Guidance for COVID-19 for patients with pre-existing digesti
Released: Doctor's guide to managing the Coronavirus/COVID19 outbreakWatch VideoDownload SlidesReleased: Doctor's guide to managing the Coronavirus/COVID19 outbreakWatch VideoDownload Slides
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Since SARS-CoV-2 RNA was first detected in a stool specimen of the first reported COVID-19 case in the USA, much attention has been paid to the study and reporting of gastrointestinal tract infection of SARS-CoV-2.

COVID-19 has implications for the management of patients with pre-existing digestive diseases. Indeed, the presence and number of comorbidities are associated with poorer clinical outcomes in patients with COVID-19.

key recommendations for managing patients with IBD during the COVID-19 pandemic:

Potential risk factors for SARS-CoV-2 infection:
-Patients with inflammatory bowel disease (IBD) on immunosuppressive agents
-Patients with active-stage IBD with malnutrition
-Elderly patients with IBD
-Patients with IBD frequently visiting a medical clinic
-Patients with IBD with underlying health conditions, such as hypertension and diabetes
-Patients with IBD who are pregnant

Medication for patients with IBD:

-Continue current treatment if the disease is stable, and -contact your doctor for suitable medicine if the disease has flared
-Use of mesalamine should be continued and should not increase the risk of infection
-Corticosteroid use can be continued, but be cautious of possible side-effects
-A new prescription of immunosuppressant or an increase in the dose of an ongoing immunosuppressant is not recommended in epidemic areas.
-Use of biologics such as the anti-TNFs infliximab or adalimumab should be continued
-If infliximab infusion is not accessible, switching to adalimumab injection at home is encouraged
-Vedolizumab use can be continued due to the specificity of the drug for the intestine
-Ustekinumab use can be continued, but starting ustekinumab requires infusion center visits and therefore is not encouraged
-Enteral nutrition might be used if biologics are not accessible
-Tofacitinib should not be newly prescribed in epidemic areas unless there are no other alternatives

Surgery and endoscopy:

-Postpone elective surgery and endoscopy
-Screening for COVID-19 (complete blood count, IgM or IgG, nucleic acid detection, and chest CT) before emergency surgery

“The data and experience with guidance on how to manage patients with underlying comorbidities in China could facilitate integrated care for patients globally”.- The Lancet

Note:-This list is a brief compilation of some of the key recommendations included in the Guideline and is not exhaustive and does not constitute medical advice.

Kindly refer to the original publication here: https://www.thelancet.com/journals/langas/article/PIIS2468-1253(20)30076-5/fulltext
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