Covid-19 And Digestive Health

As the outbreak of coronavirus disease (COVID-19) grows globally, adequate support and continuous treatment must be ensured during this public health emergency also in the area of digestive health. Digestive diseases are amongst the most prevalent health conditions in Europe. COVID-19 has various implications on digestive health, as digestive symptoms such as nausea, diarrhoea and cramps occur in COVID-19 positive patients, in some cases, prior to respiratory symptoms. Moreover, people with chronic digestive conditions, including inflammatory bowel disease (IBD), digestive cancers, liver diseases or immunosuppressed liver transplanted patients, could be particularly vulnerable. This paper outlines the status quo, risks and recommendations related to digestive health during the COVID-19 pandemic for IBD, digestive cancers, liver diseases and endoscopy. COVID-19 has various implications on digestive health. Studies report that COVID-19 positive patients develop affections of the gastrointestinal tract and the liver and respective symptoms. As the virus has been detected in gastrointestinal secretions and stool, transmission can occur from asymptomatic carriers as well.1 In some cases, digestive symptoms can appear prior to respiratory symptoms and have been linked to worse disease outcomes.2 Recent data report detection of virus RNA in stool samples from 48.1% of patients, even in stool samples taken after a negative respiratory sample. Furthermore, it was found that 17.6% of patients with COVID-19 had digestive symptoms.3 With variable incidence between 5% and 50%, digestive health-related COVID-19 symptoms include nausea, diarrhoea and cramps. Elevated liver enzymes have also been found in up to 30% of COVID-19 patients.4 People with chronic digestive conditions, including IBD, digestive cancers, liver diseases or immunosuppressed liver transplanted patients, could be particularly vulnerable, as the medium- or long-term consequences of a SARS-CoV-2 infection might increase morbidity and mortality. Therefore, patients with digestive health conditions should adhere to the general recommendations for COVID-19 (physical and social distancing, hand hygiene etc.). The implications for patients with chronic liver diseases are not clear at the moment,5 but patients with advanced stage liver disease and patients post liver transplantation need to be treated as vulnerable groups with an increased chance for a severe course and outcome of COVID-19. Patients should be offered online consultations if possible and special protection when hospital admission is absolutely necessary, as emphasized by EASL and ESCMID.5 COVID-19 pandemic requires a prompt reshaping of the activities of interdisciplinary Digestive Health Departments in order to adequately address non-deferrable gastroenterological and surgical needs of the population, while minimizing patient access to hospital services.6 Particularly, endoscopic, surgical and other procedures present a high risk of contagion for both patients and doctors.7 Several societies (such as ESGE, ASGE, SAGES and EAES) divided endoscopic and surgical procedures into elective/non-urgent procedures that can be postponed and emergent/urgent procedures that have to be performed. It has been agreed that electrosurgery should be set to the lowest possible settings, while laparoscopic surgery should be avoided in COVID-19-positive patients.8 With endoscopic procedures delayed all over the EU, digestive cancer screening programmes have also been notably impacted. The risk of mortality from a long-lasting postponement of interventions may become higher than that of a serious hospital-dependent COVID-19 disease. This is particularly important as one in three cancer-related deaths are caused by digestive cancers. Medical treatment for patients with IBD and gastrointestinal/liver cancer cannot be discontinued, therefore specific infection prevention measures may apply temporarily to these immunocompromised patients.7 The interruption of any elective or routine follow-up visits has now made telephone or digital medical consultation and advice the norm, following the recently lifted ban on remote consultation and treatment. Nevertheless, oncology patients who are undergoing chemo/radiotherapy remain in situations where they need to visit the hospital. The same applies to many IBD patients who have to visit the hospital regularly for infusion and consultation. Some IBD patients, despite their immunosuppressed status, appear to develop milder manifestations of COVID-19 (as stated by Dr Silvio Danese of Humanitas University, in Milan, Italy, for Reuters Health). This could be the result of their immunosuppressed state protecting them from developing a harmful uncontrolled and overreacting immune response against the virus. However, there are ongoing registries to collect data before drawing any definitive conclusion. Public health emergencies like the COVID-19 outbreak show the importance of consistent research funding and programmes to strengthen prevention, management and attenuating the long-term consequences of such an epidemic. At EU level, this should be ensured through an ambitious Multiannual Financial Framework budget and a bold budget for Horizon Europe. Researchers have launched several initiatives creating repositories and registries that link COVID-19 and digestive diseases (Impact on GI practice, SECURE-IBD, SECURE EOE/EGID, COVID-19 and liver disease). These initiatives need to be supported through the current ambitious national and European investments in research on COVID-19. COVID-19 is a major burden for medical professionals who are applying for Horizon 2020 grants. Hence the extension of deadlines until 4 June, for several calls under Horizon 2020 Societal Challenge (Health) has been positively received. More flexibility and continuous guidance for ongoing Horizon 2020 projects will help to reduce uncertainty. The authors have no conflicts of interest to declare. The authors received no financial support for the research, authorship, and/or publication of this article.