Sequelae of SARS-CoV-2 infection including post-COVID syndrome.

Infection with severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) can cause a variety of gastroenterological symptoms. A relevant proportion of patients complain of symptoms typical of gastroenteritis;the number of patients affected by gastroenterological symptoms has increased with the spread of the omicron variants. Furthermore, there are also signs of liver involvement in infected people. In the acute phase, increased liver enzymes and acute decompensation of pre-existing liver disease are observed, which can deteriorate into acute-on-chronic liver failure. Long-term sequelae of a SARS-CoV-2 infection must be distinguished from this. These sequelae can manifest either as direct infection- or therapy-associated sequelae, such as the development of secondary sclerosing cholangitis after intensive care therapy or as symptoms in the context of a post-coronavirus disease (COVID) syndrome. The pathophysiology leading to the development of a post-COVID syndrome is still unclear;here, the influence of the intestinal microbiome is discussed. This review article presents acute gastroenterological symptoms and long-term sequelae of a SARS-CoV-2 infection, which we are increasingly confronted with in clinical practice.Copyright © 2023, The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.

Induction and maintenance of mucosal healing in Crohn's disease with ustekinumab in clinical practice - Results of a nationwide, prospective, multicenter study in Germany (MUCUS)

Background: Ustekinumab (UST) is a fully human IgG1k monoclonal antibody to human IL-12/23p40 approved in several jurisdictions for the treatment of adult patients with moderately to severely active Crohn's disease (CD). UST's impact on induction and maintenance of mucosal healing, fistula healing and extraintestinal manifestations were not fully elucidated in the registration trial program. Method(s): In this prospective, multicenter study (EudraCT number: 2017-005151-83) across all care levels in Germany, we evaluated the real-world effectiveness of UST prescribed within its German label to achieve the primary endpoint of combined clinical (Harvey Bradshaw Index (HBI) score reduction >= 3 points from baseline) and endoscopic (50% reduction of the simple Endoscopic Score for Crohn Disease (SES-CD) from baseline) response in week 52 and a variety of secondary endpoints including mucosal healing defined as the complete absence of mucosal ulcerations in any ileocolonic segment and endoscopic remission defined as an SES-CD score of 0 - 2. Result(s): We recruited 52 CD patients (female n=28, bionaive n=13, bioexposed n=39). See Table 1 for baseline demographics and pertinent history details. At week 52, 50% (n=12/24) of patients achieved the primary endpoint [50% (n=3/6) in the bionaive, 45.5% (n=5/11) bioexposed to one and 57.1% (n=4/7) bioexposed to multiple biologics cohorts, respectively], 58.3% (n=14/24) of patients achieved endoscopic response [50% (n=3/6) in the bionaive, 54.5% (n=6/11) bioexposed to one and 71.4% (n=5/7) bioexposed to multiple biologics cohorts, respectively], 33.3% (n=8/24) of patients achieved endoscopic remission [50% (n=3/6) in the bionaive, 27.3% (n=3/11) bioexposed to one and 28.6% (n=2/7) bioexposed to multiple biologics cohorts, respectively], 45.8% (n=11/24) of patients achieved mucosal healing [50% (n=3/6) in the bionaive, 36.4% (n=4/11) bioexposed to one and 57.1% (n=4/7) bioexposed to multiple biologics cohorts, respectively]. 36 patients (69.2%) experienced >= 1 treatment emergent adverse event (TEAE), in 8 (15.4%) cases rated as severe and in 5 (9.6%) leading to discontinuation of UST, but no very severe events or deaths (Table 2). Conclusion(s): UST reliably induces endoscopic response and mucosal clinical practice. The limited samples size is a direct result from the Covid-19 pandemic. No new safety signals were recorded.

COVID-19 and inflammatory bowel disease.

The coronavirus disease 2019 (COVID-19) pandemic continues to impact the lives of patients with inflammatory bowel disease (IBD). Extensive investigations over the past 3 years have shown that the vast majority of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infections and COVID-19 diseases in IBD patients are mild. The disease activity of IBD is usually not influenced, but some patients may experience temporary gastrointestinal symptoms. With the exception of systemic glucocorticoids, commonly used immunomodulatory drugs had no influence on the severity of COVID-19 disease and the overall mortality did not differ from the general population. However, vaccine response is decreased in a substance-dependent manner. In this review, we summarize the most important, practice-relevant studies.Copyright © 2023, The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.

[German S1 Guideline Long-/Post-COVID]. / S1-Leitlinie Long-/Post-COVID.

