The position statement of the Polish Society of Gastroenterology and the Polish National Consultant in Gastroenterology regarding the management of patients with inflammatory bowel disease during the COVID-19 pandemic

Introduction

The pandemic of coronavirus disease 2019 (COVID-19), caused by the intercontinental spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has brought dramatic changes to the functioning of the modern world within the timespan of just a few months.
Patients with chronic diseases, including inflammatory bowel diseases (IBD), are among those particularly affected by the current situation. The widespread use of immunosuppressive medicines in the treatment of this group of diseases raises serious concerns among patients as well as physicians. This document was designed to facilitate diagnostic and therapeutic decision-making during the pandemic.
One should keep in mind that the short time since the pandemic onset has been insufficient to obtain good quality data with high evidence levels. This position of the Polish Gastroenterology Society is based on the Chinese experience as well as on documents developed to date by the British Society of Gastroenterology (BSG) and European Crohn’s and Colitis Organisation (ECCO) [1–5].

Intestinal manifestations of COVID-19

The most common symptoms of COVID-19 are fever, dry cough, shortness of breath, and fatigue. Some patients may also experience gastrointestinal symptoms such as nausea, vomiting, abdominal pain, or diarrhoea. Virus particles are found mainly in respiratory secretions; a smaller percentage is also detected in stool. No faecal-oral transmission has been confirmed for SARS-CoV-19. Also, no reports are available regarding the potential impact of the infection on IBD exacerbations [1–5].

Risk of SARS-CoV-2 infection in IBD patients

The spread of SARS-CoV-2 occurs in human communities. The greater the number of people and the longer the contact times, the greater the risk of infection. Thus, as demonstrated by observations made to date in areas with the highest COVID-19 morbidity, a significant percentage of infections is associated with visits to hospitals or clinics. This is the most important factor responsible for increasing the risk of infection among IBD patients. Pharmacotherapeutic agents, particularly steroids, may also be considered potential risk factors in cases of IBD exacerbations. No independent increase in the likelihood of infection was demonstrated for IBD, particularly during remission [1, 6, 7].

General principles to reduce the risk of SARS-CoV-2 infection in IBD patients

Patients should limit their...


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