COVID-19 information for patients with inflammatory bowel disease

[MUSIC PLAYING] Patients who are infected with the novel coronavirus, called SARS-CoV-2 may develop a disease called COVID-19. The symptoms of COVID-19 are most frequently fever, cough, and other respiratory symptoms, which might progress to shortness of breath. Other symptoms people commonly have include a fatigue or muscle aches. More recently, colleagues have described that you can have digestive symptoms associated with the infection with the SARS-CoV-2 development of COVID-19. The digestive symptoms most often described include a loss of appetite, but also a loss of smell or taste and abdominal discomfort or more frequent bowel movements or loose stools.

In patients who have inflammatory bowel disease, where the primary problem with their underlying condition affects the intestines, having digestive symptoms can be confusing, and it could be confused for activation of the inflammatory bowel disease. We haven't seen enough patients who have IBD who've developed COVID-19 to know whether the patients have different types of symptoms, but the unique concern here is to distinguish between someone who is having a relapse of their Crohn's disease or colitis, compared to someone who might be having symptoms of an infection. And to make it even more complicated is the infection actually triggering a relapse. So we're working hard with our patients and with additional research to try and figure some of this out.

Patients who have Crohn's disease and ulcerative colitis have a chronic condition in which the immune system of the intestines, which exists to protect us from getting infected or having other problems, is overactive. So what happens in patients with Crohn's and colitis is that the immune system the intestine continues to be activated and cause symptoms or problems. Because of this and because we haven't yet found the cause of these conditions, the primary treatment for many patients is to use immune modifying or immune-suppressive therapies. It makes sense then to be concerned that if you're on a therapy that's modifying your immune system, are you at increased risk for infection?

Some of the therapies we use have been associated with increased risks of viral infections, including influenza, the common viral infection we talk about, as well as other viral infections, like Epstein-Barr virus or even viruses that can cause warts on your hands or other things. Because of this, we've had a particular interest in whether our patients with IBD and the therapies they're on might increase their risk for infection with the novel coronavirus that causes the COVID-19 pandemic.

So far, we haven't seen that and in fact, quite the contrary. We believe some of these therapies may actually prevent progression of COVID-19, and some of them are actively being studied for patients who are suffering from COVID-19 to control the disease. It's important to understand that the goal of treatment for Crohn's disease and ulcerative colitis is not to immune suppress the patient. It's to modify that overactive immune system so that it's under better control. So in general, we don't think of our IBD patients at baseline as being immune suppressed. In fact, it's the opposite.

Their immune system is a bit overactive. And when we treat them effectively, our general strategy is to just turn down the immune system enough, so their body takes over. And we minimize the risk that they're going to have any infections.

So our general message to patients right now has been stay on your existing therapies and stay in remission. And obviously, for concerns about this, we encourage them to call their doctors and have conversations about whether there might be any adjustments to be made.

Patients with inflammatory bowel disease who develop COVID-19 will have the same symptoms as the general population of patients who don't have inflammatory bowel disease. These symptoms include fever or cough or shortness of breath or other congestion in the upper airways. It can also be that it presents with digestive symptoms, abdominal discomfort, loss of appetite, or change in your bowel habits.

Because patients with inflammatory bowel disease are often on immune therapies, it's important that you let your doctor and your doctor's team know right away if you develop some of these symptoms or if you're worried that you might have developed COVID-19. We can test you for that, and now we have reliable testing and results that come back quite quickly. And then we can make some modifications.

Based on the treatments you're on, we might have you hold your therapy for a couple weeks to let this pass. And most patients will recover uneventfully from this problem. We know so far, based on an international registry of inflammatory bowel disease patients and patients who developed COVID-19, that there does not appear to be an increased risk overall in patients with IBD developing COVID-19 or having a different set of outcomes from COVID-19.

What that means is that most people recover uneventfully, regardless of what treatments they're on. We're obviously studying this carefully, so we understand it more. But the most important thing to know is that you should be calling and having a conversation with your doctor, with your doctor's team of nurses and nurse practitioners, and have a good sense for when it would be important to be tested and when we might have you hold your therapies for a couple of weeks.

I don't recommend that you do that on your own and stop your medicines without talking to us because we really do want to make sure we have a good handle on this for you. Most people who have this won't require hospitalization, but if you get sicker or develop more shortness of breath, it is important to know that we're here for you. We're available, and we can take care of this together. Please be in touch with us.

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