The German Society of Pneumology initiated 2021 the AWMF S1 guideline Long COVID/Post-COVID. In a broad interdisciplinary approach, this S1 guideline was designed based on the current state of knowledge.The clinical recommendations describe current Long COVID/Post-COVID symptoms, diagnostic approaches, and therapies.In addition to the general and consensus introduction, a subject-specific approach was taken to summarize the current state of knowledge.The guideline has an explicit practical claim and will be developed and adapted by the author team based on the current increase in knowledge.

Vaccinations and travel for patients with IBD

Patients with chronic inflammatory bowel disease (IBD) are at increased risk of an infectious disease due to their underlying disease and the often necessary immunosuppressive therapy. Many infectious diseases can be avoided through a consistent vaccination program. However, the vaccination status of many IBD patients deviates significantly from official recommendations. Therefore, the vaccination certificate should be checked at the first contact and then ideally annually at the time of influenza vaccination. Individualized immunosuppressive therapy allows many IBD patients to live a life with few or no symptoms, and many patients want to travel. All of these topics usually only played a minor role in the IBD consultation hours, but have clearly come to the fore with the beginning of the SARS-CoV-2 pandemic. In this article we would therefore like to give an overview of what is new and interesting about vaccinations, vaccine-preventable diseases, and travel.

T Cell Response After SARS-CoV-2 Vaccination in Immunocompromised Patients with Inflammatory Bowel Disease.

BACKGROUND: Vaccination is a promising strategy to protect vulnerable groups like immunocompromised inflammatory bowel disease [IBD] patients from an infection with SARS-CoV-2. These patients may have lower immune responses. Little is known about the cellular and humoral immune response after a SARS-CoV-2 vaccination in IBD patients. METHODS: Totals of 28 patients with IBD and 27 age- and sex-matched healthy controls were recruited at Jena University Hospital. Blood samples were taken before, after the first, and in a subgroup of 11 patients after second dose of a SARS-CoV-2 vaccination. Cellular immune response, including IFN-γ and TNF-α response and antibody titres, were analysed. RESULTS: Overall, 71.4% of the IBD patients and 85.2% of the controls showed levels of anti-SARS-CoV-2 antibodies above the cutoff of 33.8 BAU/ml [p = 0.329] after the first dose. Even in the absence of SARS-CoV-2 antibodies, IBD patients showed significant T cell responses after first SARS-CoV-2 vaccination compared with healthy controls, which was not influenced by different immunosuppressive regimens. Associated with the vaccination, we could also detect a slight increase of the TNF production among SARS-CoV-2-reactive TH cells in healthy donorsn [HD] and IBD patients. After the second dose of vaccination, in IBD patients a further increase of humoral immune response in all but one patient was observed. CONCLUSIONS: Already after the first dose of a SARS-CoV-2 vaccination, cellular immune response in IBD patients is comparable to controls, indicating a similar efficacy. However, close monitoring of long-term immunity in these patients should be considered.

Inflammatory Bowel Disease in the COVID-19 Pandemic: the Patients' Perspective.

BACKGROUND: The coronavirus disease 2019 [COVID-19] pandemic is affecting lives worldwide. The influence of inflammatory bowel disease [IBD] medication and IBD itself on COVID-19 is controversial. Additionally, IBD-focused guidance is scarce. OBJECTIVE: Our aims were to determine COVID-19 prevalence/exposure, perception and information sources, medication compliance, patient behaviour and physician contact among patients with IBD compared with non-IBD controls. METHODS: A cross-sectional anonymous survey of patients with IBD [N = 415] at one university IBD clinic and one gastroenterology practice, matched 4:1 with control participants [N = 116], was performed. RESULTS: Patients with IBD had a high fear of infection. This was more pronounced in patients taking immunosuppressants and it extended to hospitals, private practices and public places, such as supermarkets. IBD patients reported leaving their homes less frequently than their peers without IBD. A total of 90% of patients with IBD reported washing their hands more frequently. Patients taking immunosuppressants were concerned about interactions between medication and COVID-19, whereas patients taking 5-aminosalicylates were not. Nonetheless, 96.4% of patients adhered to continuing their medication. Patients sought guidance primarily from television and internet news sites. Video consultations were found to be a suitable solution for a subset of patients who are young, have a high level of fear and leave their home less frequently than their peers, whereas overall acceptance of video consultations was limited. CONCLUSION: Patients with IBD are significantly more affected by the COVID-19 pandemic than their non-IBD peers, but they continue to adhere to their medication regimens. IBD-focused COVID-19 information should be actively conveyed.