What Do Influenza and COVID-19 Represent for Patients With Inflammatory Bowel Disease?

Sandra Maria Barbalho, Julia Novaes Matias, Uri Adrian Prync Flato, Joao Paulo Galletti Pilon, Piero Bitelli, Marcos Alberto Pagani Junior, Antonelly Cassio Alves de Carvalho, Jesselina Francisco dos Santos Haber, Carlos Henrique Bertoni Reis, Ricardo de Alvares Goulart

Abstract


Background: Inflammatory bowel diseases (IBD) are a group of immune and inflammatory diseases; and patients seem to be more vulnerable to influenza and coronavirus disease 2019 (COVID-19). These conditions are characterized by the augmented release of inflammatory cytokines that have been suggested as potential triggers for the acute respiratory distress syndrome, which may favor severe and even fatal outcomes. For these reasons, this review aims to evaluate what influenza and COVID-19 may represent for patients with IBD.

Methods: The search was performed in MEDLINE/PubMed, EMBASE, and Cochrane databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to build the review.

Results: The conventional therapies used by IBD patients may also interfere in the outcomes of influenza and COVID-19. Immune-suppressors agents are associated with a higher risk of infections due to the inhibition of intracellular signals necessary to the host act against pathogens. On the other hand, drugs related to the suppression of the production of cytokines in IBD could bring benefits to reduce mucosal inflammation, and for preventing pneumonia. Moreover, coronaviruses can bind to the target cells through angiotensin-converting enzyme 2 (ACE-2) receptor that is expressed in epithelial cells of the lung and largely the colon and the terminal ileum suggesting that human intestinal tract could be an alternative route for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Conclusions: Once the cytokine storm observed in influenza and COVID-19 is similar to the cytokine pattern observed in IBD patients during the disease flares, the advice is that avoiding the infections is still an optimal option for IBD subjects.




Gastroenterol Res. 2021;14(1):1-12
doi: https://doi.org/10.14740/gr1358

Keywords


Influenza: COVID-19; Ulcerative colitis; Crohn’s disease; Inflammatory bowel disease

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