Patients with inflammatory bowel disease are frequently medicated with immunosuppressant drugs. Therefore, it is natural that in this moment of pandemics many fears and doubts arise concerning treatment and the best way to manage the disease. What does the COVID-19 pandemic mean for patients with inflammatory bowel disease? It is important to stress that the data gathered until present indicate that old age and the presence of comorbidities (diabetes, high blood pressure, pulmonary disease or cancer) seem to be the main risk factors for the development of severe disease by COVID-19 . In general, patients under immunosuppressive therapeutics have a higher risk of contracting infections. However, there is no evidence until now that the immunosuppressive therapeutics used in the treatment of the inflammatory bowel disease increases the risk of complications associated with COVID-19 or associated with a worse prognosis. In this group of patients, treatments with corticoids, azathioprine or methotrexate are associated with a higher risk of viral infections. The biological drugs don’t seem to be associated to an increase in the risk of viral infection. We have to recognize that there is still little data on COVID-19 infection in patients with inflammatory bowel disease. Anyway, and in general, it is preferable that these patients maintain their therapeutics and the disease under control and in remission, in order to avoid the worsening of their condition and unnecessary trips to the hospital. Any doubt should be discussed with the attending physician. What are the current recommendations for patients with inflammatory bowel disease? Patients medicated with mesalazine Medications like mesalazine (for instance, Asacol, Pentasa, Salofalk, Azzavix) are safe and do not increase the risk of infection. Patients medicated with corticoids They should discuss with their doctor the possibility of adopting a regimen of discontinuation (dose reduction), earlier than usual. Patients medicated with thiopurine (azathioprine) The elimination of thiopurines (Imuran, Azalfalk) from the body may take several weeks, therefore the suppression of these medications in the short term does not affect the infectious risk. Patients medicated with biological substances The biological medications currently used in inflammatory bowel disease (infliximab, adalimumab, golimumab, ustekinumab, vedolizumab) are usually safe. In general, the suspension of these medications is not recommended. Should consultations and exams be maintained during the COVID-19 pandemic? Considering the current situation of social isolation, virtual consultations should be preferred, for instance video consultations, or even consultation by phone. Before such consultations, there are several ways to share with the attending doctor the results of analyses (when done outside Hospital da Luz), as well as a list of the most recent symptoms and even a list of doubts to be clarified. The feature “annex documents” on MY LUZ is one of the ways Hospital da Luz patients can store documents to share with the doctor later, in video consultation or by phone. Endoscopic exams should be done in selected cases. In this moment of pandemics, endoscopic exams for evaluation / monitoring of the disease should be adjourned, for it is safer for patients. In the situation of worsening of the inflammatory bowel disease, with or without fever, how to proceed? Presently, all hospitals have reduced patient flow to avoid contact with suspicious cases of COVID-19. In situations of worsening of inflammatory bowel disease, to contact the attending doctor is fundamental, for he will give the proper indications, at the proper moment, including when you should resort to the hospital. Important tips: Comply with the rules of social distancing and quarantine enacted by the Direção Geral da Saúde; Proceed to a proper and frequent sanitation of your hands (with water and soap during at least 20 seconds); Avoid touching the mouth, nose and eyes with your hands; Avoid unnecessary trips; Ensure the provisioning of your usual medication, in case you have to stay under quarantine; If you develop symptoms, such as coughing, shortness of breath, fever or flu-like symptoms, contact Line SNS 24 (808 24 24 24) or Line LUZ 24 (217 104 424); In case of confirmation of infection by coronavirus, contact also your attending doctor, for him to decide on the suspension of the immunosuppressive therapeutics. Source: International Organization for Inflammatory Bowel Disease Author : Joana Torres Meet the Gastroenterology team of Hospital da Luz network . Click here for more information and advice of Hospital da Luz about the novel coronavírus COVID-19 epidemic . The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
