R I Med J (2013). 2022 Dec 1;105(10):42-47.

Lawrence Kogan ¹, Ryan C Ungaro ², Freddy Caldera ³, Samir A Shah ⁴

Author information

¹Clinical Fellow, Department of Digestive Diseases, Yale School of Medicine, New Haven, CT.

²The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY.

³Associate Professor of Medicine, University of Wisconsin, Madison, WI.

⁴Clinical Professor of Medicine, Alpert Medical School of Brown University; Chief of Gastroenterology, The Miriam Hospital.

Abstract

Patients with inflammatory bowel disease (IBD) may take medications that affect their immune system, altering their ability to fight infection or making them less responsive to vaccines. Many of these patients were excluded from original studies regarding COVID-19, which creates a challenge for gastroenterologists to use evidence-based medicine to guide their management. We reviewed the available literature regarding patients with IBD and COVID-19 outcomes and response to vaccinations. Of all IBD patients, 0.3-24% acquired COVID-19 infection and 7-67% of those patients required hospitalization. Many studies have analyzed the effects of COVID-19 on patients with IBD. Observational studies suggest most IBD patients are not at higher risk from COVID-19 infection and that the COVID-19 vaccines are safe, effective and recommended. However, patients being treated with a TNF-α inhibitor with an immunomodulator and patients being treated with steroids should be monitored closely and efforts should be made to wean patients off of systemic steroids if possible. Patients treated with these regimens had lower antibody responses to vaccination and were at higher risk of acquiring severe COVID-19 infection. Antibody responses were robust after the second dose of mRNA vaccines with 85-100% of individuals showing seroconversion, albeit with lower levels of antibodies compared to the general population.