IBD Patients Should Adhere to Medications in Face of COVID-19

March 16, 2020
Miguel Regueiro, MD

Miguel Regueiro, MD

Gastroenterologists may be leaned upon more in the coming weeks as investigators in all medical fields continue to examine the novel coronavirus (COVID-19).

Miguel Regueiro, MD, chair of the Department of Gastroenterology, Hepatology, and Nutrition at the Cleveland Clinic, explained in an interview with HCPLive® that gastrointestinal symptoms seem to be prevalent in COVID-19 patients, but it is unknown if those symptoms are made worse by the virus.

“The honest answer is we don't know because we haven't seen it yet, but we do know that there does seem to be gastrointestinal involvement with COVID-19,” Regueiro said. “Given that it is found in the GI tract, and does cause GI symptoms, we would presume, as with any infection that affects the GI tract, that there could be increased symptoms of diarrhea, pain, nausea, vomiting, but we don't I don't have any data or anything to say at this point.”

Regueiro explained the current advice for immunocompromised patients is the same as the advice for patients who are not immunosuppressed.

The advice for these patients is similar to other individuals in avoiding large crowds and travel, frequently wash your hands and surfaces, and continue with medications.

“We feel that their risk of a flare of ulcerative colitis or Crohn's by stopping medication is greater than the potential chance of getting COVID-19,” Regueiro said.

However, Regueiro said the recommendations may ultimately change as researchers learn more and more on COVID-19 and its overall impact.

For the time being, the advice is similar to the advice Regueiro gives IBD patients with the flu, but with even more heightened care due to the lack of a vaccine for the new COVID-19.

This advice is particularly true for the older population, which have a higher mortality risk in regard to COVID-19.

“I think our elderly IBD patients who have called us, and we've had discussions obviously they're concerned because not only do they have IBD and maybe immunosuppressed, but also are older, which seems to be the population for the COVID-19 that's most dangerous,” Regueiro said. “It's an abundance of caution that we're advising these patients to really avoid crowds travel, air flights, cruises.”

Gastrointestinal symptoms could be a new focus for clinicians testing for novel coronavirus (COVID-19), according to 2 new papers published online in the journal Gastroenterology.

Although many clinicians were looking at fever and cough in patients, the new information detailed that gastrointestinal issues and stool samples could lead to a COVID-19 diagnosis.

In the first paper, investigators from Shanghai, China, sought to document the symptoms of the COVID-19. Although fever, dry cough, and dyspnea presented in most cases, they wanted to understand what impact the virus had on symptoms such as diarrhea, nausea, vomiting, and abdominal discomfort. So far, those symptoms have varied among different study populations, the authors wrote.

Former studies on SARS, which is related to COVID-19 and can present with similar symptoms, showed that the viral respiratory illness was verified in patients after detection in biopsy specimens and stool. This was true even after the patients had been discharged from the hospital.

In the second paper, investigators from Guangdong Province in China examined the viral RNA in feces from 71 patients with confirmed COVID-19 during their hospitalization between Feb. 1-14, 2020. They collected serum, nasopharyngeal and oropharyngeal swabs, urine, stool, and tissues (from endoscopy) from the patients.

The study authors said that viral host receptor ACE2 stained positive primarily in the gastrointestinal epithelial cells, which is rare. ACE2 is “abundantly distributed in cilia of glandular epithelia,” the study authors said, but rarely expressed in esophageal epithelium. This is likely due to esophageal epithelium mainly being composed of squamous epithelial cells, which express less ACE2 than glandular epithelial cells.

 
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