Gastrointestinal conditions and COVID-19

Gastrointestinal conditions and COVID-19

Last updated 6 April 2020

Author: Dr Pam Mellors, Consultant Occupational Physician, Healthwork Ltd
Dr Chris Valentine, Consultant Occupational Physician

 

Gastrointestinal conditions

 

 

Vulnerability

 

 

References

 

Autoimmune hepatitis Very high or high https://www.hepatitisaustralia.com/Handlers/Download.ashx?IDMF=e9924223-888a-47a3-8295-5add820aa204

https://www.bsg.org.uk/covid-19-advice/bsg-basl-rcp-guidance-for-healthcare-workers-with-moderate-risk-inflammatory-bowel-disease-and-liver-disease/

Cirrhosis

decompensated

High https://www.hepatitisaustralia.com/Handlers/Download.ashx?IDMF=e9924223-888a-47a3-8295-5add820aa204

https://www.bsg.org.uk/covid-19-advice/bsg-basl-rcp-guidance-for-healthcare-workers-with-moderate-risk-inflammatory-bowel-disease-and-liver-disease/

Cirrhosis

normal liver function and no co-morbidity

Low https://www.hepatitisaustralia.com/Handlers/Download.ashx?IDMF=e9924223-888a-47a3-8295-5add820aa204

https://www.bsg.org.uk/covid-19-advice/bsg-basl-rcp-guidance-for-healthcare-workers-with-moderate-risk-inflammatory-bowel-disease-and-liver-disease/

Coeliac disease Increased or Low https://celiac.org/celiac-disease-and-covid-19/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4103047/

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/857279/Greenbook_chapter_7_Immunsing_immunosupressed.pdfhttps://www.cghjournal.org/article/S1542-3565(05)00982-1/fulltext

The risk of hyposplenism may need to be considered and the importance ensuring they have received pneumococcal pneumonia vaccination. Association of Coeliac with associated auto-immune disease such as thyroiditis may increase the risk.

Hepatitis B or C

symptomatic, with any other health conditions or on current treatment

Very high or high

depending on co-morbidity

https://www.hepatitisaustralia.com/Handlers/Download.ashx?IDMF=e9924223-888a-47a3-8295-5add820aa204

https://www.bsg.org.uk/covid-19-advice/bsg-basl-rcp-guidance-for-healthcare-workers-with-moderate-risk-inflammatory-bowel-disease-and-liver-disease/

Hepatitis B or C

asymptomatic, with no treatment or comorbidity

Low https://www.hepatitisaustralia.com/Handlers/Download.ashx?IDMF=e9924223-888a-47a3-8295-5add820aa204

https://www.bsg.org.uk/covid-19-advice/bsg-basl-rcp-guidance-for-healthcare-workers-with-moderate-risk-inflammatory-bowel-disease-and-liver-disease/

Inflammatory Bowel Disease

currently taking oral or intravenous steroids equivalent to 20mg or more of prednisolone per day (except budesonide or beclomethasone)

started a new biologic medicine within the last 6 weeks, in combination with another immunosuppressant or steroids (except budesonide or beclomethasone)

active disease despite taking medication – e.g. in a flare

short gut syndrome which requires nutritional support

parenteral nutrition

Very high https://www.bsg.org.uk/covid-19-advice/bsg-advice-for-management-of-inflammatory-bowel-diseases-during-the-covid-19-pandemic/

 

https://www.crohnsandcolitis.org.uk/news/advice-for-people-with-crohns-and-colitis-self-isolation-social-distancing

https://academic.oup.com/ecco-jcc/advance-article/doi/10.1093/ecco-jcc/jjaa061/5811674

https://www.thelancet.com/journals/langas/article/PIIS2468-1253(20)30076-5/fulltext

https://www.ioibd.org/ioibd-update-on-covid19-for-patients-with-crohns-disease-and-ulcerative-colitis/

Inflammatory Bowel Disease

 

Stable condition on medication as follows/recently discontinued the medication within the last 3 months

BIOLOGICS

Adalimumab (Humira, Amgevita, Hyrimoz, Imraldi, Hulio)

Golimumab (Simponi)

Infliximab (Remicade, Inflectra, Remsima, Zessly)

Ustekinumab (Stelara)

Vedolizumab (Entyvio)

JANUS KINASE INHIBITORS

Tofacitinib (Xeljanz)

IMMUNOSUPPRESSANTS

Azathioprine (Imuran

Ciclosporin

Mercaptopurine (6-MP)

Methotrexate (Maxtrex, Methofill, Metoject, Ebetrex, Namaxir, Nordimetand Zlatal)

Mycophenylate mofetil

Steroids equivalent to less than 20mg prednisolone per day (except budesonide or beclomethasone)

Tacrolimus

Thalidomide

Tioguanine (6thioguanine)

OTHER

Immunosuppressant or biologic medicine as part of a clinical trial

Very high https://www.bsg.org.uk/covid-19-advice/bsg-advice-for-management-of-inflammatory-bowel-diseases-during-the-covid-19-pandemic/

https://www.crohnsandcolitis.org.uk/news/coronavirus-covid-19-advice

BSG and Crohn’s & Colitis UK aim to contact all patients on their register but may have lost contact with those they have not seen in clinic and therefore it would help to make patients aware of this. Patients should also self-identify as to which group they belong and to contact local IBD team ideally by e-mail / phone. Advice from the British Society of Gastroenterologists for NHS staff with IBD is that frontline staff with IBD  should follow the same precautions as other IBD patients. However, given the likely high exposure of frontline staff to COVID-19 it would be advisable that hospital teams consider utilising team members with IBD in roles where exposure is limited (i.e. telephone clinics as opposed to endoscopy lists and ward work), especially if that individual is ‘moderate’ risk or has other co-morbidity.

GENERAL COMMENTS ON IBD AND COVID-19

From the current understanding of the mechanisms of infection, there are concerns that people with IBD may be at more risk of COVID -2 than the general population. However Manteleone et al undertook a PubMed search on March 17, 2020, and found no evidence to suggest that Covid-19 occurs more frequently in IBD patients than in the general population and there had been no reported cases from China at 26 March 2020. https://academic.oup.com/ecco-jcc/advance-article/doi/10.1093/ecco-jcc/jjaa061/5811674

Advise strongly not to stop medication without specialist advice. This would risk a relapse of symptoms which in itself would increase the risk and might necessitate outpatient or inpatient treatment, which would also increase the risk.

RELATED CONTENT

Vulnerability levels

Very high (Red)

Risk of severe illness or death if contracts COVID-19. Read more

High (Orange)

Likely to need hospitalisation if contracts COVID-19, with protracted illness and heavy NHS burden. Read more

Increased/Moderate (Yellow)

Increased risk compared with healthy individual but should recover.

Low/Standard (Green)

No greater risk than healthy individual.