Gastrointestinal and hepatic diseases during the COVID-19 pandemic: Manifestations, mechanism and management

doi:10.3748/wjg.v27.i28.4504

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Jul 28, 2021 (publication date) through Apr 23, 2024

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastroenterol. Jul 28, 2021; 27(28): 4504-4535
Published online Jul 28, 2021. doi: 10.3748/wjg.v27.i28.4504

Table 2 Therapy-specific considerations for inflammatory bowel disease patients

Drug	Effects
Aminosalicylate acid derivatives (5-ASA)	No proof of increased risk of COVID-19 infection
Aminosalicylate acid derivatives (5-ASA)	Continue treatment even in the case of COVID-19 infection
Corticosteroids	Their safety during COVID-19 infection is uncertain
	They can be used at a low dose and for a short period to treat disease relapses
	Discontinue as soon as possible
	Ileo-cecal CD patients can be treated with Budesonide; IUC patients can be treated with Budesonide MMX
Immunomodulators (Thiopurines and Methotrexate)	No proof of increased risk of COVID-19 infection
	Accompanied by increased risk of other viral infection
	Not recommended to start with monotherapy
	Combination therapy with biologics should be maintained
	Recommendations in stopping
	Stable disease
	Sustained reduction in the case of elderly patients and/or significant comorbidities
	Symptom progression of COVID-19 infection
Anti-TNF therapy	No proof of increased risk of COVID-19 infection
	Infusion and dose intervals should be maintained
	Starting with monotherapy (adalimumab or certolizumab)
	Stop in the case of developing symptoms of COVID-19
Anti-IL-12/23p40 therapy (Ustekinumab)	No proof of increased risk of COVID-19 infection
	Monotherapy is recommended
	Stop in the case of developing symptoms of COVID-19
Anti-a4b7 integrin therapy (Vedolizumab)	No proof of increased risk of COVID-19 infection
	Monotherapy is recommended
	Stop in the case of developing symptoms of COVID-19
Janus Kinase inhibitors (tofacitinib)	Although there is no proof of increasing the risk of COVID-19 infection, it may inhibit the immune reaction against viral infections
	Starting is not recommended
	Therapy should be maintained without elevating the dose
	Stop if symptoms of COVID-19 develop

UC: Ulcerative colitis; CD: Crohn’s disease; COVID-19: Coronavirus disease 2019; TNF: Tumor necrosis factor; IL: Interleukin.

Citation: Mohamed DZ, Ghoneim MES, Abu-Risha SES, Abdelsalam RA, Farag MA. Gastrointestinal and hepatic diseases during the COVID-19 pandemic: Manifestations, mechanism and management. World J Gastroenterol 2021; 27(28): 4504-4535
URL: https://www.wjgnet.com/1007-9327/full/v27/i28/4504.htm
DOI: https://dx.doi.org/10.3748/wjg.v27.i28.4504