Summary of COVID-19 medicines guidance: Gastrointestinal disorders

This page summarises and signposts to medicine related guidance we’re aware of from professional and government bodies relating to coronavirus and gastrointestinal disorders.

This page has been put together rapidly in response to the COVID-19 pandemic.

Whilst we have tried to ensure that the information on this page is complete, please report a concern if you feel anything is omitted or inaccurate.

To see our professional guidance summaries for other clinical areas, click here

Advice in this area includes:

NICE: COVID-19 rapid guideline: gastrointestinal and liver conditions treated with drugs affecting the immune response

Last updated 23 April 2020

Our summary:

  • Includes recommendations for communicating with patients and minimising risk, including advice to give to patients about medicines, and methods of reducing contact such as electronic prescribing and prescription/medicines delivery.
  • Treatment considerations are provided for patients who are not known to have COVID-19, and signposting is provided to relevant specialist guidance to help determine the risk for adults and children with GI and liver conditions.
  • Advice is provided for patients with suspected or confirmed COVID-19, including a recommendation to contact their gastroenterology or hepatology team before making any changes to medicines that affect the immune response.
  • Recommendations are provided on modifications to usual care, including prioritisation of core services such as essential infusion services and blood tests for drug monitoring that cannot safely be delayed, as well as supply of medicines.

British Society of Gastroenterology: COVID-19 BSG and BASL advice for healthcare professionals in Gastroenterology and Hepatology

Last updated 29th May 2020

Our summary:

British Society of Gastroenterology: Advice on COVID-19 for patients with Gastrointestinal or Liver conditions

Last updated 01 April 2020

Our summary:

British Society of Gastroenterology: Expanded consensus advice for the management of IBD during the COVID-19 pandemic

Last updated 06 April 2020

Our summary:

  • This is a summary of British Society of Gastroenterology: Guidance for management of inflammatory bowel disease during the COVID-19 pandemic (Published 6th April 2020). See paper for further details.
  • Patients with active inflammatory bowel disease are likely to have a higher risk of infection both in the community and during inpatient care, even in the absence of immunosuppressant treatment. Therefore, it is of paramount importance to control the intestinal inflammation in IBD to prevent adverse outcomes.
  • NSAID use, given its association with adverse outcomes in other viral respiratory infections and in precipitating IBD flare, should be avoided.
  • A UK-wide COVID-19 working group has defined patient risk into highest, moderate and lowest for COVID-19 related poor outcome (see Table 1 and further information in full guidance). Patients classified as at highest risk correspond to Group 5 in the UK Government’s instruction to undergo active ‘shielding’. Patients should still attend for infusions of biologics no matter what category they are in.
  • An updated grid is available for clinicians, which clarifies how to classify the risk for patients with moderate-to-severely active disease, and for those who have recently stopped biologic and immunomodulatory therapy.
  • General and therapy-specific considerations are provided regarding IBD medications including corticosteroids, immunomodulators, anti-TNF therapy, ustekinumab, vedolizumab, tofacitinib and 5-ASA derivatives. Advice on clinical trials is included.

European Crohn’s and Colitis Organisation: Information on COVID-19

Last updated 28 April 2020

Our summary:

  • Weekly series of interviews with gastroenterologists and experts in infectious diseases based in Europe, with a focus on best care for patients receiving immunosuppressant or immunomodulatory therapies.
  • 1st interview: Discusses risk of catching COVID-19/ severe infection in IBD patients on immunosuppression and/or biological therapies; tapering steroids to reduce the risk of COVID-19; whether to suspend immunosuppressants and biologics during COVID-19 infection/ following close contact with a confirmed case of COVID-19.
  • 2nd interview: Discusses delay/postponement of infusion visits in stable patients; switching from IV to subcutaneous biologics; risks/ benefits of steroids during COVID-19 infection; whether any IBD medications should not be initiated in active IBD disease.
  • 3rd interview: Discusses whether biologics/ immunomodulatory agents should be used differently in elderly IBD patients and/or in IBD patients with comorbidities.
  • 4th interview: Discusses protection of healthcare professionals with IBD who may be taking immunosuppressant or immunomodulatory therapies.
  • 5th interview: Discusses management of steroids, azathioprine, JAK inhibitors and biologics in COVID-19 positive patients who are self-isolating, and recommendations on influenza and pneumococcus in non-vaccinated immunocompromised IBD patients during the COVID-19 pandemic.
  • 6th interview: Discusses the findings of a survey of ECCO members, including: whether immunosuppressive or biologic drugs should be discontinued as a preventive measure, if patients can be started on biologics, and areas identified for further research e.g.  the risk of disease flare in patients who discontinue IBD drugs.

International Organisation for the study of Inflammatory Bowel Disease (IOIBD): COVID 19 and IBD Webinars and Guidelines

Last updated 14 May 2020

Our summary:

  • There is a link to a report on the outcomes of a RAND panel survey on 76 statements. Statements related to the treatment of new patients, the risk associated with medicines, whether medicines should be discontinued or the dose reduced to prevent SARS-CoV-2 infection, whether medicines should be discontinued in patients infected with SARS-CoV-2, if patients should continue with clinical trial drugs, and when to restart IBD medicines that have been discontinued. The following medicines are included (monotherapy/ combined): 5-ASA, steroids, thiopurines, methotrexate, and biologics.
  • Links are provided to specific IOIBD Task force guidelines for the care of IBD patients during the COVID-19 pandemic. These include best practice guidance for when to restart IBD therapy in patients who have had confirmed or suspected COVID-19 (Recommendations), and a summary of treatment considerations based on IBD and COVID-19 severity for patients requiring hospitalisation or surgery (Acute Care, Table 1).
  • Following a series of 7 weekly webinars, there will now be monthly updates starting on the 5th of June – details available here

Crohn’s and Colitis UK: Patient information on Coronavirus (COVID-19)

Last Updated 11 May 2020

Our summary:

  • Crohn’s and Colitis UK provides patient facing information to answer questions such as
    • “My child has Crohn’s or Colitis, what should I do?”
    • “I’ve got coronavirus symptoms, should I stop taking my medicine for Crohn’s or Colitis?” (specific recommendations provided)
    • “What should I do if I think I’m having a Crohn’s or Colitis flare-up?”
    • “I have questions about my risk level”
    • “Will I be able to have the COVID-19 vaccine when it is available?”
    • “Dexamethasone (a steroid) as a treatment for COVID-19”

Administration update (13th July 2020): resources updated on the page as indicate by red text.