COVID-19 and Alimentary Tract: Current Evidence and Recent Recommendations

The pandemic of coronavirus disease 2019 (COVID-19), first reported in China, in December 2019 and since then the digestive tract involvement of COVID-19 has been progressively described. In this review, I summed recent studies, which have addressed the pathophysiology of COVID-19-induced gastrointestinal symptoms, their prevalence, and bowel pathological and radiological findings of infected patients. The effects of gut microbiota on SARS-CoV-2 and the challenges of nutritional therapy of the infected patients are depicted. Moreover, I provide a concise summary of the recommendations on the management of inflammatory bowel disease, colorectal cancer, and performing endoscopy in the COVID era. Finally, the COVID pancreatic relation was explored. Conclusions: digestive symptoms in COVID-19 patients can be the only manifestation and they may be correlated with worse clinical outcomes. The likelihood of fecal-oral transmission of COVID-19 has significant consequences and requires further research. A clear link may exist between the gut microbiome and COVID-19 progression and it may have a therapeutic and prognostic value. No evidence for an increased frequency of covid-19 cases in IBD and stopping immunosuppressive medications is not advised. Triage and risk assessment of patients with suspected or confirmed COVID-19 before endoscopy is essential; deferral of elective endoscopies should be considered.

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New Coronavirus Infection (COVID-19) and Digestive System

Russian Journal of Gastroenterology Hepatology Coloproctology ◽

10.22416/1382-4376-2020-30-3-7 ◽

2020 ◽

Vol 30 (3) ◽

pp. 7-13 ◽

Cited By ~ 8

Author(s):

V. T. Ivashkin ◽

A. A. Sheptulin ◽

O. Yu. Zolnikova ◽

A. V. Okhlobystin ◽

E. A. Poluektova ◽

...

Keyword(s):

Digestive System ◽

Gastrointestinal Symptoms ◽

Elevated Risk ◽

Current Evidence ◽

Transaminase Activity ◽

Key Points ◽

Bowel Diseases ◽

Inflammatory Bowel ◽

Coronavirus Infection ◽

Chronic Inflammatory Bowel

Aim. The study reviews current evidence on digestive system lesions provoked by the new COVID-19 coronavirus infection.Key points. Alongside the destructive impact on respiratory system, COVID-19 manifests itself in gastrointestinal symptoms (nausea, vomiting, diarrhoea) that may precede respiratory signs and prevail in the clinical picture of infection. Patients with chronic inflammatory bowel diseases receiving immunosuppressive therapy are at elevated risk of severe COVID-19 progression. The new coronavirus infection may induce liver damage with increased transaminase activity.Conclusion. Association of digestive system lesions with COVID-19 remains understudied and requires further research.

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Genital and Intertriginous Rashes Refractory to Antimicrobial Treatments: Have You Thought about Crohn’s Disease?

Case Reports in Pediatrics ◽

10.1155/2021/5578810 ◽

2021 ◽

Vol 2021 ◽

pp. 1-3

Author(s):

Candelaria O’Farrell ◽

Annette Roberts ◽

Claudia Riera Canales ◽

Carrie Firestone Baum ◽

Lina Maria Felipez

Keyword(s):

Inflammatory Bowel Disease ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Gastrointestinal Symptoms ◽

Extraintestinal Manifestations ◽

Extraintestinal Manifestation ◽

Tract Involvement ◽

Inflammatory Bowel ◽

Antimicrobial Treatments ◽

Bloody Stools

Crohn’s disease is an inflammatory bowel disease that can have multiple extraintestinal manifestations and can develop prior to, following, or simultaneously with gastrointestinal tract involvement (Aberumand et al. (2017), Georgious et al. (2006), Larsen et al. (2010), Levine and Burakoff (2011), Louis et al. (2018)). This report examines the case of a 16-year-old male with a rash of the genital, intergluteal, and inguinal regions refractory to antimicrobial treatments suspicious for an extraintestinal manifestation of Crohn’s disease. The patient was diagnosed with inflammatory, nonfistulizing colonic Crohn’s disease following presentation with gastrointestinal symptoms including abdominal pain and bloody stools 6 months after the onset of the rash. The genital lesions resolved after starting treatment for Crohn’s disease with adalimumab.

