key: cord-351566-z6onmkrn
authors: Bezzio, Cristina; Saibeni, Simone
title: SEVERE IBD FLARES AND COVID-19: EXPAND THE GASTROENTEROLOGY-SURGERY TEAM TO INCLUDE AN INFECTIOUS DISEASE SPECIALIST
date: 2020-06-16
journal: Gastroenterology
DOI: 10.1053/j.gastro.2020.05.082
sha: 
doc_id: 351566
cord_uid: z6onmkrn

nan

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new virus that was first identified in Wuhan, China, and has now spread worldwide. It causes a potentially fatal infectious respiratory syndrome called coronavirus disease 2019 (COVID-19), which has rapidly evolved into a pandemic (1) . COVID-19 is a major health emergency that has had a substantially impact on everyday clinical practice. It has raised several new questions and concerns about its potential impact on patients with chronic illnesses, especially those treated with immunomodulating drugs.

In the field of inflammatory bowel disease (IBD), the British Society of Gastroenterology (2) and American Gastroenterological Association (AGA) (3) have recently provided guidance on the management of patients with Crohn's disease and ulcerative colitis during this complicated period.

For example, AGA recommends following standard therapeutic algorithms for patients hospitalized for IBD who also have mild or incidentally identified COVID-19 (3). It also recommends scheduling the usual surgical consultation, but acknowledges that it is reasonable to medically attempt to postpone surgery during the pandemic. Perhaps because of the lack of empirical evidence, these guidelines did not specifically address the challenging case of IBD patients hospitalized due to a severe flare of disease with subsequent or concomitant pneumonia due to SARS-CoV-2.

Especially in ulcerative colitis, a severe flare of disease is a life-threatening emergency that requires prompt recognition, hospitalization, early initiation of treatment and close monitoring (4).

The outcome of severe flares is measured in terms of surgery and mortality rates. Therefore, a multidisciplinary approach involving a gastroenterologist and a colorectal surgeon is essential. This professional pair shares the responsibility in correctly identifying the most effective type and timing of rescue therapy or surgery. However, in the COVID-19 pandemic, this professional pair may not be enough to effectively manage the infection in an IBD patient with a severe disease flare.

We recently published a prospective, observational study of 79 IBD patients with COVID-19 (5) . The study found that active disease, age >65 years and comorbidities associated with worse assessing the risk-benefit ratio we decided to start with infliximab at 5 mg/kg.

We do not yet know what will be the final effect of this treatment and the outcome for the patient. Nonetheless, we think that the issues raised by this case are of great interest to physicians managing IBD patients during the COVID-19 pandemic. In particular, we suggest that an infectious disease specialist join the gastroenterologist and surgeon on the team managing IBD patients hospitalized for a severe flare of disease. In this way, they will become "three of a perfect pair".

Gut 2020, accepted