In this installment of The Regueiro Report, Miguel Regueiro, MD, a professor of medicine and the chair of the Department of Gastroenterology, Hepatology and Nutrition at Cleveland Clinic in Cleveland, highlights discussion topics covered during a recent Inflammatory Bowel Disease Live Interinstitutional Interdisciplinary Videoconference Education (IBD Live) meeting hosted by Cleveland Clinic gastroenterologists and colorectal surgeons.

Dr. Regueiro:

We’ve been holding the IBD Live virtual IBD educational conference once a week for several years, but recently attendance has doubled and some weeks even tripled. Over 200 physicians from up to 30 sites internationally have joined us on some days. I think the popularity underlines that in the era of COVID-19, virtual conferencing has really taken off and is filling an important need for information sharing. It allows participants to join from their home or office, and for providers joining from their hospital, it’s an opportunity to be in the same room as their peers and to hold discussions on-site following the meeting. I think virtual conferencing will be the new educational platform moving forward, not only because of the need to be physically distant now, but even after the pandemic has passed, and allows a broad audience from many sites to join without needing to travel. In addition, IBD Live is continuing medical education accredited through Cleveland Clinic.

When it comes to COVID-19, we’ve had important presentations during IBD Live. We have ongoing updates on what we know about the disease and how it affects those with IBD. As highlighted below, the SECURE-IBD registry offers providers an important snapshot of how COVID-19 is playing out in this patient population. During a recent IBD Live meeting, we also discussed the work done by the International Organization for the Study of Inflammatory Bowel Disease (IOIBD), which is a group of physicians and researchers who have dedicated their careers to understanding and investigating IBD. Most recently, the group has issued an opinion statement on the impact of IBD medications on COVID-19. I think readers will find it a useful resource.

A Registry for IBD Patients With COVID-19

The web-based SECURE-IBD registry includes a variety of clinician-provided data on IBD patients with confirmed and resolved COVID-19, ranging from the demographic to the clinical. The registry is updated three times each week, and an entry takes about five minutes to complete, said Ryan Ungaro, MD, MS, an assistant professor at the Susan and Leonard Feinstein IBD Clinical Center at Icahn School of Medicine at Mount Sinai in New York City, who helped build the registry.

“The goal is to help keep the gastroenterology community informed in this rapidly changing area and particularly to learn if common immune-suppressing IBD medications impact the risk of severe disease,” Dr. Ungaro said.

By late April, the registry included data on nearly 600 patients with IBD and COVID-19 from 30 countries. The findings are encouraging. According to Dr. Ungaro, the only IBD medications that seem to be associated with poorer outcomes from COVID-19 are corticosteroids, while moderate to severe active disease also places patients at risk for more severe symptoms of the infection.

“The best thing for IBD patients to do is maintain remission and avoid steroids,” Dr. Ungaro said.

IBD Management During the COVID-19 Pandemic

Is it safe to receive treatment at an infusion center during the COVID-19 pandemic? Does budesonide increase the risk for infection with SARS-CoV-2, the virus that causes COVID-19? Should patients receiving prednisone stop the drug if they develop COVID-19? These are some of the questions 66 IBD experts addressed and published online in Gastroenterology. David Rubin, MD, a professor of medicine and the chief of gastroenterology at the University of Chicago Medicine, and other members of IOIBD opined on 76 statements covering everything from medication-related risk for COVID-19 to the wisdom of proceeding with elective endoscopies during the pandemic. The fact that the experts agreed on 84% of the statements should reassure providers that they can implement most of these recommendations without needing to distract themselves from their daily responsibilities.

Remember to Distinguish Between IBD and COVID-19

When your IBD patients present with what seems like a flare, keep in mind they could be experiencing the gastrointestinal symptoms of COVID-19, cautioned Sara El Ouali, MD, an IBD fellow in the Department of Gastroenterology, Hepatology and Nutrition in Cleveland Clinic’s Digestive Disease and Surgery Institute.

“Data from the United States suggests that up to 60% of COVID-19 patients may have diarrhea, loss of appetite or vomiting,” said Dr. El Ouali, who presented during a recent IBD Live webinar. Co-occurrence of fever, shortness of breath and cough, as well loss of smell or taste, should increase the clinical index of suspicion that a patient is experiencing COVID-19 symptoms, Dr. El Ouali said. She noted that inflammatory markers like fecal calprotectin are not helpful in differentiating between IBD and COVID-19, as levels of the protein also are elevated in those with the virus. 

—David Wild