RESUMEN
BACKGROUND AND AIMS: Patients with inflammatory bowel disease (IBD) have an attenuated response to initial COVID-19 vaccination. We sought to characterise the impact of IBD and its treatment on responses after third vaccine against SARS-CoV-2. METHODS: Prospective multicentre observational study of patients with IBD (n=202) and healthy controls (HC, n=92). Serological response to vaccination was assessed by quantification of anti-spike protein (SP) immunoglobulin (Ig)G levels (anti-SPIgG) and in-vitro neutralisation of binding to Angiotensin-Converting-Enzyme (ACE2). Peripheral blood B-cell phenotype populations were assessed by flow cytometry. SARS-CoV-2 antigen specific B-cell responses were assessed in ex-vivo culture. RESULTS: Median anti-SP IgG post-third vaccination in our IBD cohort is significantly lower than HCs (7,862 versus 19,622 AU/mL, p <0.001) as is ACE2 binding inhibition (p <0.001). IBD patients previously infected with COVID-19 (30%) have similar quantitative antibody response as HCs previously infected with COVID-19 (p = 0.12). Lowest anti-SP IgG titres and neutralisation are seen in IBD patients on anti-TNF agents, without prior COVID-19 infection but all IBD patients show attenuated vaccine response compared to HCs. Patients with IBD have reduced memory B-cell populations and attenuated B-cell responses to SARS-CoV-2 antigens if not previously infected with COVID-19 (p = 0.01). Higher anti-TNF drug levels and zinc levels < 65ng/ml are associated with significantly lower serologic response. CONCLUSIONS: Patients with IBD have an attenuated response to three doses of SARS-CoV-2 vaccine. Physicians should consider patients with higher anti-TNF drug levels and/or zinc deficiency as potentially at higher risk of attenuated response to vaccination.
RESUMEN
Helicobacter pyloriInfection is formally recognised as an infectious disease, an entity that is now included in the International Classification of Diseases 11th Revision. This in principle leads to the recommendation that all infected patients should receive treatment. In the context of the wide clinical spectrum associated with Helicobacter pylori gastritis, specific issues persist and require regular updates for optimised management.The identification of distinct clinical scenarios, proper testing and adoption of effective strategies for prevention of gastric cancer and other complications are addressed. H. pylori treatment is challenged by the continuously rising antibiotic resistance and demands for susceptibility testing with consideration of novel molecular technologies and careful selection of first line and rescue therapies. The role of H. pylori and antibiotic therapies and their impact on the gut microbiota are also considered.Progress made in the management of H. pylori infection is covered in the present sixth edition of the Maastricht/Florence 2021 Consensus Report, key aspects related to the clinical role of H. pylori infection were re-evaluated and updated. Forty-one experts from 29 countries representing a global community, examined the new data related to H. pylori infection in five working groups: (1) indications/associations, (2) diagnosis, (3) treatment, (4) prevention/gastric cancer and (5) H. pylori and the gut microbiota. The results of the individual working groups were presented for a final consensus voting that included all participants. Recommendations are provided on the basis of the best available evidence and relevance to the management of H. pylori infection in various clinical fields.
RESUMEN
Infusion centres are a central part in the management of patients with inflammatory bowel disease [IBD] and could be a source of transmission of SARS-COV-2. Here we aimed to develop global guidance for best practices of infusion centres for IBD patients and to determine the impact of the COVID-19 pandemic on these centres. Under the auspices of the International Organization for the Study of Inflammatory Bowel Disease [IOIBD], a task force [TF] was formed, an online survey was developed to query infusion centre protocols during COVID-19, and recommendations were made, based on TF experience and opinion. Recommendations focus mainly on patients screening, infusion centres re-organization, personnel protection, and protocol modifications such as shortening infusion duration or replacing it with subcutaneous alternatives. Implementing these recommendations will hopefully reduce exposure of both IBD patients and care givers to SARS-COV-2 and improve the function and safety of infusion centres during the COVID-19 pandemic as well as potential future threats.