Managing Inflammatory Bowel Disease During the Coronavirus Pandemic

Podcast Transcript

Speaker 1:
Butts and Guts, a Cleveland Clinic podcast, exploring your digestive and surgical health from end to end.

Scott Steele:
Hi everyone and welcome to another episode of Butts and Guts. I'm your host, Scott Steele, the Chairman of Colorectal Surgery at the Cleveland Clinic in beautiful Cleveland, Ohio. Very excited to have a third time returning guest, Dr. Miguel Regueiro, who is the Chairman of the Department of Gastroenterology, Hepatology and Nutrition in Cleveland Clinic, Digestive Disease and Surgery Institute. Miguel, welcome to Butts and Guts.

Miguel Regueiro:
Thanks Scott. Good to be here.

Scott Steele:
Absolutely great to have you back. So, we're going to talk a little bit about today in managing IBD during the time of the coronavirus pandemic. Obviously, for a lot of our listeners out there, they understand that coronavirus has had a dramatic impact on our daily lives. Uncertain times, and oftentimes even scary. And I guess both Miguel and I would be amiss if we didn't want to thank all of our listeners, who are not only working in the healthcare, but also all over the community, to helping out those in need.

I just want to remind everybody that as representatives of the Cleveland Clinic, we're here for you, and that our facilities are open. We are working extremely hard to make sure that we hold up our commitment to keeping our patients safe and having our hospitals be among the safest places in the world. So Miguel, you've been on here before, if you would kindly just give us a little bit of an overview about IBD and what does this mean? What conditions does it encapsulate? And talk a little bit about the COVID-19, it's impact on your patients.

Miguel Regueiro:
Thanks Scott. Inflammatory bowel disease, or IBD, really encompasses Crohn's disease and ulcerative colitis. Our current thinking is that these are inflammatory conditions in the gastrointestinal tract. Crohn's can occur anywhere from mouth inflammation all the way down to the anus, and the small intestine is most commonly involved. Ulcerative colitis is mainly the colon. Both present with diarrhea. They can have bleeding, pain. Surgery, as you know, is sometimes required as well. We think that this is an immune mediated disease, meaning something in the environment triggers the immune system to attack the small intestine and the colon. So, that's inflammatory bowel disease in a nutshell.

In terms of COVID-19, as we know in this pandemic, this is a novel coronavirus, SARS-COvi-2. This is primarily manifested with upper respiratory tract infection, specifically pulmonary failure. So, infiltrates in the lungs. Pneumonia. We've seen on the TV and news so many cases of people getting sick very, very quickly. However, Coronavirus, COVID-19, can also impact the GI track, and as we've discussed before, there are a variety of GI symptoms. So, in IBD, the worry is that COVID-19 does it increase problems? Is there more prevalent? And what about medicine? So, thanks for that question.

Scott Steele:
One of the things we'd like to kind of go over from here is a little bit about truth or myth. So, truth or myth? If I have a chronic disease, such as Crohn's disease or ulcerative colitis, am I more likely to get COVID-19? Or reverse, is COVID-19 more apt to have a dramatic impact on me with that disease

Miguel Regueiro:
Myth, overall. To answer it in one word, I would say myth. IBD itself does not mean that somebody who has IBD will get coronavirus or get COVID-19, and IBD itself is not a disease that has been linked to COVID-19, like other diseases, diabetes, hypertension, et cetera. If you're a patient with IBD and you get SARS-Covi-2, actually get the virus that causes COVID-19, there are not higher rates of COVID-19, meaning the systemic elements that we see and hear about. So, having IBD, being on medicine, does not mean that the virus, the coronavirus, will lead to the systemic illness of COVID-19. With one exception, high-dose steroids. High-dose steroids probably are linked to worse outcomes in COVID-19, but all of the other medications, we have not found that true.

Scott Steele:
So, truth or myth? Kind of just to piggyback on that last point that you made. Let's say that I'm somebody who's on some of the immunosuppressants in terms of IBD. Should I stop those IBD medications to have either prevention for COVID-19 or an impact on COVID-19?

Miguel Regueiro:
Myth. Excellent question. What we recommend to our patients every day that we see them, talk to them. And I think globally, we've now learned this from several good research studies, a couple of which that we're involved with here at Cleveland clinic, is that patients with IBD on medications, biologic, immunosuppressants, small molecules, should stay on their medicines to stay in remission. Being in remission is probably more important than anything else. We don't want people to come off medicines, flare up, to come to the hospital, flare a bad inflammation. And if they then get COVID-19, maybe actually the act of flare is worse than actually the medicine. So we do not recommend stopping medicine during this pandemic.

Scott Steele:
Truth or myth? It is safe to come to the infusion center or should I switch to another medication

Miguel Regueiro:
Myth. It is safe to come to the infusion center. Do not switch to another medication. And more specifically, the infusion centers have done a wonderful job in terms of safety, hygiene, social distancing. The nurses and other personnel that work in the infusion center are absolutely phenomenal. They understand. And actually, if anything as you said up front, sometimes these are the most safe places. So we're not switching people off infusions to subcutaneous or oral medicine. We're not switching people who come to infusion centers to get home infusion. So, if they're in a safe environment as an infusion center, we do not want to disrupt that care.

