What People With IBD Need to Know About COVID-19

Number one? Breathe a sigh of relief. Inflammatory bowel disease doesn't seem to be a huge factor for coronavirus infection.

by Sarah Ludwig Rausch Health Writer

We’ve all been hearing that we need to be on the lookout for symptoms of COVID-19 like coughing, fever, and shortness of breath. But a March 2020 study conducted in China and published in The American Journal of Gastroenterology (AJG) found that nearly half of the 204 COVID-19 patients had gastrointestinal (GI) symptoms like loss of appetite, diarrhea, vomiting, and abdominal pain along with the more typical fever and respiratory symptoms when they were admitted to the hospital.

If you’re someone who’s already living with symptoms like these thanks to chronic bowel inflammation, does this mean you have even more to worry about when it comes to COVID-19? The short answer? Probably not…but it’s also a little too soon for clear answers. In this particular study, all of the patients had severe infections that required hospitalization, and doctors don’t yet know how often or to what degree gastro symptoms affect people with milder forms, says David T. Rubin, M.D., section chief of gastroenterology, hepatology and nutrition at University of Chicago Medicine.

However, a recent study done at Stanford Medicine in Palo Alto, CA, demonstrated that in addition to upper respiratory symptoms, a significant number of COVID-19 patients also suffered from loss of appetite, nausea, vomiting and diarrhea. In a news release, one of the study authors, Alexander Podboy, M.D., said: “A third of the patients we studied had gastrointestinal symptoms. It’s possible we may be missing a significant portion of patients sick with the coronavirus due to our current testing strategies focusing on respiratory symptoms alone.”

That said, doctors are making progress, and there are still some important things to know about the new coronavirus if you’re living with a form of inflammatory bowel disease like ulcerative colitis or Crohn’s. We break it down:

COVID-19 Can Travel to the Intestines…

People typically contract COVID-19 from inhaling viral particles or picking up them up with their hands and transferring them to the eyes, nose, or mouth. Once it's gotten in the body, the virus usually beelines to the respiratory tract where it latches on to ACE-2 receptors.

But it turns out that those receptors also happen to line the digestive tract as well, says Dr. Rubin. So when patients cough up mucus, some of that inevitably gets swallowed, giving the virus a free ride into the intestinal tract, where it can start multiplying and causing those digestive symptoms.

However, the reason we’re probably seeing more respiratory symptoms than digestive ones is “because there’s a much lower amount of virus that gets into your gut than into your lungs,” says Dr. Rubin. Also important to know: It’s pretty unusual for COVID-19 patients to have only gastro symptoms. In the Chinese study, just 3% of hospitalized patients did. And while about 30% of the patients in the Stanford study reported gastrointestinal symptoms, nearly all described them as mild. Plus, none of the patients in this study group developed GI symptoms first.

What does this all mean for you? Continue to be vigilant. If you do have new GI symptoms, don’t just assume they’re from your IBD, especially if you have other symptoms like fever and cough; they could be a sign of COVID-19 so check in with your doc, says Andrew Grossman, M.D., a pediatric gastroenterologist who’s the co-director of the Center for Pediatric Inflammatory Bowel Disease at Children’s Hospital Philadelphia.

…But IBD Patients Aren’t Necessarily at More Risk

Right now, the evidence indicates that simply having IBD doesn’t put you at any more risk of either getting COVID-19 or having more severe illness if you do get it than the general population. “We’re continuing to study it, but thus far, the data we have accumulated is reassuring,” says Dr. Grossman.

That said, if you’re on immunosuppressants like Azasan or Imuran (azathioprine), Purinethol or Purixan (mercatopurine), Gengraf, Neoral, or Sandimmune (cyclosporine), or Trexall (methotrexate), you may be especially concerned about your risk since they can make it harder to fight off infections of any kind.

