AGA releases COVID-19 guidelines for IBD patients

Inflammatory bowel disease (IBD) Patients Coronavirus disease 2019 (COVID-19) For general use of immunosuppressive or immunomodulatory therapies to treat IBD.

A team led by Dr. David T. Rubin, Ph.D. of the Center for Inflammatory Bowel Disease, University of Chicago School of Medicine, has developed new guidelines for the American Society of Gastroenterology (AGA) on how to manage IBD during a COVID-19 pandemic.

New recommendations suggest that IBD patients should continue on IBD therapy, including all scheduled infusions.

Currently, there is no evidence that IBD increases the risk of developing SARS-CoV-2 infection or COVID-19.

However, the guidelines recommend that patients with IBD who develop COVID-19 discontinue medications such as thiopurine, methotrexate, and tofacitinib, and biological therapies such as anti-TNF, ustekinumab, and vedolizumab .

Recommendations suggest that patients infected with the virus can resume these treatments after the symptoms of COVID-19 have completely resolved.

Ultimately, the patient must discuss with the medical team before discontinuing medication, the physician must submit an IBD case, and confirm COVID-19 with the SECURE-IBD ​​registry. COVIDIBD.org.

The majority of individuals with COVID-19 experience similar symptoms of fever and respiratory problems, but a significant portion of patients experience changes in bowel habits and other gastrointestinal symptoms You.

These symptoms may reflect ingestion of the virus into the gastrointestinal tract by swallowing. This is because the angiotensin converting enzyme 2 (ACE2) receptor is expressed in the intestine.

According to recent reports, the virus is detectable in the stool even after the respiratory symptoms have resolved or the virus has been detected in the oropharynx.

AGA has recently been released Guidelines Propose to physicians that doctors treat all patients like COVID-19 and enhance personal protective equipment (PPE) regardless of the patient’s COVID-19 status

The main guidance is that doctors should consider all patients at risk if there is no accurate and reliable test for COVID-19, and there is no long-term asymptomatic shedding before symptoms appear .

“Data related to the spread of SARS-CoV-2 during the early stages of a pandemic confirm that healthcare workers are at higher risk of infection than the general population,” the authors write. “While COVID-19 is primarily spread by droplet propagation, endoscopic surgery can lead to aerosolization and subsequent airborne transmission.”

The AGA also recommends a new method of PPE for all endoscopic procedures. The new guidelines require all healthcare professionals to use N95, N00, or PAPR masks instead of surgical masks. They also recommend that healthcare workers use double gloves instead of using a single glove as part of the PPE (RR, 0.36, 95% CI, 0.16-0.78).

Another suggestion to reduce the threat of infection is to use a negative pressure chamber where possible.

The committee also reviewed data on long-term use and reuse of masks, but did not find sufficient evidence to comment on the use of masks or the safety of mask re-use for up to eight hours at a time.

For gastrointestinal procedures, the authors recommend triage procedures to minimize risk to both providers and patients and to limit the spread of infection.

IBD guidelines have been developed and approved by the AGA Institute Clinical Practice Updates Committee (CPUC) and the AGA Governing Board. The new guidelines have undergone an internal peer review by the CPUC and an external peer review with the following standard procedures: Department of Gastroenterology.

“The purpose of this AGA Institute Clinical Practice Update is to quickly review new evidence regarding the management of patients with inflammatory bowel disease during a COVID-19 pandemic and provide timely expert recommendations.” The authors stated.

the study, “AGA Clinical Practice Update on Managing Inflammatory Bowel Disease During COVID-19 Pandemic: Expert CommentaryHas been published online Department of Gastroenterology.