Hôpital Saint-Louis, Department of Gastroenterology, APHP, Université de Paris, France.
Division of Colorectal Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
J Crohns Colitis. 2020 Oct 21;14(14 Suppl 3):S774-S779. doi: 10.1093/ecco-jcc/jjaa150.
The management of IBD has been highly affected in the context of the COVID-19 pandemic, with restriction of hospitalisations and unprecedented redeployment of health care resources. Hospital admissions of IBD patients should be limited to reduce the risks of coronavirus transmission. However, delaying hospitalisation of IBD patients with severe or complicated disease may increase the risk of poor outcomes. Delaying surgery in some cases may increase the risk of disease progression, postoperative morbidity, and disease complications. IBD patients who are infected with SARS-CoV-2 may have a higher risk of poor outcomes than the general population, potentially related to concomitant medications, especially corticosteroids. There is no evidence today that IBD patients with COVID-19 have worse outcomes if they receive immunosuppressant medications including thiopurines, biologics, and novel small molecules. This article summarises recommendations by the international membership of IOIBD regarding hospitalisations of IBD patients, either for active or complicated IBD or for severe COVID-19, and for management of IBD patients according to SARS-CoV-2 infectious status.
在 COVID-19 大流行背景下,炎症性肠病(IBD)的管理受到了极大影响,医院病床占用率受到限制,医疗资源也以前所未有的方式重新部署。应限制 IBD 患者的住院治疗,以降低冠状病毒传播的风险。然而,延迟治疗严重或复杂疾病的 IBD 患者可能会增加不良结局的风险。在某些情况下延迟手术可能会增加疾病进展、术后发病率和疾病并发症的风险。感染 SARS-CoV-2 的 IBD 患者的不良结局风险可能高于一般人群,这可能与伴随的药物治疗有关,尤其是皮质类固醇。目前尚无证据表明 COVID-19 合并 IBD 患者如果接受免疫抑制剂治疗(包括硫唑嘌呤、生物制剂和新型小分子药物)会有更差的结局。本文总结了 IOIBD 的国际成员组织针对 IBD 患者住院治疗的建议,包括活动性或复杂 IBD 或严重 COVID-19 患者的住院治疗,以及根据 SARS-CoV-2 感染状态管理 IBD 患者的建议。