The impacts of the SARS-CoV-2 pandemic on digestive health

The United European Gastroenterology (UEG) Public Affairs Committee has published a position paper in the UEG review raise awareness among decision-makers, patients, healthcare professionals and the general public of the impacts of the 2019 coronavirus disease (COVID-19) pandemic on digestive health. They also provide recommendations for clinical considerations on the use of COVID-19 vaccines in patients with chronic digestive disorders.

To study: COVID-19 and Digestive Health: Implications for the Prevention, Care and Use of COVID-19 Vaccines in Vulnerable Patients. Image Credit: Have a Good Day Photo / Shutterstock

COVID-19 and digestive health

COVID-19 is a respiratory disease caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Even so, it also affects other organs and presents complications outside of the lungs.

The COVID-19 pandemic has severely affected digestive health care. The clinical routines of gastroenterologists and hepatologists have been disrupted. Endoscopy was limited to emergencies.

Additionally, the lockdown measures have resulted in unhealthy eating habits, decreased exercise, decreased patient interactions with medical services, and increased alcohol use or relapses in patients.

Gastrointestinal (GI) patients are vulnerable to increased morbidity and worse outcomes due to infection with SARS-CoV-2. Policy makers should consider the health of immunocompromised patients when developing disease prevention and vaccination strategies against COVID-19.

Consequences of the containment of COVID-19

Beyond the mortality and morbidity of COVID-19, COVID-19 has surely had social consequences.

Screening delays affecting patients with colorectal cancer (CRC)

CRC death rates in Europe have declined due to the roll-out of screening programs. Several gastrointestinal endoscopy procedures have been canceled due to the pandemic. Since this procedure is used for the screening, early diagnosis, and treatment of cancers of the digestive tract, recent studies have predicted an increased burden of gastrointestinal cancer.

COVID-19 pandemic has resulted in rising obesity rates

Lockdown and social distancing have resulted in weight gain in many people due to decreased exercise and increased eating due to boredom, anxiety or stress. depression. In addition, there has been an increase in the consumption of snacks, unhealthy foods and sweets. Since nutrition affects immunity, adopting poor lifestyle habits can increase the risk of chronic and communicable diseases.

A study from the UK showed that the risk of COVID-19 positivity was lower when people ate vegetables and higher when they ate processed meat. In addition, the COVID-19 pandemic could have potentially increased the prevalence of digestive and liver diseases associated with obesity. In addition, alcohol-free fatty liver disease is a potential risk factor for SARS-CoV-2 infection and severe COVID-19.

Vaccination of vulnerable GI patients

The conditions under which patients with inflammatory bowel disease (IBD), liver disease, digestive cancers, and liver transplant recipients should be cared for for vaccination should be clarified.

Cancer patients

Several professional oncology societies strongly recommend vaccination of cancer patients because they are at higher risk of severe COVID-19. A recent study that assessed the effectiveness of Vaccination in patients on chemotherapy and / or immunotherapy indicates that COVID-19 vaccination will achieve an adequate antibody response in these patients. However, the duration of the immune response in patients has not yet been evaluated.

IBD patients

Patients with IBD have impaired underlying immune responses that can increase susceptibility to infections. In addition, they are treated with immunosuppressive drugs. All approved COVID-19 vaccines are considered safe in immunocompromised patients. However, the immunological response to vaccination can be expected to be suboptimal in these patients. Nevertheless, expert reviews encourage vaccination in all patients with IBD, preferably with mRNA vaccines.

Patients with liver disease

No safety concerns have been reported in liver transplant recipients or patients with mild to moderate liver disease who have received the COVID-19 vaccine. In a study from China, patients with non-alcoholic fatty liver disease reported mild side effects and produced neutralizing antibodies against SARS-CoV-2. Clinical guidelines recommend pre-transplant and post-transplant vaccination against a variety of pathogens for patients with liver disease awaiting liver transplantation and in liver transplant recipients. Some studies have shown that a third dose of the vaccine in these patients elicited a higher immune response.

UEG recommendations

For healthcare establishments:

• Governments should take the latest clinical data into account when deciding policies and guidelines and ensuring the protection and support of citizens, especially when the lockdowns are lifted.
• Elective procedures such as endoscopies must be repeated and maintained to protect patients and healthcare.
• The effects of lockdowns across Europe on cancer screening, diagnosis and staging should be assessed.

For COVID-19 vaccines:

• Groups of immunocompromised patients should be given priority in vaccination programs and epidemiological settings.
• Booster doses should be evidence-based. Post-vaccination antibody levels should be determined in vulnerable populations such as patients with IBD on immunosuppressive therapy, patients with digestive cancers on treatment, and transplant recipients.

For EU policy makers:

• The European Commission aims to build a European Health Union. The mandates of the European Center for Disease Control and Prevention (ECDC) and the European Medicines Agency facilitate a strong and coordinated response at Union level to health crises. UEG strongly supports these mandates.
• The COVID-19 pandemic is amplifying links between communicable and non-communicable diseases. Therefore, the review of ECDC’s mandate should include activities in the area of ​​noncommunicable diseases.