Impact of COVID-19 on inflammatory bowel disease practice and perspectives for the future

Table 1 British Society of Gastroenterology stratification of inflammatory bowel disease patients according to the risk of severe acute respiratory syndrome coronavirus 2 infection

Highest risk patients“shielding indicated”	Moderate risk patients“stringent social distancing”	Lowest risk patients“social distancing”
Patients who either have a comorbidity (respiratory, cardiac, hypertension or diabetes mellitus) and/or age ≥ 70 yr old and are on any “moderate risk” therapy for IBD (per middle column) and/or have moderate to severely active disease.	Patients with moderate to severely active disease who are not on any of the medications in this column. Patients on the following medications: (1) anti-TNF (infliximab, adalimumab, golimumab) monotherapy; (2) biologic plus immunomodulatory in stable patients; (3) ustekinumab; (4) vedolizumab; (5) Thiopurines (azathioprine, mercaptopurine, tioguanine); (6) methotrexate; (7) calcineurin inhibitors (tacrolimus or ciclosporin); (8) JAK inhibitors (tofacitinib); (9) immunosuppressive trial medication; (10) mycophenolate mofetil; (11) thalidomide; and (12) prednisolone > 20 mg or equivalent per day	Patients on the following medications: (1) 5ASA; (2) rectal therapies; (3) orally administered topically acting steroids (budesonide or beclometasone); (4) therapies for bile acid diarrhea (colestyramine, colesevelam, colestipol); (5) anti-diarrheals (e.g., loperamide); and (6) antibiotics for bacterial overgrowth or perianal disease
Patients of any age regardless of comorbidities and who meet one or more of the following: (1) intravenous or oral steroids ≥ 20 mg prednisolone or equivalent per day (only while on this dose); (2) began biologic plus immunomodulator or systemic steroids within previous 6 wk; (3) moderate-to-severe active disease not controlled by “moderate risk” treatments; (4) short bowel syndrome requiring nutritional support; and (5) requirement for parenteral nutrition

5ASA: 5-aminosalicylic acid; IBD: Inflammatory bowel diseases; JAK: Janus kinase; TNF: Tumor necrosis factor.