Effects of SARS-CoV-2 pandemic on gastrointestinal health

United European Gastroenterology (UEG) Public Affairs Committee UEG journal Educate policy makers, patients, health professionals, and the general public about the impact of the 2019 coronavirus disease (COVID-19) pandemic on gastrointestinal health. It also provides recommendations on clinical considerations when using the COVID-19 vaccine in patients with chronic gastrointestinal disorders.

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COVID-19 and digestive health

COVID-19 is a respiratory illness caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Nevertheless, it also affects other organs, causing complications other than the lungs.

The COVID-19 pandemic has a major impact on digestive health care. The clinical routines of gastroenterologists and liver specialists have been interrupted. Endoscopy is limited to emergencies.

In addition, blockade measures resulted in unhealthy eating habits, reduced exercise, reduced patient interaction with medical services, and increased patient alcohol consumption or recurrence.

Patients with gastrointestinal (GI) are vulnerable to increased morbidity and worsening outcomes from SARS-CoV-2 infection. Policy makers need to consider the health of patients with weakened immunity in order to develop diseases prevention and COVID-19 vaccination strategies.

Result of COVID-19 blockade

Beyond the mortality and morbidity of COVID-19, COVID-19 has certainly had a social impact.

Delayed screening affecting patients with colorectal cancer (CRC)

CRC mortality in Europe is declining due to the deployment of screening programs. Due to the pandemic, some gastrointestinal endoscopy procedures have been cancelled. Recent studies predict that the burden of gastrointestinal cancer will increase because this procedure is used for screening, early diagnosis, and treatment of gastrointestinal cancer.

COVID-19 pandemic led to increased obesity rate

Blockade and social distance have caused weight gain in many people due to decreased exercise and increased diet due to boredom, anxiety, or depression. In addition, the consumption of snacks, unhealthy foods and sweets is increasing. Since nutrition affects immunity, poor lifestyle habits can increase your risk of chronic and infectious diseases.

According to a UK study, the risk of COVID-19 positivity was low when individuals consumed vegetables and increased when they consumed processed meats. The COVID-19 pandemic may also potentially increase the prevalence of obesity-related gastrointestinal and liver diseases.In addition, non-alcoholic Fatty liver disease It is a potential risk factor for SARS-CoV-2 infection and severe COVID-19.

Vaccination of vulnerable GI patients

Patients with inflammatory bowel disease (IBD), liver disease, gastrointestinal cancer, and liver transplant recipients need to clarify the conditions that should be managed for vaccination.

Cancer patients

Some associations of oncology experts strongly recommend vaccination of cancer patients due to the high risk of severe COVID-19.Recent studies evaluated Effectiveness of Vaccination of patients receiving chemotherapy and / or immunotherapy has shown that COVID-19 vaccination achieves an appropriate antibody response in these patients. However, the duration of the patient’s immune response has not yet been evaluated.

Patients with IBD

Patients with IBD have altered the underlying immune response that can increase their vulnerability to infection. In addition, they are treated with immunosuppressive drugs. All approved COVID-19 vaccines are considered safe for immunocompromised patients. However, it is expected that the immune response to vaccination may not be optimal in these patients. Nonetheless, expert reviews encourage all IBD patients to be vaccinated with the mRNA vaccine, if possible.

Patients with liver disease

No safety issues have been reported in COVID-19 vaccinated liver transplant recipients or patients with mild to moderate liver disease. In a Chinese study, patients with non-alcoholic fatty liver disease reported mild side effects, Neutralizing antibody For SARS-CoV-2. Clinical guidelines recommend pre- and post-transplant vaccination against a variety of pathogens in patients with liver disease and liver transplant recipients awaiting liver transplant. Several studies have shown that a third dose of the vaccine in these patients achieved a higher immune response.

UEG recommendations

For medical institutions:

• Governments need to review up-to-date clinical data to determine policies and guidelines to ensure the protection and support of their citizens. This is especially true when lifting the blockade.
• Selective procedures such as endoscopy need to be resumed and maintained to protect the patient and medical care.
• The impact of the European blockade on cancer screening, diagnosis and staging needs to be assessed.

For COVID-19 vaccination:

• A group of immunocompromised patients should be prioritized in vaccination planning and epidemiological settings.
• Administration of booster doses should be evidence-based. Post-vaccination antibody levels should be determined in vulnerable populations such as IBD patients undergoing immunosuppressive treatment, gastrointestinal cancer patients undergoing treatment, and transplant recipients.

For EU policy makers:

• The European Commission aims to build a European Health Union. The obligations of the European Center for Disease Control and Prevention (ECDC) and the European Medicines Agency promote a strong and coordinated coalition-level response to the health crisis. UEG strongly supports these obligations.
• The COVID-19 pandemic amplifies the link between infectious and non-communicable diseases. Therefore, the ECDC mandate revision should include activities in the area of ​​non-communicable diseases.