By Pat Anson, PNN Editor

Patients with Crohn's disease, ulcerative colitis and other inflammatory bowel diseases (IBD) are not at greater risk from the coronavirus and should continue their regular therapies, according to new guidance by the American Gastroenterological Association (AGA) published in the journal Gastroenterology.

IBD is an immune system disorder that causes abdominal pain, diarrhea and weight loss. Symptoms and progression of the disease can be controlled by medications such as prednisone that suppress the immune system, which has led to concern that patients taking the drugs may be more susceptible to coronavirus infections.

Some IBD patients also need to visit medical facilities for infusions and other procedures, which may increase their risk of exposure to the SARS-CoV-2 virus.

“Despite the potential for increased exposure to SARS-CoV-2, the limited available data and expert opinion suggest that patients with IBD do not appear to have a baseline increased risk of infection with SARS-CoV-2 or development of COVID-19,” wrote lead author David Rubin, MD, Co-Director of the Digestive Diseases Center at University of Chicago Medicine.  

“It is unclear whether inflammation of the bowel per se is a risk for infection with SARS-CoV-2, but it is sensible that patients with IBD should maintain remission in order to reduce the risk of relapse and need for more intense medical therapy or hospitalization.”

Rubin and his co-authors say there is limited information on the severity of coronavirus symptoms in IBD patients, although one study in China found they were “more likely to be hospitalized.” While COVID-19 is primarily a respiratory illness, the virus can cause digestive problems and is detected in stool samples.

The experts recommend that IBD patients who do not have coronavirus symptoms continue their current treatments to avoid relapsing.

“Aside from the obvious negative consequences of a relapse, relapsing IBD will strain available medical resources, may require steroid therapy or necessitate hospitalization, outcomes that are all much worse than the known risks of existing IBD therapies,” Rubin wrote. “Similar to the recommendations to the general population, patients with IBD should practice strict social distancing, work from home, have meticulous hand hygiene, and separate themselves from known infected individuals.”

Infusion centers should have a protocol to pre-screen IBD patients for fever and other coronavirus symptoms, and providers and patients should wear masks and gloves.

For patients who test positive for the coronavirus or develop symptoms, the experts recommend lower doses of prednisone and a temporary halt to biological therapies and immune suppressing drugs such as thiopurines, methotrexate, and tofacitinib.   

“For the patient with COVID-19, adjustment of the medical therapy for IBD is appropriate, based on the understanding of the immune activity of the therapy and whether that therapy may worsen outcomes with COVID-19,” Rubin wrote. “For hospitalized patients with severe COVID-19 and risks of poor outcomes, IBD therapy likely will take a back seat, but choice of therapies for COVID-19 should take into account the co-existing IBD, if feasible.”

Over 3 million people in the United States have IBD. The AGA has developed a flow chart for providers treating IBD during the COVID-19 outbreak and a reference chart for IBD patients.