The British Society of Gastroenterology (BSG) has generated a risk grid with the aim of protecting patients with inflammatory bowel disease (IBD) and the clinical services they rely on during the COVID-19 pandemic. Dr. Charlie W. Lees of the University of Edinburgh and colleagues stratified IBD patients into three risk categories: highest risk, including patients with a morbidity, advanced age, and/or moderately to severely active disease and those requiring higher doses of intravenous or oral steroids; moderate risk, including patients on most IBD medications and those with moderately to severely active disease not on any medications; and lowest risk, including patients treated with 5-acetylsalicylic acid, rectal therapies, orally administered topically active steroids, therapies for bile acid diarrhea, anti-diarrheals, or antibiotics for bacterial overgrowth or perianal disease. Highest-risk patients should follow government guidelines for social distancing and "shielding." Moderate-risk patients should practice "stringent social distancing," and lowest-risk patients should practice "social distancing." According to the guidance, published in Gut, all patients should still attend appointments for infusion of biologics, irrespective of their risk stratification. Moreover, the Working Group strongly emphasizes that patients should continue their current medications. Patients who develop symptoms suggestive of COVID-19 should follow the government recommendations about self-isolation and household quarantine. Those who test positive for SARS-CoV-2 should contact their IBD care team and stop taking certain IBD medications until 14 days after symptoms have resolved or the household quarantine period ends. The guidance reiterates recommendations recently published by the International Organization for the Study of IBD and others, including limiting face-to-face appointments and meetings where possible, maintaining phone and/or email contact with patients, and deferring endoscopy and elective surgery where possible. "The IBD community must continue to demonstrate adaptability in this rapidly moving field," the authors conclude. "Collaborative working is vital to ensure we gather as much knowledge as possible collectively, sharing ideas to provide the best outcomes for our patients as new evidence emerges." Dr. Lees did not respond to a request for comments. —Reuters Staff Source