Scott Steele:
And Miguel, kind of switching gears now. We have both patients as well as providers that listen to Butts and Guts. I want to focus in on something that is near and dear to your heart, and that's having an endoscopic procedure. I want to ask this in two different ways that you could address. From a patient's perspective, it's one thing to say, "Hey, listen, I want to go in and get my infusion." It's another thing to say that I'm going to get a colonoscopy. So, is it safe to go to the doctor's office to have a colonoscopy? And then conversely, for our providers out there that listen to this, what safety precautions are you making, it's an aerosolized virus obviously, to ensure? And what is the data out there so far in terms of providers getting sick from performing these procedures?

Miguel Regueiro:
These are excellent questions about endoscopy. To start with the patient perspective first, again, as we've discussed, it is very safe to get an endoscopic procedure during the pandemic. There have not been higher risk to the patient in any study for the act of simply coming in to get an endoscopy. So, we highly recommend whether now even be a screening colonoscopy in Ohio. We are open for screening colonoscopies. We're open for all endoscopic procedures. If the patient needs a procedure, they should get that.

As with the infusion center, we practice social distancing, hygiene, we make sure the patient is safe. These are usually fairly short procedures, tolerated very, very well, and we have not seen an increase in risk or complications. So our patients should come in for their endoscopy if they need them, and even if they need screening.

Regarding the healthcare provider, I'm happy to say, based on large data now from across the world, there is not, and I'll say it again, there's not an increased risk of COVID-19 being transmitted to providers who are performing endoscopic procedures. Generally, especially for the aerosolization, that seems to be more with upper endoscopy than lower colonoscopy. For those procedures we do wear a 95 mask, as a precaution. Although there's not been a study to say that wearing a surgical mask would also be protective, we do wear a 95 mask.

There is regional variation in terms of testing before an endoscopic procedure. Many of my colleagues out there as I feel that the endoscopic procedure itself does not require testing in advance, unlike surgical cases, as long as we're wearing a 95. However, if you are in a center across the country that does testing because they're also testing their surgical patients in the next room from a colonoscopy and they're negative, then wearing a 95 is not necessary in a negative tested patient.

Scott Steele:
From a nutritional standpoint, are there things that, if I'm a patient out there, I should be eating that can help manage my IBD, or maybe even have some impact on COVID?

Miguel Regueiro:
Diet's so important in IBD that this is a common question, and I'm happy to say, as you know, because you're part of our medical home in IBD, that we have a dietitian and they're experts in diet and IBD. Simply put, we recommend a healthy diet in the time of pandemic. So, good sleep hygiene, good diet exercise, take care of yourself. A healthy body is actually probably the best thing we can do in terms of preventing coronavirus. There's not a specific diet per se, an antiviral or anti coronavirus diet, but again, more practical tips on staying healthy, eating well. If you do need dietary counseling, I think dietitians are an excellent resource in terms of providing this information, especially to our IBD patients.

Scott Steele:
And I just would ask all of our listeners out there, we've had several dietitians on, on Butts and Guts in the past, so please take a look, browse the back podcasts. There's a lot of good information about diet in general, then as specific that relates to some of the GI disorders. So, Miguel, you've been a leader in this space in terms of not only IBD, but a [inaudible 00:10:44] leader, a worldwide leader, and especially taking on this treatment pathway in this coronavirus pandemic fate. So, what's the final take-home message to our listeners, especially for those patients with chronic disease like IBD? What is your take-home message to not only your patients, but also your providers?

Miguel Regueiro:
Take-home messages in terms of chronic diseases during the time of the pandemic are, first and foremost, take care of yourself. Secondly, that ties into taking care of yourself, if you are on medicine, don't stop your medicine. Confer and consult with your provider if you have any questions or concerns about your medicines. Thirdly, being in remission and staying in remission for IBD, but this is true of other chronic diseases, is probably the single most important factor in terms of this pandemic. And then finally, if you do contract SARS-COvi-2, which means you get the virus, it doesn't necessarily mean that you'll get this severe systemic illness that we refer to as COVID-19. And work with your providers then on what medicines you can continue, because there are some in IBD that we don't do not stop, just because you have the virus. But also work with your providers on overall care management, longterm, how to manage both the chronic disease like IBD and the SARS_COvi-2. So, thank you for that question.

Scott Steele:
So, for the most up-to-date information on COVID-19, including appointment and visitor policies, please visit clevelandclinic.org/coronavirus. That's clevelandclinic.org/coronavirus. And to speak with a specialist in the digestive disease and surgery Institute, please call 216-444-7000. That's 216-444-7000.

And remember, in times like these it's important to keep up with your medical care, and rest assured, here at the Cleveland clinic, within the DDSI, we're taking all the necessary precautions to sterilize our facilities and protect our patients.

Miguel, thank you again so much for joining us once again on Butts and guts.

Miguel Regueiro:
Thank you.

Speaker 1:
That wraps things up here at Cleveland Clinic. Until next time. Thanks for listening to Butts and guts.