The natural history of COVID-19 in vaccinated inflammatory bowel disease patients.

AIM: Assess the characteristics of break through COVID-19 in Inflammatory Bowel Disease (IBD) patients, despite complete vaccination. METHODS: Patients who reported a COVID-19 at least 3 weeks after complete vaccination were asked to answer an on-line anonymous questionnaire which included patient and disease characteristics, vaccination history, and the evolution of COVID-19. RESULTS: Among 3240 IBD patients who reported complete vaccination between 1st May 2021 and 30thJune 2022, 402 (12.4%) were infected by SARS Cov-2 [223 male, 216 Crohn's disease (CD), 186 Ulcerative Colitis (UC), mean (SD) age 42.3 (14.9) years, mean (SD) IBD duration 10.1 (9.7) years]. Three hundred and sixty-nine patients (91.8%) were infected once and 33 (8.2%) twice. The mean (SD) time between last vaccination and infection was 4.1 (1.6) months. Overall, 351 (87.3%) patients reported mild constitutional and/or respiratory symptoms, 34 (8.4%) were asymptomatic and only 17 patients (4.2%) required hospitalization. Of hospitalized patients, 2 UC patients died of COVID-19 pneumonia. The remaining hospitalized patients did not need high flow oxygen supply or ICU admission. CONCLUSIONS: A minority of completely vaccinated IBD patients developed COVID-19 which evolved with mild symptoms and a favorable outcome. These results reinforce the importance of vaccination especially in vulnerable populations.

The Natural History of Covid-19 in Vaccinated Inflammatory Bowel Disease Patients

Introduction: Patients with Inflammatory Bowel Disease (IBD), especially those on immunosuppressives (IMS), should be vaccinated against SARSCoV- 2 to prevent hospitalization, mechanical ventilation, and death. However, IMS may adversely affect response to vaccination, raising concerns as to how vulnerable these patients are to break through COVID-19 infections. Thus, we aimed to assess the proportion of IBD patients who despite complete vaccination developed COVID-19, as well as the course of COVID-19 disease. Aims & Methods: This study was an initiative of the Hellenic IBD Study Group (EOMIFNE) and involved 12 IBD referral Centers. Patients attending these Centers who reported a COVID-19 infection at least 3 weeks after vaccination completion were asked to complete an on-line anonymous questionnaire which included patient demographics and IBD clinical and therapeutic data, a detailed vaccination history, and the course and outcome of COVID-19, especially the need for hospitalization, oxygen supply, and admission to ICU. In patients with a grave outcome information was sought by family members. Result(s): On estimate, 3240 patients reported full vaccination (vaccination scheme either with combined Vaxzevria- Comirnaty or onlyComirnaty vaccine) in the 12 centers. Between 1stMay 2021 and 20thApril 2022,351 (10.8%) fully vaccinated IBD patients reported COVID-19 infection [187 male, 212 CD, 139 UC, mean (SD) age 42.3 (14.9) years, mean (SD) IBD duration mean (SD), 10.1 (9.7) years]. Among them, 322 (91.7%) were infected once and 29 (8.3%) patients twice. Seventy-three patients were receiving 5-ASAs, 15 corticosteroids, 46 azathioprine/methotrexate, 117 anti-TNFs as monotherapy and 21 in combination with azathioprine/methotrexate, and 2 with corticosteroids, 43 vedolizumab, 25 ustekinumab, 5 tofacitinib and 1 rizakinzumab at the time of COVID-19 diagnosis. Three patients did not receive any treatment. IBD was in remission in 279/351 patients (79.5%). Comorbidities were reported by 112 patients (thyroid disease 66;diabetes mellitus 13;hypertension 12;coronary heart disease 11;prior cancer 4;psoriasis 2;spondyoartropathy 2;dyslipidemia 1;and PSC 1 patient). The mean (SD) time between last vaccination dose and infection was 4.1 (1.6) months. Overall, 308 (87.7%) patients reported mild constitutional and respiratory symptoms, 29 (8.6%) were asymptomatic and only 14 patients (3.9%) required hospitalization. Of those hospitalized, 2 patients, both with UC, died because of COVID pneumonia (one aged 67, on infliximab, with diabetes and the second one aged 80, on 5-ASA, with a history of laryngeal cancer);however, the remaining 12 patients did not need high flow oxygen supply or ICU admission, and none reported symptoms of long COVID. IBD medications were stopped in 145 patients (41.3%) during the COVID-19 infection. Conclusion(s): A minority of fully vaccinated IBD vaccinated patients developed COVID-19 which was relatively mild and uneventful. These results reinforce the importance of vaccination especially in vulnerable populations.

COVID-19 and Gastrointestinal manifestations

SARS-CoV-2 appeared in December 2019 in the Wuhan and has been rapidly spreading from China to other countries. In March 2020 has been declared a pandemic and one of the most important public health emergencies. It's a virus that typically concern respiratory system, and is manifested by fever, dry cough, dyspnea and fatigue. Moreover, gastrointestinal, and hepatic manifestations can also appear. In this article we briefly describe the link between angiotensin-converting enzyme II (ACE2) and digestive system, a receptor that mightly can be the entry mechanism of SARS-COV2. Gastrointestinal symptoms can be abdominal pain, nausea, vomiting and diarrhea. Liver chemistry abnormalities are also common and include elevation of aspartate transferase, alanine transferase, and total bilirubin. Furthermore, an important fact is that viral RNA has been isolated from stool specimens of COVID-19 patients even more when tests from respiratory system turn negative. Finally, we underline the role of gut microbiota between SARS - COV2 infection and inflammatory respone and immune homeostasis.

ESGE and ESGENA Position Statement on gastrointestinal endoscopy and the COVID-19 pandemic

Europe is severely affected from Covid-19 pandemic with an exponential increase in incident infections and deaths. The clinical manifestations of COVID-19 can be subtle, encompassing a broad spectrum from asymptomatic mild disease to severe respiratory illness. Health care professionals in endoscopy units are at increased risk of infection from COVID-19. Infection prevention and control has been shown to be dramatically effective in assuring the safety of both health care professionals and patients. The prolonged lockdown period across Europe resulted in the cancellation of elective GI endoscopies as only urgent endoscopies were performed. The aim of this present Position Statement is to provide up-dated evidence-based guidance on endoscopy practice for the lockdown and the post-lockdown phase of the COVID-19 pandemic.