Covid-19 and hepato-gastroenterology
1 Klinika hepatogastroenterologie, Transplantcentrum, IKEM, Praha
The new coronavirus disease (covid-19) pandemic has become a global health and social issue with specific context in gastroenterology and hepatology. The organisational and restrictive measures are similar to those in other instrumental specialties and include the protection of patients and staff in reaction to the current epidemiological situation and presumed infection route. In addition to this specific protection, the effects of covid-19 on other aspects of the field leading to potential limitation of health care and adversely affecting other diseases must be minimised. In endoscopy, this protection is predominantly oral in focus due to the respiratory route of the infection; transmission through excrement and instruments is possible but insignificant. Gastrointestinal and liver manifestations of the infection represent a significant part of the overall symptomatology and may correlate with the severity of the disease. Covid-19 does not deteriorate the course of inflammatory bowel disease (IBD) and likewise, the immunosuppressive and biological treatment of IBD patients does not worsen in the course of the infection. Higher mortality was reported with corticosteroid therapy. The combination of liver disease and covid-19 is under investigation. Viral hepatitis does not represent a significant risk; however, non-alcoholic steatohepatitis and advanced liver cirrhosis are risk factors. The available data on the effects of transplantation are sporadic; its insignificance is further supported by our own experience at IKEM as well as documented data on renal insufficiency and kidney transplant, which show a higher risk. Furthermore, interactions of antiviral and immunosuppressive drugs are being investigated. Atazanavir, lopinavir and to a lesser extent chloroquine and hydrochloroquine are not considered to be suitable. On the other hand, there are no considerable interactions with remdesivir.
KeywordsCOVID-19, inflammatory bowel disease, immunosuppression, biologic therapy, NAFLD, liver transplantation
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