Outcomes of COVID-19 in 79 patients with IBD in Italy : an IG-IBD study

COVID-19 has rapidly become a major health emergency worldwide. Patients with IBD are at increased risk of infection, especially when they have active disease and are taking immunosuppressive therapy. The characteristics and outcomes of COVID-19 in patients with IBD remain unclear. Design: This Italian prospective observational cohort study enrolled consecutive patients with an established IBD diagnosis and confirmed COVID-19. Data regarding age, sex, IBD (type, treatments and clinical activity), other comorbidities (Charlson Comorbidity Index (CCI)), signs and symptoms of COVID-19 and therapies were compared with COVID-19 outcomes (pneumonia, hospitalisation, respiratory therapy and death). Results: Between 11 and 29 March 2020, 79 patients with IBD with COVID-19 were enrolled at 24 IBD referral units. Thirty-six patients had COVID-19-related pneumonia (46%), 22 (28%) were hospitalised, 7 (9%) required non-mechanical ventilation, 9 (11%) required continuous positive airway pressure therapy, 2 (3%) had endotracheal intubation and 6 (8%) died. Four patients (6%) were diagnosed with COVID-19 while they were being hospitalised for a severe flare of IBD. Age over 65 years (p=0.03), UC diagnosis (p=0.03), IBD activity (p=0.003) and a CCI score >1 (p=0.04) were significantly associated with COVID-19 pneumonia, whereas concomitant IBD treatments were not. Age over 65 years (p=0.002), active IBD (p=0.02) and higher CCI score were significantly associated with COVID-19-related death. Conclusions: Active IBD, old age and comorbidities were associated with a negative COVID-19 outcome, whereas IBD treatments were not. Preventing acute IBD flares may avoid fatal COVID-19 in patients with IBD. Further research is needed

Inflammatory bowel disease course in liver transplant versus non-liver transplant patients for primary sclerosing cholangitis: LIVIBD, an IG-IBD study

Background: Data regarding the effect of orthotopic liver transplantation (OLT) for primary sclerosing cholangitis (PSC) on inflammatory bowel disease (IBD) course are scarce and conflicting. Aims: To compare the incidence of refractory IBD in two groups (OLT and non-OLT) of patients affected by IBD and PSC. Methods: An observational, multicentre, cohort retrospective study was conducted by the Italian Group for the study of IBD in Italy. The primary outcome was the need for biologic therapy or bowel resection for medically refractory IBD or hospitalization due to IBD relapse during the follow-up. Secondary outcomes were rate of colonic dysplasia, colorectal cancer, other solid tumours, lymphoma. Results: Eighty-four patients were included in the study. The primary outcome was not different between OLT and non-OLT groups (11/27, 40.7%, versus 20/57, 35.1%, respectively, p = 0.62). The lymphoma and other tumours (thyroid cancer, kidney cancer, ileal tumour, ovarian cancer, cervical cancer) rates were significantly higher in the OLT group (p = 0.04 and p = 0.005, respectively), at the limit of statistical significance for high-grade colonic dysplasia (p = 0.06). Conclusion: OLT in patients affected by IBD and PSC is not a risk factor for a more severe IBD course, but it is associated with a higher occurrence of cancer

Activities related to inflammatory bowel disease management during and after the coronavirus disease 2019 lockdown in Italy: How to maintain standards of care

Background and aims:Restructuring activities have been necessary during the lockdown phase of the coronavirusdisease 2019 (COVID-19) pandemic. Few data are available on the post-lockdown phase in terms of health-careprocedures in inflammatory bowel disease (IBD) care, and no data are available specifically from IBD units. Weaimed to investigate how IBD management was restructured during the lockdown phase, the impact of therestructuring on standards of care and how Italian IBD units have managed post-lockdown activities.Methods:A web-based online survey was conducted in two phases (April and June 2020) among the Italian Groupfor IBD affiliated units within the entire country. We investigated preventive measures, the possibility of continuingscheduled visits/procedures/therapies because of COVID-19 and how units resumed activities in the post-lockdownphase.Results:Forty-two referral centres participated from all over Italy. During the COVID-19 lockdown, 36% of first visitsand 7% of follow-up visits were regularly done, while>70% of follow-up scheduled visits and 5% of first visits weredone virtually. About 25% of scheduled endoscopies and bowel ultrasound scans were done. More than 80% ofbiological therapies were done as scheduled. Compared to the pre-lockdown situation, 95% of centres modifiedmanagement of outpatient activity, 93% of endoscopies, 59% of gastrointestinal ultrasounds and 33% of biologicaltherapies. Resumption of activities after the lockdown phase may take three to six months to normalize. Virtualclinics, implementation of IBD pathways and facilities seem to be the main factors to improve care in the future.Conclusion:Italian IBD unit restructuring allowed quality standards of care during the COVID-19 pandemic to bemaintained. A return to normal appears to be feasible and achievable relatively quickly. Some approaches, suchas virtual clinics and identified IBD pathways, represent a valid starting point to improve IBD care in the post-COVID-19 er

