key: cord-0056864-f4tgtw0n
authors: Ruan, Wenly; Ihekweazu, Faith; Walsh, Seema; Karam, Lina; Wyatt, Allyson; Nguyen, Huyen; Kellermayer, Richard
title: SARS-COV-2 INFECTION AND SEROCONVERSION IN PEDIATRIC INFLAMMATORY BOWEL DISEASE PATIENTS
date: 2021-01-21
journal: Inflamm Bowel Dis
DOI: 10.1093/ibd/izaa347.108
sha: de7be0f637500ba34f77351abbf6372f8b79ae68
doc_id: 56864
cord_uid: f4tgtw0n

BACKGROUND: As the Coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), continues to evolve, its influence on specific patient populations suffering from chronic disorders becomes increasingly important. Patients with inflammatory bowel disease (IBD) are commonly immunosuppressed with immunomodulators, biologics, and steroids. Therefore, IBD patients have been considered as a risk population for COVID-19. Yet, emerging epidemiologic data may indicate otherwise. It is still unclear, however, how COVID-19 infection affects IBD patients and how seroconversion against the virus might take place depending upon disease states and treatments. We describe a single center cohort of pediatric IBD patients with COVID-19, a subset of whom were tested for seroconversion subsequent to the laboratory test supported infection. METHODS AND RESULTS: The electronic medical records of pediatric IBD patients who tested positive for SARS-CoV-2 by nasopharyngeal swab based PCR testing were included in the study. The clinical course of IBD, concurrent medications, COVID-19 related symptoms, SARS-CoV-2 testing date, and SARS-CoV-2 IgG antibody testing date and result were examined. A total of 13 pediatric IBD patients at Texas Children’s Hospital tested positive for SARS-CoV-2. Patient demographics and specifics of IBD disease and management are detailed in table 1. Management was not altered in any of these patients in response to the positive COVID-19 test. Seven (53.8%) had symptoms including fever, sore throat, fatigue, loss of taste, dizziness, loss of smell, abdominal pain, and/or diarrhea; six (46.2%) were asymptomatic. No patients required hospitalization attributed to COVID-19. Of the 13 patients, 6 (46.2%) have been already tested for seroconversion. Four (67.7%) had elevated SARS-CoV-2 IgG of whom 3 patients (50%) had acute and resolved symptoms; one (16.7%) had an ambiguous serology (reactive total IgG and IgM but negative IgG and IgM individually), and one (16.7%) had nonreactive antibody titers. Seroconversion was tested between 0.4, or 4 to 13.7 weeks after initial positive SARS-CoV-2 PCR testing. The close antibody testing at 0.4 weeks had the ambiguous results. Serologic testing for the additional cases is pending. CONCLUSIONS: We describe a cohort of pediatric IBD patients with COVID-19 ranging from 1 week to 4 months after infection whose disease course has not been significantly affected. A large proportion of patients tested for seroconversion were found to mount a detectable IgG based immune response in spite of their medical immunosuppression. More research needs to be performed to evaluate the importance of seroconversion with relation to disease course andCOVID-19 reinfection in pediatric IBD patients. [Image: see text]

Background: As the Coronavirus disease 2019 pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), continues to evolve, its influence on specific patient populations suffering from chronic disorders becomes increasingly important. Patients with inflammatory bowel disease (IBD) are commonly immunosuppressed with immunomodulators, biologics, and steroids. Therefore, IBD patients have been considered as a risk population for COVID-19. Yet, emerging epidemiologic data may indicate otherwise. It is still unclear, however, how COVID-19 infection affects IBD patients and how seroconversion against the virus might take place depending upon disease states and treatments. We describe a single center cohort of pediatric IBD patients with COVID-19, a subset of whom were tested for seroconversion subsequent to the laboratory test supported infection. Methods and Results: The electronic medical records of pediatric IBD patients who tested positive for SARS-CoV-2 by nasopharyngeal swab based PCR testing were included in the study. The clinical course of IBD, concurrent medications, COVID-19 related symptoms, SARS-CoV-2 testing date, and SARS-CoV-2 IgG antibody testing date and result were examined. A total of 13 pediatric IBD patients at Texas Children's Hospital tested positive for SARS-CoV-2. Patient demographics and specifics of IBD disease and management are detailed in table 1. Management was not altered in any of these patients in response to the positive COVID-19 test. Seven (53.8%) had symptoms including fever, sore throat, fatigue, loss of taste, dizziness, loss of smell, abdominal pain, and/or diarrhea; six (46.2%) were asymptomatic. No patients required hospitalization attributed to COVID-19. Of the 13 patients, 6 (46.2%) have been already tested for seroconversion. Four (67.7%) had elevated SARS-CoV-2 IgG of whom 3 patients (50%) had acute and resolved symptoms; one (16.7%) had an ambiguous serology (reactive total IgG and IgM but negative IgG and IgM individually), and one (16.7%) had nonreactive antibody titers. Seroconversion was tested between 0.4, or 4 to 13.7 weeks after initial positive SARS-CoV-2 PCR testing. The close antibody testing at 0.4 weeks had the ambiguous results. Serologic testing for the additional cases is pending. Conclusions: We describe a cohort of pediatric IBD patients with COVID-19 ranging from 1 week to 4 months after infection whose disease course has not been significantly affected. A large proportion of patients tested for seroconversion were found to mount a detectable IgG based immune response in spite of their medical immunosuppression. More research needs to be performed to evaluate the importance of seroconversion with relation to disease course andCOVID-19 reinfection in pediatric IBD patients.

