Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 21, 2021; 27(11): 1022-1042
Published online Mar 21, 2021. doi: 10.3748/wjg.v27.i11.1022
How to manage inflammatory bowel disease during the COVID-19 pandemic: A guide for the practicing clinician
Júlio Maria Fonseca Chebli, Natália Sousa Freitas Queiroz, Adérson Omar Mourão Cintra Damião, Liliana Andrade Chebli, Márcia Henriques de Magalhães Costa, Rogério Serafim Parra
Júlio Maria Fonseca Chebli, Liliana Andrade Chebli, Division of Gastroenterology, Department of Medicine, Inflammatory Bowel Disease Center, Federal University of Juiz de Fora, Juiz de Fora 36036-900, MG, Brazil
Natália Sousa Freitas Queiroz, Adérson Omar Mourão Cintra Damião, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo 05403-000, SP, Brazil
Márcia Henriques de Magalhães Costa, Department of Clinical Medicine, Fluminense Federal University, Rio de Janeiro 24210-200, RJ, Brazil
Rogério Serafim Parra, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14048-900, SP, Brazil
Author contributions: All authors equally contributed to data collection, data interpretation, and literature review; all authors wrote the paper and contributed to critical revision of the manuscript; all authors granted final approval of the version to be published and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work were appropriately investigated and resolved.
Conflict-of-interest statement: Parra RS has received fees for serving as a speaker and/or an advisory board member for AbbVie, Ferring Pharmaceuticals, Janssen, and Takeda. Chebli JMF has received fees for serving as a speaker and/or an advisory board member for Abbott, AbbVie, Janssen, and Takeda. Chebli LA has received fees for serving as a speaker for Janssen and Takeda. Queiroz NSF reports receiving consulting and lecture fees from Janssen, Takeda, and Abbvie. Damião AOMC has received fees for serving as a speaker and/or an advisory board member for Takeda, Abbvie, Pfizer, Janssen, Ferring, and Natulab.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Rogério Serafim Parra, MD, PhD, Assistant Professor, Staff Physician, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto 14048-900, SP, Brazil.
Received: January 24, 2021
Peer-review started: January 24, 2021
First decision: February 10, 2021
Revised: February 11, 2021
Accepted: March 11, 2021
Article in press: March 11, 2021
Published online: March 21, 2021

Managing inflammatory bowel disease (IBD) during the coronavirus disease 2019 (COVID-19) pandemic has been a challenge faced by clinicians and their patients, especially concerning whether to proceed with biologics and immunosuppressive agents in the background of a global outbreak of a highly contagious new coronavirus (severe acute respiratory syndrome coronavirus 2, SARS-CoV-2). The knowledge about the impact of this virus on patients with IBD, although it is still scarce, is rapidly evolving. In particular, concerns surrounding medications’ impact for IBD on the risk of acquiring SARS-CoV-2 infection or developing COVID-19, and potentially exacerbate viral replication and the COVID-19 course, are a current thinking of both practicing clinicians and providers caring for patients with IBD. Managing patients with IBD infected with SARS-CoV-2 depends on both the clinical activity of the IBD and the occasional development and severity of COVID-19. In this review, we summarize the current data regarding gastrointestinal involvement by SARS-CoV-2 and pharmacologic and surgical management for IBD concerning this infection, and the COVID-19 impact on both the patient's psychological functioning and endoscopy services, and we concisely summarize the telemedicine roles during the COVID-19 pandemic.

Keywords: Inflammatory bowel disease, SARS-CoV-2, COVID-19, Crohn disease, Colitis ulcerative, Biological therapy

Core Tip: The knowledge on coronavirus disease 2019 (COVID-19) is rapidly evolving. Although patients with inflammatory bowel disease (IBD) do not appear to be at increased risk for COVID-19, the potential impact of immunosuppressive therapies on patients with IBD infected with severe acute respiratory syndrome coronavirus 2 calls for concern for clinicians and patients. Several recommendations and guidelines have recently been published, including the necessary reorganization of gastroenterology and endoscopy services to attendance of these patients, the growing role played by telemedicine, and the importance of addressing aspects of mental health in this context. We provide an overview and practical guidance for managing patients with IBD medically and surgically in the COVID-19 era.