Gastrointestinal Disorders and the Coronavirus
Published 5 May 2020 • By Camille Dauvergne
More than 300,000 patients suffer from chronic Inflammatory Bowel Disease (IBD) in the United Kingdom. And this number is constantly increasing! The conditions that fall under the IBD umbrella include Crohn's disease and ulcerative colitis (UC). Patients are most often diagnosed between the ages of 20 and 30. While there is no known cure at present, several effective symptomatic treatments are available. However, some of these treatments can cause immunosuppression, which worries patients in this period of coronavirus pandemic!
What is the risk of serious complications? Should immunosuppressive treatments be temporarily stopped? What precautions should be taken? We answer your questions!
Does my GI condition put me at greater risk of complications with COVID-19?
According to Dr. William Berrebi, a gastroenterologist, the risk of complications with COVID-19 is not caused by the disease itself, whether Crohn's or UC, but rather by the treatments taken to mitigate the disease.
If you are taking mesalazine (Octasa, Pentasa, Asacol, Salofalk, Mezavant) and your disease is stable and controlled, there is no particular risk of complications.
If you are on corticosteroids with a dosage higher than 20 mg (Prednisolone), immunosuppressant drugs (Imuran, Metoject) or biologics (Remicade, Humira) then there may be a significant risk of complications in case of COVID-19 infection as these treatments weaken your immune system. You are therefore more vulnerable to an infection. It is therefore extremely important to follow strictly the barrier gestures as well as the confinement in case of taking immunosuppressive treatments.
Should I stop my immunosuppressive drugs to avoid a severe form of COVID-19?
You should never stop or change your chronic treatment, whether immunosuppressive or not, without consulting your doctor first. This could lead to a worsening of your gastrointestinal condition and complications specific to it. It will also not protect you against the coronavirus.
For certain COVID-19 patients, it may be possible to temporarily stop corticosteroid/immunosuppressant/biologic medications to reduce the risk of serious complications, but only under medical supervision. Decisions should be made on a case-by-case basis with a doctor.
If you have no COVID-19 symptoms, continue taking your medications and pursuing your medical follow-up (appointments, tests, etc.) to keep your chronic condition stable.
In the case of symptoms suggestive of COVID-19 (cough, fever, shortness of breath, aches and pains, etc.) contact your GP and/or specialist who will tell you how to proceed. In the case of a life-threatening emergency, such as severe respiratory distress, call 999 immediately.
I'm taking a preventative course of mesalazine, is it risky given the current situation??
Preventive or even curative treatment with mesalazine does not present any particular risk with regard to COVID-19. Continue to take your treatment as usual.
I have had a permanent ostomy, am I more at risk of complications?
The stoma itself is not a risk factor for complications with COVID-19, especially if you have had it for some time and are doing well. But again, corticosteroids, immunosuppressant drugs, or biologics may increase this risk.
If you have any questions about your treatment, do not hesitate to contact your doctor by phone or by teleconsultation.
How can I tell distinguish the digestive symptoms of COVID-19 from a relapse of my GI condition?
SARS-CoV-2 can cause digestive problems such as diarrhoea, vomiting and abdominal pain, which can be mistaken for symptoms of Crohn's disease or UC. If these digestive symptoms are isolated, it does not mean that it is not the coronavirus. Dr. Berrebi points out that one in six patients with coronavirus admitted to hospital has isolated digestive symptoms several days before the onset of other symptoms such as fever and breathing difficulties.
In case of isolated digestive symptoms, do not hesitate to take your temperature regularly and contact your doctor who will assess your overall condition.
What explains the digestive symptoms of COVID-19?
The digestive symptoms observed in COVID-19 patients can be explained by different mechanisms:
- A direct toxicity of SARS-CoV-2 (coronavirus) in the gastrointestinal tract because the same receptors are present in the gastrointestinal tract as in the lungs.
- An autoimmune reaction with release of cytokines (pro-inflammatory molecules) in the gastrointestinal tract due to infection.
- An imbalance of the intestinal microbiota also induced by the infection.
I'm feeling a lot of stress, can it make Crohn's disease/UC worse?
Stress may play a role in the progression of your Crohn's disease or your UC.
