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

The United European Gastroenterology (UEG) Public Affairs Committee has published a position paper in UEG journal to educate policy makers, patients, healthcare professionals and the general public about the effects of coronavirus disease 2019 (COVID-19) pandemic on digestive health. They also provide recommendations for the clinical considerations regarding the use of COVID-19 vaccines in patients with chronic digestive disorders.

Study: COVID-19 and digestive health: Implications for the prevention, care and use of COVID-19 vaccines in vulnerable patients.  Photo credit: Have a good day Photo / ShutterstockStudy: COVID-19 and digestive health: Implications for the prevention, care and use of COVID-19 vaccines in vulnerable patients. Photo 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). Yet it also affects other organs and causes complications besides the lungs.

The COVID-19 pandemic has severely affected the digestive system. The clinical routines of gastroenterologists and liver physicians have been disrupted. Endoscopy has been limited to emergencies.

In addition, lockdown measures have led to unhealthy eating habits, decreased physical exercise, decreased patient interaction with medical services, and increased alcohol consumption or relapse in patients.

Gastrointestinal (GI) patients are vulnerable to increased morbidity and poorer outcomes due to SARS-CoV-2 infection. Politicians should consider the health of patients with impaired immunity to make strategies for disease prevention and COVID-19 vaccination.

COVID-19 lockdown consequences

In addition to COVID-19 mortality and morbidity, COVID-19 has certainly had social consequences.

Screening delays affecting patients with colorectal cancer (CRC)

CRC mortality in Europe has fallen due to the rollout of screening programs. Several GI endoscopy procedures were canceled due to the pandemic. As this procedure is used for screening, early diagnosis, and treatment of cancer of the digestive tract, recent studies have predicted an increase in the GI cancer burden.

The COVID-19 pandemic has led to increased obesity

Lockdown and social distancing have caused weight gain in many individuals due to decreased physical exercise and increased eating due to boredom, anxiety or depression. In addition, there has been increased consumption of snacks, unhealthy foods and sweets. As nutrition affects immunity, the introduction of 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 individuals ingested vegetables and higher when they ingested processed meat. In addition, the COVID-19 pandemic could potentially have increased the incidence of digestive and liver diseases associated with obesity. In addition, non-alcoholic fatty liver disease is a potential risk factor for SARS-CoV-2 infection and severe COVID-19.

Vaccination of vulnerable GI patients

The conditions in which patients with inflammatory bowel disease (IBD), liver disease, digestive cancer and liver transplant recipients need to be treated for vaccination need to be clarified.

Patients with cancer

Several oncology unions strongly recommend vaccination of patients with cancer as they have a higher risk of severe COVID-19. A recent study evaluating the efficacy of vaccination in patients undergoing chemotherapy and / or immunotherapy indicates that COVID-19 vaccination will achieve an adequate antibody response in these patients. However, the duration of immune response in patients has not yet been evaluated.

Patients with IBD

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

Patients with liver disease

No safety problems have been reported in liver transplant recipients or patients with mild to moderate liver disease who 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 to SARS-CoV-2. Clinical guidelines recommend pre- and post-transplant vaccination against a range of pathogens in patients with liver disease awaiting liver transplantation and in liver transplant recipients. Some studies have shown that a third dose of vaccine in these patients achieved a higher immune response.

UEGs recommendations

For health organizations:

  • Governments should consider the latest clinical data to determine policies and guidelines and ensure citizens’ protection and support, especially while repealing decommissioning measures.
  • Elective procedures such as endoscopies should be resumed 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 vaccinations:

  • Immunocompromised patient groups should be prioritized in vaccination schemes and epidemiological settings.
  • The administration of booster doses should be evidence-based. Post-vaccination antibody levels should be determined in vulnerable populations such as patients with IBD during immunosuppressive therapy, patients with digestive cancer during treatment, and transplant recipients.

To EU policy makers:

  • The European Commission has a goal of building a European Health Union. The European Center for Disease Control and Prevention (ECDC) and the European Medicines Agency promote a strong and coordinated response to health crises at EU level. The UEG strongly supports these mandates.
  • The COVID-19 pandemic amplifies the links between infectious and non-communicable diseases. Therefore, the revision of the ECDC mandate should include activities in the field of non-communicable diseases.

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