While that is true, Dr. Rubin says the general recommendation is to continue taking your medicine and to be very careful about social distancing. If you stop taking your medicine, your disease activity can jump, making you sicker—and that’s much more concerning to doctors. “The use of additional healthcare resources, needing to go to the hospital, needing to have procedures done, or being on steroids all present a higher risk than anything we’ve seen so far with COVID-19,” he says.

COVID-19 Probably Won’t Exacerbate Your IBD

Right now, doctors don’t believe COVID-19 will cause more exacerbations in people with IBD, partly because the immune responses in each condition are different, says Dr. Rubin. Plus, as he points out, past coronavirus epidemics like the 2003 severe acute respiratory syndrome (SARS) outbreak in China and the 2012 epidemic in Saudi Arabia of Middle East Respiratory Syndrome (MERS), showed no spikes in patients with IBD. There haven’t been spikes reported yet in IBD patients in China or Italy either, “so we’re hopeful this means it isn’t going to happen,” Dr. Rubin says.

Since no one really knows a whole lot about COVID-19 yet though, Dr. Grossman says that doctors in the United States and Europe have started a registry to gather data about IBD patients with COVID-19 so they can learn more about its effects.

What People with IBD Can Do to Stay Safe

The good news? We bet you’re already all over these recommendations, so just stick with ‘em:

  • Be vigilant about sticking to public health recommendations like social distancing and hand washing. “Be extra careful to protect yourself and your family members,” Dr. Rubin says.

  • Stay on your medication. “We strongly feel that the best way to stay healthy for an IBD patient is to keep the digestive tract as healthy as possible and try to prevent any flares,” says Dr. Grossman.

  • Communicate with your healthcare providers. “We’re here, we want to hear from them, we need to help them figure it out. They should not hesitate to get in touch with us,” says Dr. Grossman. “I know people are stressed and they might be worried about their busy doctors not being able to get back to them, but they should be reaching out on a regular basis so that they can get the information they need,” Dr. Rubin says.

  • Talk to your kids about what’s going on. “We’re all feeling a little anxious and our children are too,” Dr. Grossman says. “There are multiple resources available to help children understand what’s going on.”

  • Don’t leave the TV on and take breaks from the news coverage on COVID-19, which can add to your kids’ anxiety and fear (not to mention yours).

  • Maintain a healthy diet. “This is something that everyone can do in order to try to be as healthy as possible going into this,” says Dr. Grossman.

  • Acknowledge the effect this pandemic might be having on your mental health, especially since this can impact your physical health. “Although we're all under stress right now, there is an acknowledged component of stress that can worsen GI symptoms,” Dr. Rubin says.

  • Make sure you’re consulting reliable, reputable sources. Dr. Rubin recommends the Crohn’s & Colitis Foundation and the International Organization for the Study of Inflammatory Bowel Disease (IOIBD).

  • Keep in mind that researchers are working hard on immunity tests and vaccines. “I know that we’re going to get through this,” says Dr. Rubin. “What we’re waiting for that will really help us is additional ways to test for immunity so then you know that you’ve been exposed and you’re immune. And of course, we’re also waiting for a vaccine so that we can then protect people against COVID-19, but I think we’ll probably have antibody tests available before a working vaccine.”

  • GI Symptoms in Hospitalized Chinese Patients: The American Journal of Gastroenterology. (2020). “Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: a descriptive, cross-sectional, multicenter study.”
  • 2003 SARS Epidemic: World Health Organization (WHO). (n.d.). “SARS (Severe Acute Respiratory Syndrome).”
  • 2012 MERS Epidemic: Centers for Disease Control and Prevention (CDC). (n.d.). “Middle East Respiratory Syndrome (MERS).” cdc.gov/coronavirus/mers/about/index.html
Sarah Ludwig Rausch
Meet Our Writer
Sarah Ludwig Rausch

Sarah Ludwig Rausch is a health writer and editor whose specialties include mental health, diseases, research, medications, and chronic conditions. She’s written for The Christian Science Monitor, American Cancer Society, Cleveland Clinic, PsychologyToday.com, MedShadow Foundation, the ACT Test, and more.