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1.
J Crohns Colitis ; 16(5): 757-767, 2022 Jun 24.
Article in English | MEDLINE | ID: covidwho-1510961

ABSTRACT

BACKGROUND AND AIMS: The health consequences of coronavirus disease 2019 [COVID-19] among patients with ulcerative colitis [UC] and Crohn's disease [CD] remain largely unknown. We aimed to investigate the outcomes and long-term effects of COVID-19 in patients with UC or CD. METHODS: We conducted a prospective, population-based study covering all Danish patients with CD or UC and confirmed COVID-19 between January 28, 2020 and April 1, 2021, through medical records and questionnaires. RESULTS: All 319 patients with UC and 197 patients with CD who developed COVID-19 in Denmark were included in this study and compared with the Danish background population with COVID-19 [N = 230 087]. A significantly higher risk of COVID-19-related hospitalization was observed among patients with UC (N = 46 [14.4%], relative risk [RR] = 2.49 [95% confidence interval, CI, 1.91-3.26]) and CD (N = 24 [12.2%], RR = 2.11 [95% CI 1.45-3.07]) as compared with the background population (N = 13 306 [5.8%]). A similar pattern was observed for admission to intensive care (UC: N = 8 [2.51%], RR = 27.88 [95% CI 13.88-56.00]; CD: N = 3 [1.52%], RR = 16.92 [95% CI 5.46-52.46]). After a median of 5.1 months (interquartile range [IQR] 4.5-7.9), 58 [42.3%] and 39 [45.9%] patients with UC and CD, respectively, reported persisting symptoms which were independently associated with discontinuation of immunosuppressive therapies during COVID-19 (odds ratio [OR] = 1.50 [95% CI 1.07-10.22], p = 0.01) and severe COVID-19 (OR = 2.76 [95% CI 1.05-3.90], p = 0.04), but not with age or presence of comorbidities. CONCLUSION: In this population-based study of 516 patients with IBD and COVID-19, 13.6% needed hospitalization and 2.1% required intensive care. Furthermore, sequelae were frequent, affecting 43.7% of COVID-19-infected patients. These findings might have implications for planning the healthcare of patients in the post-COVID-19 era.


Subject(s)
COVID-19 , Colitis, Ulcerative , Crohn Disease , Inflammatory Bowel Diseases , COVID-19/epidemiology , Cohort Studies , Colitis, Ulcerative/diagnosis , Crohn Disease/complications , Crohn Disease/epidemiology , Crohn Disease/therapy , Denmark/epidemiology , Humans , Inflammatory Bowel Diseases/complications , Inflammatory Bowel Diseases/epidemiology , Inflammatory Bowel Diseases/therapy , Prospective Studies
4.
Hum Cell ; 34(6): 1585-1600, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1316345

ABSTRACT

Mesenchymal stem cells (MSCs), a kind of multipotent stem cells with self-renewal ability and multi-differentiation ability, have become the "practical stem cells" for the treatment of diseases. MSCs have immunomodulatory properties and can be used to treat autoimmune diseases, such as systemic lupus erythematosus (SLE) and Crohn's disease. MSCs also can be used in cancer and aging. At present, many clinical experiments are using MSCs. MSCs can reduce the occurrence of inflammation and apoptosis of tissue cells, and promote the proliferation of endogenous tissue and organ cells, so as to achieve the effect of repairing tissue and organs. MSCs presumably also play an important role in Corona Virus Disease 2019 (COVID-19) infection.


Subject(s)
COVID-19/therapy , Cell- and Tissue-Based Therapy/methods , Mesenchymal Stem Cells , Animals , Apoptosis , Autoimmune Diseases/therapy , Cell Proliferation , Cell- and Tissue-Based Therapy/trends , Crohn Disease/therapy , Humans , Immunomodulation , Inflammation , Lupus Erythematosus, Systemic/therapy , Mesenchymal Stem Cell Transplantation , Mesenchymal Stem Cells/immunology , Mice , Neoplasms/therapy
5.
BMJ Case Rep ; 14(3)2021 Mar 22.
Article in English | MEDLINE | ID: covidwho-1146828

ABSTRACT

Active inflammatory bowel disease (IBD), combined immunosuppression and corticosteroid therapy have all been identified as risk factors for a poor outcome in COVID-19 infection. The management of patients with both COVID-19 infection and active IBD is therefore complex. We present the case of a 31-year-old patient with Crohn's disease, on dual immunosuppression with infliximab and mercaptopurine presenting with inflammatory small bowel obstruction and COVID-19 infection. The case highlights the use of nutritional therapy, which remains underused in the management of adults with IBD, to manage his flare acutely. Following negative SARS-CoV-2 PCR testing and SARS-CoV-2 IgG testing confirming an antibody response, ustekinumab (anti-interleukin 12/23) was prescribed for long-term maintenance.


Subject(s)
COVID-19/complications , Crohn Disease/immunology , Crohn Disease/therapy , Enteral Nutrition , Immunocompromised Host , Adult , Crohn Disease/complications , Crohn Disease/diagnostic imaging , Humans , Immunosuppressive Agents/therapeutic use , Interleukin-12/immunology , Interleukin-23/immunology , Male , SARS-CoV-2 , Tomography, X-Ray Computed , Treatment Outcome , Ustekinumab/therapeutic use
6.
Z Gastroenterol ; 58(10): 982-1002, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-886826

ABSTRACT

The COVID-19 pandemic is a global outbreak of new onset infections with the SARS-CoV-2 virus. To date, more than 3.4 million people have been infected throughout the world. In Germany, approximately 450,000 patients suffer from inflammatory bowel disease; these patients generally require continuous expert care and support. Against the background of a rapidly accumulating knowledge base on SARS-CoV-2, 68 expert authors of the current DGVS guidelines for Crohn's disease and ulcerative colitis took part in a virtual meeting to compile up-to-date, practice-orientated recommendations aimed at improving the care of patients with IBD. These recommendations address the risk of infection, including the risk for specific patient groups, the possible course of the disease, and consequences for pharmacological and surgical therapies of the underlying disease, as well as general measures for infection prevention and adjuvant prophylactic and therapeutic options.