Telemedicine and Remote Screening for COVID-19 in Inflammatory Bowel Disease Patients: Results From the SoCOVID-19 Survey

none46noneFantini, Massimo Caludio; Biancone, Livia; Dragoni, Gabriele; Bezzio, Cristina; Miranda, Agnese; Ribaldone, Davide Giuseppe; Bertani, Angela; Bossa, Fabrizio; Allocca, Mariangela; Buda, Andrea; Mocci, Giammarco; Soriano, Alessandra; Guglielmi, Francesco William; Bertani, Lorenzo; Baccini, Flavia; Loddo, Erica; Privitera, Antonino Carlo; Sartini, Alessandro; Viscido, Angelo; Grossi, Laurino; Casini, Valentina; Gerardi, Viviana; Ascolani, Marta; Di Ruscio, Mirko; Casella, Giovanni; Savarino, Edoardo; Stradella, Davide; Pumpo, Rossella; Cortelezzi, Claudio Camillo; Daperno, Marco; Ciardo, Valeria; Nardone, Olga Maria; Caprioli, Flavio; Vitale, Giovanna; Cappello, Maria; Comberlato, Michele; Alvisi, Patrizia; Festa, Stefano; Campigotto, Michele; Bodini, Giorgia; Balestrieri, Paola; Viola, Anna; Pugliese, Daniela; Armuzzi, Alessandro; Saibeni, Simone; Fiorino, GionataFantini, Massimo Caludio; Biancone, Livia; Dragoni, Gabriele; Bezzio, Cristina; Miranda, Agnese; Ribaldone, Davide Giuseppe; Bertani, Angela; Bossa, Fabrizio; Allocca, Mariangela; Buda, Andrea; Mocci, Giammarco; Soriano, Alessandra; Guglielmi, Francesco William; Bertani, Lorenzo; Baccini, Flavia; Loddo, Erica; Privitera, Antonino Carlo; Sartini, Alessandro; Viscido, Angelo; Grossi, Laurino; Casini, Valentina; Gerardi, Viviana; Ascolani, Marta; Di Ruscio, Mirko; Casella, Giovanni; Savarino, Edoardo; Stradella, Davide; Pumpo, Rossella; Cortelezzi, Claudio Camillo; Daperno, Marco; Ciardo, Valeria; Nardone, Olga Maria; Caprioli, Flavio; Vitale, Giovanna; Cappello, Maria; Comberlato, Michele; Alvisi, Patrizia; Festa, Stefano; Campigotto, Michele; Bodini, Giorgia; Balestrieri, Paola; Viola, Anna; Pugliese, Daniela; Armuzzi, Alessandro; Saibeni, Simone; Fiorino, Gionat

Endoscopic Postoperative Recurrence in Crohn's Disease After Curative Ileocecal Resection with Early Prophylaxis by Anti-TNF, Vedolizumab or Ustekinumab: A Real-World Multicentre European Study.

BACKGROUND: Endoscopic-post-operative-recurrence [ePOR] in Crohn's disease [CD] after ileocecal resection [ICR] is a major concern. We aimed to evaluate the effectiveness of early prophylaxis with biologics and to compare anti-tumour necrosis factor [anti-TNF] therapy to vedolizumab [VDZ] and ustekinumab [UST] in a real-world setting. METHODS: A retrospective multicentre study of CD-adults after curative ICR on early prophylaxis was undertaken. ePOR was defined as a Rutgeerts score [RS] ≥ i2 or colonic-segmental-SES-CD ≥ 6. Multivariable logistic regression was used to evaluate risk factors, and inverse probability treatment weighting [IPTW] was applied to compare the effectiveness between agents. RESULTS: The study included 297 patients (53.9% males, age at diagnosis 24 years [19-32], age at ICR 34 years [26-43], 18.5% smokers, 27.6% biologic-naïve, 65.7% anti-TNF experienced, 28.6% two or more biologics and 17.2% previous surgery). Overall, 224, 39 and 34 patients received anti-TNF, VDZ or UST, respectively. Patients treated with VDZ and UST were more biologic experienced with higher rates of previous surgery. ePOR rates within 1 year were 41.8%. ePOR rates by treatment groups were: anti-TNF 40.2%, VDZ 33% and UST 61.8%. Risk factors for ePOR at 1 year were: past-infliximab (adjusted odds ratio [adj.OR] = 1.73 [95% confidence interval, CI: 1.01-2.97]), past-adalimumab [adj.OR = 2.32 [95% CI: 1.35-4.01] and surgical aspects. After IPTW, the risk of ePOR within 1 year of VDZ vs anti-TNF or UST vs anti-TNF was comparable (OR = 0.55 [95% CI: 0.25-1.19], OR = 1.86 [95% CI: 0.79-4.38]), respectively. CONCLUSION: Prevention of ePOR within 1 year after surgery was successful in ~60% of patients. Patients treated with VDZ or UST consisted of a more refractory group. After controlling for confounders, no differences in ePOR risk were seen between anti-TNF prophylaxis and other groups