Covid-19 advice issued for those with Inflammatory Bowel Disease

Justin Kelly

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Justin Kelly

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justin.kelly@iconicnews.ie

Covid-19 advice issued for those with Inflammatory Bowel Disease

Covid-19 advice issued for those with Inflammatory Bowel Disease

New advice for patients with IBD (Crohn’s disease or ulcerative colitis) says they are not at any increased risk of developing Covid-19.

The guidance was issued by the National Clinical Programme in Gastroenterology and Hepatology of the Royal College of Physicians of Ireland and the HSE. The Irish Society of Gastroenterology also endorses this advice.

Prof Laurence Egan, Consultant Gastroenterologist and IBD group lead, National Clinical Programme in Gastroenterology and Hepatology said that while patients with IBD and doctors should be mindful of Covid-19 symptoms that might mimic an IBD flare they are not at increased risk of Covid-19.

“While patients with IBD have similar symptoms to non-IBD patients- fever, dry cough, muscle pain and the other usual features of the disease, Chinese data shows us that about 4% of Covid-19 patients report diarrhoea, abdominal cramping or vomiting. Therefore, one should keep an open mind about symptoms that might mimic an IBD flare, and doctors should arrange a test for any patient with a fever and other symptoms of Covid-19 according to HSE testing guidance,” Prof Egan said.

“All IBD patients should strictly adhere to the standard HSE and Government advice to minimize their risk of infection- social distancing, hand hygiene and cough etiquette.

“Those IBD patients over 70 years of age, with other chronic diseases or with active disease on immunosuppressant agents, biologics or systemic corticosteroids should stay at home, ‘cocoon’ themselves because these medicines lower your immune system and may make it harder to fight Covid-19.  The HSE has advised that this should continue for two weeks from 27 March,” Prof Egan said.

To date, worldwide 275 IBD patients who tested positive for Covid-19 have been reported to the Secure-IBD registry, the database to monitor and report on outcomes of Covid-19 in IBD patients. This suggests that having IBD does not indicate a greater risk of contracting the virus. There is also no evidence to suggest a more severe case of the infection for those with IBD. However, the reported numbers are small making it hard to draw conclusions.

Further advice specified in the new guidelines includes:

- If the patient with IBD is an essential worker and taking one ofthe medicines listed below, they should discuss with their occupational health department before working.
- If symptoms of COVID-19 develop such as fever, cough or shortness of breath, the patient should immediately contact their GP or consultant.
- If the patient’s symptoms of IBD are getting worse (flaring), they should contact their GP or Consultant.
Any IBD patient who tests positive for COVID-19 should be registered in Secure-IBD (covidibd.org)

- If you take any of the following medicines you should cocoon yourself (stay at home) because these medicines lower your immune system and may make it harder to fight COVID-19. The HSE has advised that this should continue for two weeks from 27 March.

Ustekinumab (Stelara)
Vedolizumab  (Entyvio)
Methotrexate
Infliximab (Remicade, Inflectra, Remsima)
Adalimumab (Humira, Amgevita, Hulio, Imraldi)
Golimumab (Simponi)
Azathioprine (Imuran)
Mercaptopurine (Purinethol)
Tacrolimus (Prograf)
Ciclosporin (Sandimmune, Neoral)
Tofacitinib (Xeljanz)
Clinical trial medications
Prednisolone (Deltacortril) at a daily dose of 20mgs or greater