27th April 2020
The situation with Covid-19 has had a significant impact on healthcare for patients with confirmed or suspected IBD. Hospital services have stopped doing almost all routine work so that wards and staff can be diverted to dealing with patients with Covid-19. Endoscopy has been affected, but urgent and suspected cancer investigations are still happening. Access to blood tests and faecal calprotectin is harder, and some hospital trusts have temporarily stopped doing the latter. All patients who are due a colonoscopy will be have their notes reviewed and will be written to if it is appropriate to delay their colonoscopy. If patients have been given a date for a colonoscopy then please encourage them to attend.
Shielding has been the source of much discussion, with the government stating that patients would be contacted at the end of March then retracting that promise as it became clear that the initial guidance did not match that issued by specialist organisations. The British Society of Gastroenterology have produced a grid to help determine who falls into the highest, moderate, or lowest risk groups and the IBD registry have turned this into a useful interactive tool to assess and share risk scores with secondary care. Patients in the highest-risk category should have their care delivered at home where possible, although visits to healthcare facilities (for infusions and some blood tests) can still be carried out where this is done in a manner that keeps the risk of exposure to an minimum.
The symptoms of Covid-19 can include abdominal pain and diarrhoea, and it can be difficult to know if these are the symptoms of a flare. For those patients with new onset persistent symptoms, please do not assume that any gastrointestinal symptoms may be due to Covid-19.
For those patients on medication, much has been written about the risks versus benefits of immunosuppressants. Almost every patient will be at a lower risk of Covid-19 if they continue their prescribed medication than if they stop or reduce their dose against medical advice and then suffer a flare with subsequent hospitalisation and high systemic steroid doses. The one exception to this is patients taking high dose prednisolone, and these patients should have had a discussion with their IBD team about their risk. Patients should not stop prednisolone suddenly because of the risk of an adrenal crisis occurring.
As well as the advice for patients on the Crohn’s & Colitis UK website, the BSG have published guidance for the management of Inflammatory Bowel Disease during the COVID-19 pandemic to help balance the risks of Covid-19 against those of undertreated, active IBD. NICE has released a rapid guideline to help secondary care manage patients with gastrointestinal and liver conditions treated with immunosuppressants, however guidance specifically for primary care is still needed.
The advice regarding Covid-19 has changed on a daily basis over the last month, but the situation is now settling. It looks like we will be stuck in some form of lockdown for several months. As the BSG said “Take care of yourself but also be kind and considerate to others in these difficult times”