2019 Novel Coronavirus Disease (COVID-19) in Patients With Inflammatory Bowel Diseases

Carlos Taxonera; Iñigo Sagastagoitia; Cristina Alba; Norberto Mañas; David Olivares; Enrique Rey

Disclosures

Aliment Pharmacol Ther. 2020;52(2):276-283. 

In This Article

Abstract and Introduction

Abstract

Background: Data on patients with inflammatory bowel diseases (IBD) who have had 2019 novel coronavirus (SARS-CoV-2) disease (COVID-19) are needed.

Aims: To report the clinical characteristics, including gastrointestinal symptoms, of COVID-19 in IBD patients, and to assess the risk of COVID-19 in IBD.

Methods: This case series included consecutive IBD patients with laboratory-confirmed COVID-19. Age-adjusted cumulative incidences were compared with the general population in the Madrid region.

Results: Through April 8, 12 of 1918 IBD patients were diagnosed with COVID-19. The average age was 52 years, 75% of the patients were female and 58.3% had Crohn's disease. Seven patients (58%) were on maintenance treatment with immunomodulators/biologics, of these four with combined therapy (33%). Eight patients (66%) required hospitalisation (one intensive care unit admission, and two deaths), and four patients were isolated at home. Nine patients had diarrhoea ranging between 4 and 10 loose stools per day (mean 5.4, SD 1.6). In five patients (42%) diarrhoea was a presenting symptom. In two patients, diarrhoea was the only symptom at debut. Cumulative incidence of COVID-19 was 6.2 per 1000 IBD patients. IBD patients had a lower adjusted incidence ratio of COVID-19 (OR 0.74, 95% CI 0.70–0.77; P < 0.001), and a similar associated mortality ratio (OR 0.95, 95% CI: 0.84–1.06; P = 0.36), compared with the general population.

Conclusions: IBD patients do not have an increased risk of COVID-19 and associated mortality compared with the general population. In many IBD patients, diarrhoea was a presenting symptom, and sometimes, was the only symptom at onset of COVID-19.

Introduction

The World Health Organization (WHO) recently declared 2019 novel coronavirus disease (COVID-19) outbreak as a pandemic of international concern.[1] Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the novel coronavirus causing COVID-19, has spread rapidly throughout the world since it was first identified in Wuhan in December 2019.[2] Currently, Spain has one of the highest number of confirmed COVID-19 cases worldwide, with Madrid being the most affected region.

Elderly individuals and those with other chronic underlying conditions have more severe disease and a higher mortality rate when infected with SARS-CoV-2.[3,4] Inflammatory bowel diseases (IBD) are chronic, immune-mediated inflammatory diseases affecting people of all ages. A high percentage of IBD patients require immunosuppressive therapies for inducing and maintaining remission. These patients may have a greater risk of acquisition or progression of serious viral infections, including COVID-19.[5] However, the initial available evidence suggests that IBD patients do not have an increased risk of contracting SARS-CoV-2 infection or development of COVID-19, since no patients have been reported to be infected with SARS-CoV-2 in IBD centres in China.[6] Moreover, a recent study reported that none of the patients with IBD followed at a tertiary referral centre in Italy developed COVID-19.[7]

To date, there are limited data on patients with IBD who have had COVID-19. Therefore, there is a need for studies assessing the risk and clinical characteristics of the disease in IBD. The objective of this case series was to describe the clinical characteristics, including gastrointestinal (GI) symptoms, of COVID-19 among IBD patients followed at an IBD Unit. We also aimed to assess the risk of developing COVID-19 and the associated mortality in patients with IBD and compare it with that of the general population.

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