述。     

Obesity and novel management of inflammatory bowel disease

Obesity is prevalent within the inflammatory bowel disease(IBD) population,particularly in newly developed countries.Several epidemiological studies have suggested that 15%-40% of IBD patients are obese,and there is a potential role of obesity in the pathogenesis of IBD.The dysfunction of mesenteric fat worsens the inflammatory course of Crohn’s disease and may induce formation of strictures or fistulas.Furthermore,obesity may affect the disease course or treatment response of IBD.Given the incr...     

炎症性肠病药物联合治疗的获益与风险

目前炎症性肠病(IBD)的发病机制未完全明确,虽有越来越多的生物制剂问世,但其治疗仍存在难点,有时无法得到令人满意的疗效。在临床实践中,当常规治疗收效不佳时,将几种药物联合应用治疗IBD不失为一种重要的治疗策略,但药物联合治疗提高疗效的同时可能会增加感染及肿瘤等风险。因此应用联合治疗时需结合患者的疾病类型、病情程度、病变范围、高危因素、既往用药情况,对治疗方案进行技巧性地选择和甄别必不可少。     

Serum beta 2-microglobulin as a biomarker in inflammatory bowel disease

AIM: To investigate the diagnostic utility of beta 2 microglobulin (B2-M) levels and analyze this correlation with the activity of inflammatory bowel disease (IBD).METHODS: Overall, 78 IBD patients and 30 healthy controls were enrolled in the study. We examined B2-M serum levels in 43 ulcerative colitis (UC) patients, 35 with Crohn’s disease (CD) and 30 control subjects, using an enzymatic method. Patients were divided into two groups according to two disease types: active and in remission. Subjects were also divided into two subgroups according to extent of the disease: left-side and pancolitis for UC and ileitis and ileocolitis for CD. All groups were compared for mean serum B2-M levels and also examined to see whether there was a correlation between serum B2-M levels and other inflammatory markers.RESULTS: The mean serum B2-M levels in the control group, UC and CD were 1.71, 2.41 and 2.24 respectively. B2-M values ≥ 1.96 mg/L had a 62% sensitivity, 76% specificity, a 79% positive predictive value, and a 58% negative predictive value for UC patients. B2-M values ≥ 1.70 mg/L had 80% sensitivity, 53% specificity, 66% positive predictive value, and 69% negative predictive value for CD patients. Mean B2-M values were significantly higher in ulcerative colitis and Crohn’s disease patients than in healthy controls (UC 2.41 ± 0.87 vs 1.71 ± 0.44, P = 0.002; CD 2.24 ± 1.01 vs 1.71 ± 0.44, P = 0.033). Also, mean B2-M values were significantly higher in active disease when compared to patients in remission (UC 2.66 ± 0.92 vs 1.88 ± 0.41, P = 0.004; CD 2.50 ± 1.15 vs 1.73 ± 0.31, P = 0.033). The difference between groups (UC and CD) in terms of serum B2-M levels was statistically insignificant (2.41 ± 0.87 vs 2.24 ± 1.01, P > 0.05 respectively).CONCLUSION: Serum B2-M levels may be used as an activity parameter in IBD.     

Monitoring inflammatory bowel disease during pregnancy:Current literature and future challenges

Inflammatory bowel disease has a high prevalence in women of childbearing age and can have a significant impact on pregnancy, from conceiving to carrying the pregnancy. Active disease during pregnancy is known to have negative effects on pregnancy outcomes; therefore, careful monitoring during this period is an important but challenging aspect of care and is crucial as it affects important management decisions. Recent data seems to suggest that endoscopy is a relatively safe procedure during all trimesters of pregnancy. Serum biomarkers such as C-reactive protein and fecal calprotectin are helpful non-invasive markers, but have shown conflicting results for correlation with disease activity in some initial studies. Further work is necessary to establish standard of care monitoring during pregnancy.     

Comorbidity in inflammatory bowel disease

Patients with inflammatory bowel disease (IBD) can be affected by other unrelated diseases. These are called comorbid conditions, and can include any secondary health problem that affects a person suffering from a primary or main disease, and which is neither linked physiopathologically to the primary condition, nor is it due to the treatments used for the primary condition or to its long-term anatomical or physiological consequences. Different comorbid conditions, as well as their influence on IBD, are dis...     

炎症性肠病相关性肝病的研究进展

炎症性肠病(inflammatory bowel disease,IBD)是一种累及回肠、结肠、直肠的特发性炎症性疾病,本病主要包括溃疡性结肠炎(ulcerative colitis,UC)和克罗恩病(Crohn’s disease,CD)。除常见的消化道症状外,研究发现IBD合并肝脏疾病较为常见,是IBD常见的肠外表现之一,其严重影响IBD的预后与转归。本文就IBD相关性肝病的分类和总结作一概述,以期为IBD及其肝脏病变的临床诊疗提供参考。     

炎症性肠病的肠外表现与治疗

炎症性肠病(IBD)病变主要累及肠道,但亦常合并各种肠外表现。许多肠外表现可作为IBD的首发症状出现,有些甚至危及生命。目前关于IBD肠外表现的报道较多,但大样本的流行病学调查不多,而其特有的治疗更少。     

肠黏膜屏障与炎症性肠病

炎症性肠病（Innammatory bowel disease，IBD）是一组病因不明的慢性肠道炎症性疾病，主要包含两个独立的疾病，溃疡性结肠炎（Ulcerative colitis，UC）和克罗恩病（Crohn’s disease，CD）。近年研究发现，肠黏膜屏障功能异常在IBD发病机制中发挥重要作用。更好地了解正常及疾病状态下肠黏膜屏障的结构和功能可以为IBD的治疗提供新的思路。     

转基因方法治疗炎症性肠病

使用类固醇药物和抗炎症药物治疗炎症性肠病(IBD)时常产生不良反应或不能达到痊愈,所以IBD的生物治疗,包括基因转移疗法就提到日程上来。文章简要地综述了IBD相关的基因治疗靶向分子,并总结了近期肠道基因治疗临床前研究的结果和讨论了未来的发展方向。     

经腹超声在炎症性肠病诊察中的应用

随着炎症性肠病(inflammatory bowel disease,IBD)近年来发病率的增加及新的靶向药物的应用,对于其诊断及药物疗效随访越来越受到重视.经腹超声(transabdominal ultrasound,US)作为一种无创的新兴检查方法疾病诊断、病变活动性的评估、药物疗效的随访观察等方面有重要作用,成为研究热点.现本文将其在炎症性肠病诊察中的应用做一综述.