Subject(s)
Colitis, Ulcerative , Coronavirus Infections , Crohn Disease , Inflammatory Bowel Diseases , Pneumonia, Viral , Practice Guidelines as Topic , Betacoronavirus , COVID-19 , Colitis, Ulcerative/diagnosis , Colitis, Ulcerative/therapy , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Crohn Disease/diagnosis , Crohn Disease/therapy , Germany , Humans , Inflammatory Bowel Diseases/diagnosis , Inflammatory Bowel Diseases/therapy , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , SARS-CoV-2
8.
Gut ; 70(6): 1044-1052, 2021 06.
Article in English | MEDLINE | ID: covidwho-740292

ABSTRACT

OBJECTIVE: Paediatric acute severe colitis (ASC) management during the novel SARS-CoV-2/COVID-19 pandemic is challenging due to reliance on immunosuppression and the potential for surgery. We aimed to provide COVID-19-specific guidance using the European Crohn's and Colitis Organisation/European Society for Paediatric Gastroenterology, Hepatology and Nutrition guidelines for comparison. DESIGN: We convened a RAND appropriateness panel comprising 14 paediatric gastroenterologists and paediatric experts in surgery, rheumatology, respiratory and infectious diseases. Panellists rated the appropriateness of interventions for ASC in the context of the COVID-19 pandemic. Results were discussed at a moderated meeting prior to a second survey. RESULTS: Panellists recommended patients with ASC have a SARS-CoV-2 swab and expedited biological screening on admission and should be isolated. A positive swab should trigger discussion with a COVID-19 specialist. Sigmoidoscopy was recommended prior to escalation to second-line therapy or colectomy. Methylprednisolone was considered appropriate first-line management in all, including those with symptomatic COVID-19. Thromboprophylaxis was also recommended in all. In patients requiring second-line therapy, infliximab was considered appropriate irrespective of SARS-CoV-2 status. Delaying colectomy due to SARS-CoV-2 infection was considered inappropriate. Corticosteroid tapering over 8-10 weeks was deemed appropriate for all. After successful corticosteroid rescue, thiopurine maintenance was rated appropriate in patients with negative SARS-CoV-2 swab and asymptomatic patients with positive swab but uncertain in symptomatic COVID-19. CONCLUSION: Our COVID-19-specific adaptations to paediatric ASC guidelines using a RAND panel generally support existing recommendations, particularly the use of corticosteroids and escalation to infliximab, irrespective of SARS-CoV-2 status. Consideration of routine prophylactic anticoagulation was recommended.


Subject(s)
Anticoagulants/therapeutic use , COVID-19 , Colectomy/methods , Colitis, Ulcerative , Crohn Disease , Infliximab/therapeutic use , Methylprednisolone/therapeutic use , Adolescent , COVID-19/epidemiology , COVID-19/therapy , Child , Colitis, Ulcerative/epidemiology , Colitis, Ulcerative/therapy , Crohn Disease/epidemiology , Crohn Disease/therapy , Humans , Immunosuppressive Agents/classification , Immunosuppressive Agents/therapeutic use , Patient Care Management/methods , Patient Care Management/standards , Patient Care Management/trends , Practice Guidelines as Topic , Risk Adjustment/methods , SARS-CoV-2/isolation & purification , Severity of Illness Index , Sigmoidoscopy/methods , United Kingdom
15.
J Crohns Colitis ; 14(9): 1334-1336, 2020 Sep 16.
Article in English | MEDLINE | ID: covidwho-15707

ABSTRACT

Crohn's disease [CD] and ulcerative colitis [UC], the main inflammatory bowel diseases [IBD] in humans, are chronic, immune-inflammatory diseases, the pathogenesis of which suggests a complex interaction between environmental factors and genetic susceptibility. These disabling conditions affect millions of individuals and, together with the drugs used to treat them, can put patients at risk of developing complications and other conditions. This is particularly relevant today, as coronavirus disease [Covid-19] has rapidly spread from China to countries where IBD are more prevalent, and there is convincing evidence that Covid-19-mediated morbidity and mortality are higher in subjects with comorbidities. The primary objectives of this Viewpoint are to provide a focused overview of the factors and mechanisms by which the novel severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] infects cells and to illustrate the link between such determinants and intestinal inflammation. We also provide clues about the reasons why the overall IBD population might have no increased risk of developing SARS-CoV-2 infection and highlight the potential of cytokine blockers, used to treat IBD patients, to prevent Covid-driven pneumonia.


Subject(s)
Colitis, Ulcerative , Coronavirus Infections , Crohn Disease , Pandemics , Pneumonia, Viral , Betacoronavirus/physiology , COVID-19 , Colitis, Ulcerative/epidemiology , Colitis, Ulcerative/immunology , Colitis, Ulcerative/therapy , Communicable Disease Control/methods , Comorbidity , Coronavirus Infections/epidemiology , Coronavirus Infections/immunology , Coronavirus Infections/prevention & control , Crohn Disease/epidemiology , Crohn Disease/immunology , Crohn Disease/therapy , Humans , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/immunology , Pneumonia, Viral/prevention & control , Prevalence , Risk Assessment , Risk Factors , SARS-CoV-2
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