AGA Clinical Practice Update on Management of Inflammatory Bowel Disease During the COVID-19 Pandemic: Expert Commentary

Abstract

The purpose of this American Gastroenterological Association (AGA) Institute Clinical Practice Update was to rapidly review the emerging evidence and provide timely expert recommendations regarding the management of patients with inflammatory bowel disease during the coronavirus disease 2019 pandemic. This expert commentary was commissioned and approved by the AGA Institute Clinical Practice Updates Committee and the AGA Governing Board to provide timely perspective on a topic of high clinical importance to the AGA membership, and underwent internal peer review by the Clinical Practice Updates Committee and external peer review through standard procedures of Gastroenterology.

Keywords: Coronavirus; Crohn’s Disease; IBD; Immunosuppression; SARS-CoV-2; Ulcerative Colitis.

Figure 1

Management of patients with IBD during the COVID-19 pandemic. 5-ASA, 5-aminosalicylic acid medication; CRP, C-reactive protein; mAb, monoclonal antibodies. ∗Symptoms and findings of COVID-19: fever (83%–99%); cough (59%–82%); fatigue (44%–70%); anorexia (40%–84%); shortness of breath (31%–40%); sputum production (28%–33%); myalgias (11%–35%); headache, confusion, rhinorrhea, sore throat, hemoptysis, vomiting, and diarrhea (<10%); lymphopenia (83%); computed tomography chest: bilateral, peripheral, ground-glass opacities. ∗∗Clearance of SARS-Cov-2 may enable resumption of IBD therapy; role of serologic antibody testing unclear at the current time. (Viral clearance testing may or may not be possible or appropriate, given local testing capabilities and health system-approved epidemiological testing strategies during the COIVD-19 pandemic.) ∗∗∗Treatment of COVID-19 under investigation, consider therapies that have safety and efficacy in IBD.