Impact of COVID-19 on inflammatory bowel disease: course and outcome

ABSTRACT

Introduction. Coronavirus infection is an acute viral disease with a primary lesion of the upper respiratory tract, caused by an RNA-virus of the Betacoronavirus genus of the Coronaviridae family. The course of a viral infection varies from asymptomatic to a wide range of clinical manifestations, including fever, chills, gastrointestinal manifestations, pneumonia, respiratory distress, and death. Ulcerative colitis (UC) and Crohn's disease (CD) are chronic immune-mediated diseases with intestinal and systemic symptoms, which are based on an impairment of the intestinal microbiota and dysregulation of the immune system in genetically predisposed individuals. In the Kazakh population, risk factors also include irregular food intake (p=0.043;OR=3.61 [95% CI 1.04-12.51]), consumption of fish and seafood (p=0.000;OR= 15.77 [95% CI 4.56-54.59]), consumption of frozen processed foods (p = 0.018;OR = 4.62 [95% CI 1.3-16.4]), diet based on meat dishes (p=0.029;OR=3.2 [95% CI 1.13-9.2]), use of NSAIDs other than aspirin (p=0.031;OR=3.79 [1.13-12.69]) and smoking (p=0.008;OR=4.93 [95% CI 1.52-15.98]) [26]. The suppression of the immune response is associated with the risk of infection with viral or bacterial pathogens, including potentially the SARS-CoV-2 virus. On the other hand, SARS-CoV-2 infection as a potential trigger factor for de novo occurrence of inflammatory bowel disease is currently being discussed [22, 25]. The aim of this study was to assess the characteristics of the course of COVID-19 during the treatment of inflammatory bowel diseases (IBD), risk factors and outcomes of COVID-19, as well as the activity of IBD before and after a coronavirus infection. Materials and methods. A longitudinal descriptive study included 158 patients with IBD who applied on an outpatient basis (including via remote consultation) or inpatient with SARS-Cov2 or COVID-19 infection in the academic centers of Almaty (Kazakhstan) n=54 and St. Petersburg (Russia), n= 104. The observation period was from May 2020 to May 2022. The median and interquartile range were used to describe quantitative data (age), and absolute frequencies and percentages were used for qualitative data. The Mann-Whitney U-test was used for intergroup comparison of quantitative data (age), for the remaining indicators, the likelihood ratio test (Likehood ratio test), and in the case of 2X2 tables, Fisher's exact test. Results. There was no association between IBD type/activity or drugs taken and the severity of COVID-19. However, the severity of COVID-19 affected the activity of IBD. We've identified the same risk factors for the development of a more severe course of COVID-19 were as in the world literature cardiovascular pathology, arterial hypertension and chronic liver pathology. Conclusion. Thus, inflammatory bowel disease and current therapy do not affect the risk of SARS-Cov-2 infection and/or the severity of COVID-19, while infection associated with severe COVID-19 affects the activity or outcomes of IBD.