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Therapeutic Implications of Diet in Inflammatory Bowel Disease and Related Immune-Mediated Inflammatory Diseases

Nutrients ◽

10.3390/nu13030890 ◽

2021 ◽

Vol 13 (3) ◽

pp. 890

Author(s):

Yan Jiang ◽

Karolin Jarr ◽

Cosima Layton ◽

Christopher D. Gardner ◽

Judith F. Ashouri ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Clinical Trials ◽

Bowel Disease ◽

Inflammatory Diseases ◽

Gastrointestinal Symptoms ◽

Current Evidence ◽

Therapeutic Implications ◽

Additional Information ◽

Immune Mediated ◽

Inflammatory Bowel

Despite being a focal issue to patients, the effect of diet on adult inflammatory bowel disease (IBD) remains underexplored with limited guidance. While promising clinical trials are currently underway, there is a need for further evidence-based recommendations. As such, we summarize the current evidence on various diets used in the treatment of IBD and also explore the potential applications of dietary data from related immune-mediated inflammatory diseases (IMIDs), such as rheumatoid arthritis and psoriasis, to provide additional information to inform IBD providers. To date, there have been multiple diets investigated as adjunctive therapy in IBD, but many associated studies are small, non-randomized, and not controlled. Mediterranean, vegetarian/vegan, and reduced-calorie/fasting diets have been studied and have shown some positive results in other IMIDs, which may suggest potential applicability to those with IBD, but larger, well-designed clinical trials are needed for further guidance. Gluten-free and low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP)diets do not appear to have an impact on IBD disease activity, but low FODMAP may potentially be helpful for those with concurrent functional gastrointestinal symptoms. Specific carbohydrate diets have been mainly assessed in children but show some potential in small adult studies.

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Lactobacillus Reuteri DSM 17938 (Limosilactobacillus reuteri) in Diarrhea and Constipation: Two Sides of the Same Coin?

Medicina ◽

10.3390/medicina57070643 ◽

2021 ◽

Vol 57 (7) ◽

pp. 643

Author(s):

Angela Saviano ◽

Mattia Brigida ◽

Alessio Migneco ◽

Gayani Gunawardena ◽

Christian Zanza ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Emergency Department ◽

Abdominal Pain ◽

Human Health ◽

Bowel Disease ◽

Chronic Constipation ◽

Lactobacillus Reuteri ◽

Current Knowledge ◽

Gastrointestinal Symptoms ◽

Inflammatory Bowel

Background and Objectives: Lactobacillus reuteri DSM 17938 (L. reuteri) is a probiotic that can colonize different human body sites, including primarily the gastrointestinal tract, but also the urinary tract, the skin, and breast milk. Literature data showed that the administration of L. reuteri can be beneficial to human health. The aim of this review was to summarize current knowledge on the role of L. reuteri in the management of gastrointestinal symptoms, abdominal pain, diarrhea and constipation, both in adults and children, which are frequent reasons for admission to the emergency department (ED), in order to promote the best selection of probiotic type in the treatment of these uncomfortable and common symptoms. Materials and Methods: We searched articles on PubMed® from January 2011 to January 2021. Results: Numerous clinical studies suggested that L. reuteri may be helpful in modulating gut microbiota, eliminating infections, and attenuating the gastrointestinal symptoms of enteric colitis, antibiotic-associated diarrhea (also related to the treatment of Helicobacter pylori (HP) infection), irritable bowel syndrome, inflammatory bowel disease, and chronic constipation. In both children and in adults, L. reuteri shortens the duration of acute infectious diarrhea and improves abdominal pain in patients with colitis or inflammatory bowel disease. It can ameliorate dyspepsia and symptoms of gastritis in patients with HP infection. Moreover, it improves gut motility and chronic constipation. Conclusion: Currently, probiotics are widely used to prevent and treat numerous gastrointestinal disorders. In our opinion, L. reuteri meets all the requirements to be considered a safe, well-tolerated, and efficacious probiotic that is able to contribute to the beneficial effects on gut-human health, preventing and treating many gastrointestinal symptoms, and speeding up the recovery and discharge of patients accessing the emergency department.

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Secukinumab as a potential trigger of inflammatory bowel disease in ankylosing spondylitis or psoriatic arthritis patients

Rheumatology ◽

10.1093/rheumatology/keab193 ◽

2021 ◽

Cited By ~ 1

Author(s):

Ioana A Onac ◽

Benjamin D Clarke ◽

Cristina Tacu ◽

Mark Lloyd ◽

Vijay Hajela ◽

...

