From the Guidelines
Ulcerative colitis can increase the risk for complications of COVID-19, particularly in patients with comorbidities, those aged 70 years or older, or those on certain immunosuppressive medications. According to the British Society of Gastroenterology guidance for management of inflammatory bowel disease during the COVID-19 pandemic 1, patients with ulcerative colitis who have comorbidities such as respiratory, cardiac, hypertension, or diabetes mellitus, and/or are aged 70 years or older, are considered at highest risk for COVID-19 related poor outcomes. Additionally, patients on certain medications, including intravenous or oral steroids, biologic plus immunomodulator, or those with moderate to severely active disease, are also at increased risk.
Key factors that contribute to the increased risk include:
- Comorbidities such as respiratory, cardiac, hypertension, or diabetes mellitus
- Age 70 years or older
- Use of immunosuppressive medications, including:
- Intravenous or oral steroids ≥20 mg prednisolone or equivalent per day
- Biologic plus immunomodulator
- Anti-TNF monotherapy
- Moderate to severely active disease
- Short gut syndrome requiring nutritional support
- Requirement for parenteral nutrition
It is essential for patients with ulcerative colitis to maintain their prescribed treatment regimens unless directed otherwise by their gastroenterologist, stay current with COVID-19 vaccinations, and practice preventive measures like hand hygiene and appropriate masking in high-risk situations, as recommended by the British Society of Gastroenterology 1.
From the Research
Ulcerative Colitis and COVID-19 Complications
- The relationship between ulcerative colitis and the risk of COVID-19 complications is not directly addressed in the provided studies 2, 3, 4, 5, 6.
- However, it is known that patients with inflammatory bowel diseases, including ulcerative colitis, may be at a higher risk of developing complications from COVID-19 due to their compromised immune system and potential use of immunosuppressive medications 2.
- A study published in 2020 discussed the potential link between inflammatory bowel diseases and COVID-19, highlighting the need for careful management of patients with these conditions during the pandemic 2.
- Another study from 2022 examined the risk of hospitalization in patients with ulcerative colitis and Crohn's disease, finding that approximately one in five patients with ulcerative colitis are hospitalized within 5 years of diagnosis 3.
- The provided studies primarily focus on the effectiveness and safety of azathioprine and 6-mercaptopurine for maintaining remission in ulcerative colitis 4, 5, 6, rather than the specific risk of COVID-19 complications.
Immunosuppressive Medications and COVID-19 Risk
- The use of immunosuppressive medications, such as azathioprine and 6-mercaptopurine, may impact the risk of COVID-19 complications in patients with ulcerative colitis 2.
- However, the provided studies do not directly address this topic, and more research is needed to understand the relationship between immunosuppressive medications and COVID-19 risk in patients with ulcerative colitis.
Hospitalization Risk in Ulcerative Colitis Patients
- A study from 2022 found that patients with ulcerative colitis are at a significant risk of hospitalization, with approximately one in five patients hospitalized within 5 years of diagnosis 3.
- This increased risk of hospitalization may be relevant to the risk of COVID-19 complications, as hospitalized patients may be more likely to be exposed to the virus or experience severe symptoms.