What People with Crohn's Disease or Ulcerative Colitis Should Know About COVID-19

Daniel Marcus';

By Daniel Marcus

Posted on December 19th, 2020 in Covid-19

At Cedars-Sinai Marina del Rey Hospital we understand that there’s a lot of information in the news about COVID-19 and you may be concerned.

While all individuals are at risk for getting COVID-19 if they are exposed to the virus, this risk is of particular concern to those with weakened immune systems because of disease or pharmacologic therapy.

Inflammatory bowel disease (IBD) - not to be confused with irritable bowel syndrome (IBS) - is a condition of an overactive immune system and is often treated with immune modification or immune suppression. Some of the medications may have different risks for complications than others. For instance, available data have shown that prolonged use of systemic corticosteroids puts patients who get COVID at increased risk for developing serious complications. Therefore, if you are on this medication, you may need additional protection and should discuss it with your gastroenterologist.

Patients With IBD Treated with Immunomodulators, Biologics, and Jak Inhibitors Are More Susceptible to Infection

Inflammatory bowel disease includes two distinct conditions: ulcerative colitis and Crohn’s disease. Together they affect about 1.6 million Americans, causing:

  • abdominal pain
  • persistent diarrhea
  • rectal bleeding
  • weight loss
  • fatigue

In patients who suffer from IBD, the immune system itself becomes the enemy. Even when the body faces no threat, T helper cells, also known as CD4-positive cells, take up arms against imaginary enemies, resulting in a kind of perpetual warfare that causes "collateral damage" to the gut.

Inflammatory bowel disease (IBD) patients are presumed to be vulnerable, particularly those on biological therapy as well as immunosuppressants and/or oral steroids.

Am I at an Increased Risk of Getting COVID-19 Because I Have Crohn’s or Ulcerative Colitis?

Current data provided by the Surveillance Epidemiology of Coronavirus Under Research Exclusion for Inflammatory Bowel Disease (SECURE-IBD) does not reveal higher risks of infection, more severe outcomes, or important differences in disease course between IBD patients and non-IBD patients with a confirmed infection caused by the novel coronavirus.

Solely by having IBD does not categorize you into a high-risk group, but certain related factors might:

  • IBD patients whose condition is not well-controlled may face an increased risk
  • Patients with IBS may have significant nutrient deficiencies, which could, in turn, make them more susceptible to catching a viral infection such as COVID-19
  • During a flare or whilst on certain medications IBD patients may be at increased risk of complications
  • Corticosteroids, such as prednisone, are associated with adverse COVID-19 outcomes in patients with Crohn’s disease or ulcerative colitis

"In patients who have IBD, gastrointestinal symptoms such as abdominal discomfort, vomiting, more frequent bowel movements, and diarrhea could be mistaken for IBD flare-ups. Our unique concern here is to distinguish between someone who is having a relapse of inflammatory bowel disease, compared to someone who might be having coronavirus symptoms. We are working hard with our patients and carrying out scientific research to figure this out”, says Dr. Mayur Trivedi - a board-certified gastroenterologist at Cedars-Sinai Marina del Rey Hospital.

What Should I Do If I Have IBD and Have COVID-19 Symptoms?

Patients with inflammatory bowel disease diagnosed with COVID-19 will have the same symptoms as the general population of patients who don't have IBD: fever, cough, and other respiratory symptoms, which might progress to shortness of breath.

Digestive symptoms, such as loss of appetite, nausea, vomiting, diarrhea, and generalized abdominal pain, have been associated with COVID-19 as well. Call your doctor to know right away if you develop some of these symptoms or if you're worried that you might have developed COVID-19.

Reminders for IBD patients:

  • Adhere to CDC guidelines for minimizing infection risk
  • Stock up on necessary medications that can last a few weeks
  • Stay on your medications to avoid flare-ups
  • Seek care you're experiencing a flare-up
  • Talk to your doctor if exposed, test positive, or have signs of COVID-19
  • Postpone elective surgery or procedures

IBD Patients Are Eligible to Receive COVID-19 Vaccines

According to the International Organization for the Study of Inflammatory Bowel Disease recommendations, patients with IBD should receive the COVID-19 vaccine as soon as possible. Patients with Crohn’s or ulcerative colitis should be offered the opportunity to discuss the risks and benefits of vaccination with their health care professionals, and make a vaccination decision based on their individual risk factors.

IBD patients receiving specific types of immunosuppressive therapies may have a reduced vaccine immune response, nonetheless, vaccination should not be deferred only because they are receiving those treatments. However, people with IBD who receive a coronavirus vaccine should be advised by their healthcare team on potential decreased vaccine efficacy.

Our Gastroenterologists Are at the Forefront of Understanding COVID-19 in IBD Patients

For people living with IBD, flare-ups occur randomly and are often unpredictable, lasting hours, days, or weeks. It is therefore important that you have full access to advice and support. Cedars-Sinai Marina del Rey Hospital runs a great IBD service that encompasses all aspects of IBD care: medical, nursing, and surgical treatments, as well as psychological and nutritional support. Our experienced team at Cedars-Sinai Marina del Rey Hospital continues to safely provide care for our patients during the coronavirus pandemic.