Keyword(s):

Alternative Explanation ◽

Drug Withdrawal ◽

De Novo ◽

Gastrointestinal Symptoms ◽

Temporal Association ◽

Objective Evidence ◽

Baseline Evaluation ◽

Biopsy Confirmation ◽

Potential Trigger ◽

Inflammatory Bowel

Abstract Objective Real-world secukinumab gastrointestinal-related adverse events (GIRAE) data during treatment for AS and PsA are lacking. We aimed to obtain this through baseline evaluation of pre-existing IBD rates and predictors of GIRAE. Methods Patient electronic and paper records commencing secukinumab from 10 UK hospitals between 2016 and 2019 were reviewed. GIRAE after initiation were defined as: definite [objective evidence of IBD (biopsy proven), clear temporal association, resolution of symptoms on drug withdrawal, no alternative explanation felt more likely], probable (as per definite, but without biopsy confirmation) or possible (gastrointestinal symptoms not fulfilling definite or probable criteria). Results Data for all 306 patients started on secukinumab were analysed: 124 (40.5%) AS and 182 (59.5%) PsA. Twenty-four of 306 (7.8%) experienced GIRAE after starting secukinumab. Amongst patients who developed GIRAE, four (1.3%) had definite, seven (2.3%) probable and 13 (4.2%) possible IBD. All definite cases were patients with AS and stopped secukinumab; two had pre-existing IBD and two (0.7%) were de novo cases of which one required surgical intervention. Seven patients (2.3%) had pre-existing diagnoses of IBD prior to initiation, of which five patients experienced GIRAE. Conclusion Absolute rates of new IBD in patients starting secukinumab are low. The majority of patients developing new GIRAE did not develop objective evidence of IBD or stop therapy. For patients with pre-existing IBD and AS the risk of GIRAE is much higher, and prescribing alternatives should be considered.

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Impact of COVID-19 on the diagnosis, assessment and management of children with inflammatory bowel disease in the UK: implications for practice

BMJ Paediatrics Open ◽

10.1136/bmjpo-2020-000786 ◽

2020 ◽

Vol 4 (1) ◽

pp. e000786

Author(s):

Abbie Maclean ◽

James J Ashton ◽

Vikki Garrick ◽

R Mark Beattie ◽

Richard Hansen

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Delayed Diagnosis ◽

High Standard ◽

Current Evidence ◽

Faecal Calprotectin ◽

Paediatric Patients ◽

Inflammatory Bowel ◽

Working Practices ◽

The Impact

The assessment and management of patients with known, or suspected, paediatric inflammatory bowel disease (PIBD) has been hugely impacted by the COVID-19 pandemic. Although current evidence of the impact of COVID-19 infection in children with PIBD has provided a degree of reassurance, there continues to be the potential for significant secondary harm caused by the changes to normal working practices and reorganisation of services.Disruption to the normal running of diagnostic and assessment procedures, such as endoscopy, has resulted in the potential for secondary harm to patients including delayed diagnosis and delay in treatment. Difficult management decisions have been made in order to minimise COVID-19 risk for this patient group while avoiding harm. Initiating and continuing immunosuppressive and biological therapies in the absence of normal surveillance and diagnostic procedures have posed many challenges.Despite this, changes to working practices, including virtual clinic appointments, home faecal calprotectin testing kits and continued intensive support from clinical nurse specialists and other members of the multidisciplinary team, have resulted in patients still receiving a high standard of care, with those who require face-to-face intervention being highlighted.These changes have the potential to revolutionise the way in which patients receive routine care in the future, with the inclusion of telemedicine increasingly attractive for stable patients. There is also the need to use lessons learnt from this pandemic to plan for a possible second wave, or future pandemics as well as implementing some permanent changes to normal working practices.In this review, we describe the diagnosis, management and direct impact of COVID-19 in paediatric patients with IBD. We summarise the guidance and describe the implemented changes, evolving evidence and the implications of this virus on paediatric patients with IBD and working practices.