It is important to relax by doing one or more activities that you enjoy every day. Continuing even moderate daily physical activity can also help reduce your stress levels. You can try relaxation techniques such as meditation or yoga that can help you regulate your breathing and improve your resistance to stress.
The GI Research Foundation offers a series of videos on its site to assist with stretching and relaxation. You will find numerous videos and audio clips of sessions for yoga, breathing, and meditation!
What should my return to work look like when the lockdown is over?
It is best to seek the advice of your doctor about returning to work, especially if you are undergoing immunosuppressive treatment or biotherapy. If the risk is too great, your doctor may recommending starting or extending your sick leave.
If you plan to return to work, it is absolutely essential to respect social distancing (minimum 1 metre of distance from others), wear a proper mask or respirator, and wash your hands very regularly with soap or hand sanitiser gel.
How can I find support on Carenity?
Carenity currently has thousands of patients and relatives of patients affected by gastrointestinal diseases. On the platform, you can find support from other members of the community. It is important that we help one another especially in this difficult context of the COVID-19 pandemic. Feel free to join in on the discussions below!
- Biotherapy and COVID-19: Has the virus had an impact on your treatment?
- Crohn's and coronavirus: what measures should be taken?
- Coronavirus: How to keep busy while self-isolating?
- Today I feel... A coronavirus special!
Was this article helpful to you? Do you have any other tips to share with the community?
Take care and stay home!
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http://www.observatoire-crohn-rch.fr/les-mici-en-france/
https://www.inserm.fr/information-en-sante/dossiers-information/maladies-inflammatoires-chroniques-intestin-mici
https://www.afa.asso.fr/lafa-a-vos-cotes-pendant-le-confinement/
2 comments
I suffer with coeliac disease which upsets your stomach I was tested for this when I was 49 I had low foliate level of 2.5 I was anorexic ,weighed under 4 stone ,I suffered with very brittle bones, I was completely tired all the time ,when I was little I split the bone in my leg which they had to break to set it ,I had to wear a boot for a long time ,when I was diagnosed at 49 I had to have all my teeth extracted because I had no calcium, then I developed all my other illnesses it's been one thing and another ,I should have been tested for this when I was a baby as this is when my coeliac disease started from birth, if I hadn't have had a endoscopy I would have died as I was eating all the wrong foods that's what was poising all the lining in my stomach now I have to be on wheat and gluten free diet and I should have been on this from birth but when I had to change my eating habits it started all my PTSD and anxiety now I begin to wonder if coeliac disease can cause cancer as I do know its is hereditary so if you feel like I do then ask to be tested for this ,but what angers me thd most is the labelled food products everything say suitable for vegetarians and vegans but never says suitable for coeliacs and that's all people want to see things labelled properly with the coeliac logo but with coeliacs you can be wheat free ,plus dairy free and sugar free I'm now have so many illnesses I have lost count plus you can be a diabetic ,and it can also be connected to bowel cancer ,I am now borderline diabetic so if you are unsure ask for a coeliac test Tiger
I've had IBS for years but put this down to allergies to wheat, dairy, protein, nuts and many other foods, i.e. certain fruit and vegetables etc. I am also gluten and lactose intolerant which is sometimes hard to control.
I am on many medications for several conditions, i.e. high blood pressure, epilepsy, osteoporosis, stomach acid and blood thinners. I get a lot of stomach cramping, for which I take Buscopan regularly. I am on a new epilepsy medication at the moment for 12 weeks, whilst increasing dosage of one medication, and decreasing dosage of an older medication in order to gain control of seizures. I have reached the 10 week mark and got 2 more weeks to go. This obviously can cause a reaction with the other medications, as well as allergies to food products.
I spoke to my GP many months ago and he put me on a waiting list for a gastroscopy. I was contacted by the hospital and told the waiting list was then 6 months, but obviously due to COVID-19 this will be delayed for some time ahead. All I can do is persevere, and wait for the testing and results to come. I will be contacting the hospital again once the situation has settled to find out if and when there might be any progress.
Currently I take Lansoprazole for stomach acid, but this only gives a certain amount of relief. Due to other medications, the GP has me on a low dosage.