Background: Patients with inflammatory bowel disease (IBD) sometimes require proctocolectomy with ileal pouch-anal anastomosis (IPAA) due to medically refractory colitis or neoplasia. However, pouchitis can develop in up to 80% of patients after the surgery. Given that previous studies demonstrated an association between chronic pouchitis and inflammatory polyps, we hypothesize that inflammatory polyps can be a predictor for pouch outcomes. This study assesses the frequency, risk factors, and prognosis of the J pouch with inflammatory polyps. Methods: This is a retrospective single-center study of IBD patients treated by total proctocolectomy with IPAA and who subsequently underwent pouchoscopies at the University of Chicago between January 2007 and September 2019. We reviewed the endoscopic findings in different anatomic areas of the pouch: the pre-pouch ileum, inlet, "tip of the J", proximal and distal pouch, anastomosis, rectal cuff, anal canal, and perianal area. Endoscopic findings included erythema/edema, erosions/friability, ulcerations, stenosis, granularity, loss of vascular pattern, and inflammatory polyps. To compare the J pouch with and without inflammatory polyps, we evaluated all available pouchoscopies and included any patient who had inflammatory polyps noted at least once. Demographic and clinical data were also assessed. Fisher's test was used for a univariate analysis to assess factors contributing to inflammatory polyps in the J pouch. Logistic regression analysis was performed by including univariate variables with a P-value < 0.05. To assess the relevance between inflammatory polyps and pouch excision, log-rank test and Kaplan-Meier curve were used. Results: We reviewed 1,195 pouchoscopies from 426 IBD patients who underwent proctocolectomy with IPAA and identified 61 patients (14.3%) with at least 1 inflammatory polyp in the J pouch. The most common anatomical location developing inflammatory polyps was the distal pouch (23, 38%), followed by the proximal pouch (21, 34%), afferent limb (13, 21%), rectal cuff (9, 15%), and inlet (7, 11%). Multivariable analysis showed that inflammatory polyps were significantly associated with male sex (OR = 2.8; 95% CI = 1.4-5.3; P = 0.002), postoperative anti-TNF drugs (OR = 2.9; 95% CI = 1.6-5.4; P < 0.001), and pouchitis (OR = 6.1; 95% CI = 1.4-25.9; P = 0.015) (Table) . Kaplan-Meier curve showed that inflammatory polyps significantly increased the risk of pouch excision (P = 0.03) (Figure 1 ). Conclusion: Our analysis found that more than 10% of IBD patients with a J pouch developed inflammatory polyps. Male patients had an increased risk of inflammatory polyps in the J pouch. Furthermore, our study suggested that inflammatory polyps can develop in patients with pouchitis requiring anti-TNF drugs and are an independent predictor of pouch excision. Table   Figure 1 

Methods: This is a retrospective study of adult patients diagnosed with both IBD and cirrhosis (by liver biopsy or Fibroscan) treated with biologic agents or small molecule agents between 2012 and 2020 within the Yale-New Haven Hospital system. We included patients on tofacitinib or any of the following biologic agents: infliximab, adalimumab, certolizumab pegol, golimumab, vedolizumab, ustekinumab. Primary outcomes were rates of adverse events (infection, infusion reaction, IBD-related hospitalization) and mortality. Secondary outcomes were clinical remission (defined by the physician global assessment) and mucosal healing

Decompensated cirrhosis was present in 33.3% of the population prior to initiation of biologic/small molecule therapy. The most common etiology of cirrhosis was primary sclerosing cholangitis at 38.9%