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Management of Crohn’s disease in an immunosuppressed COVID-19-positive patient: safety-driven prioritisation of nutritional therapy as a bridge to restarting immunosuppression

BMJ Case Reports ◽

10.1136/bcr-2020-239404 ◽

2021 ◽

Vol 14 (3) ◽

pp. e239404

Author(s):

Clare Harris ◽

Richard James Harris ◽

Louise Downey ◽

Markus Gwiggner

Keyword(s):

Risk Factors ◽

Inflammatory Bowel Disease ◽

Patient Safety ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Nutritional Therapy ◽

Interleukin 12 ◽

Inflammatory Bowel ◽

Term Maintenance

Active inflammatory bowel disease (IBD), combined immunosuppression and corticosteroid therapy have all been identified as risk factors for a poor outcome in COVID-19 infection. The management of patients with both COVID-19 infection and active IBD is therefore complex. We present the case of a 31-year-old patient with Crohn’s disease, on dual immunosuppression with infliximab and mercaptopurine presenting with inflammatory small bowel obstruction and COVID-19 infection. The case highlights the use of nutritional therapy, which remains underused in the management of adults with IBD, to manage his flare acutely. Following negative SARS-CoV-2 PCR testing and SARS-CoV-2 IgG testing confirming an antibody response, ustekinumab (anti-interleukin 12/23) was prescribed for long-term maintenance.

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Food and Food Groups in Inflammatory Bowel Disease (IBD): The Design of the Groningen Anti-Inflammatory Diet (GrAID)

Nutrients ◽

10.3390/nu13041067 ◽

2021 ◽

Vol 13 (4) ◽

pp. 1067

Author(s):

Marjo J. E. Campmans-Kuijpers ◽

Gerard Dijkstra

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Food Group ◽

Dietary Guidelines ◽

Current Evidence ◽

Group Level ◽

Food Groups ◽

Inflammatory Bowel ◽

Anti Inflammatory

Diet plays a pivotal role in the onset and course of inflammatory bowel disease (IBD). Patients are keen to know what to eat to reduce symptoms and flares, but dietary guidelines are lacking. To advice patients, an overview of the current evidence on food (group) level is needed. This narrative review studies the effects of food (groups) on the onset and course of IBD and if not available the effects in healthy subjects or animal and in vitro IBD models. Based on this evidence the Groningen anti-inflammatory diet (GrAID) was designed and compared on food (group) level to other existing IBD diets. Although on several foods conflicting results were found, this review provides patients a good overview. Based on this evidence, the GrAID consists of lean meat, eggs, fish, plain dairy (such as milk, yoghurt, kefir and hard cheeses), fruit, vegetables, legumes, wheat, coffee, tea and honey. Red meat, other dairy products and sugar should be limited. Canned and processed foods, alcohol and sweetened beverages should be avoided. This comprehensive review focuses on anti-inflammatory properties of foods providing IBD patients with the best evidence on which foods they should eat or avoid to reduce flares. This was used to design the GrAID.

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Butyrate and the Fine-Tuning of Colonic Homeostasis: Implication for Inflammatory Bowel Diseases

International Journal of Molecular Sciences ◽

10.3390/ijms22063061 ◽

2021 ◽

Vol 22 (6) ◽

pp. 3061

Author(s):

Naschla Gasaly ◽

Marcela A. Hermoso ◽

Martín Gotteland

Keyword(s):

Inflammatory Bowel Diseases ◽

Barrier Function ◽

Cell Types ◽

Fine Tuning ◽

Current Evidence ◽

Aryl Hydrocarbon ◽

Gut Barrier Function ◽

Bowel Diseases ◽

Inflammatory Processes ◽

Inflammatory Bowel

This review describes current evidence supporting butyrate impact in the homeostatic regulation of the digestive ecosystem in health and inflammatory bowel diseases (IBDs). Butyrate is mainly produced by bacteria from the Firmicutes phylum. It stimulates mature colonocytes and inhibits undifferentiated malignant and stem cells. Butyrate oxidation in mature colonocytes (1) produces 70–80% of their energetic requirements, (2) prevents stem cell inhibition by limiting butyrate access to crypts, and (3) consumes oxygen, generating hypoxia and maintaining luminal anaerobiosis favorable to the microbiota. Butyrate stimulates the aryl hydrocarbon receptor (AhR), the GPR41 and GPR109A receptors, and inhibits HDAC in different cell types, thus stabilizing the gut barrier function and decreasing inflammatory processes. However, some studies indicate contrary effects according to butyrate concentrations. IBD patients exhibit a lower abundance of butyrate-producing bacteria and butyrate content. Additionally, colonocyte butyrate oxidation is depressed in these subjects, lowering luminal anaerobiosis and facilitating the expansion of Enterobacteriaceae that contribute to inflammation. Accordingly, gut dysbiosis and decreased barrier function in IBD seems to be secondary to the impaired mitochondrial disturbance in colonic epithelial cells.

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