Abstract
Background & Aims: COVID-19 pandemic causes more severe illness in patients with pre-existing comorbidities and the elderly. It is unclear whether patients with chronic inflammatory disorders, such as inflammatory bowel disease (IBD), are at increased risk of infection and of more severe disease. We performed a case-control study in Lombardy, Italy, aimed at comparing the prevalence of COVID-19 symptoms, diagnosis and hospitalization in IBD patients and matched controls referred for other digestive disorders or complaints. Patients and Methods: This multicentre study included 2733 consecutive outpatients (1397 IBD patients; cases, and 1336 patients with non-inflammatory bowel disorders, controls), from eight major gastrointestinal centres. Patients were invited to complete a web-based questionnaire regarding their demographic, historical and clinical features over the previous 6 weeks. The prevalence of COVID-19 symptoms, diagnosis and hospitalization for COVID-19 was assessed in IBD cases and controls. Results: One thousand eight hundred and ten patients (64%) responded to the questionnaire (941 IBD patients and 869 controls). IBD patients were significantly younger and of male sex than controls. Comorbidities were not significantly different other than oncologic and rheumatological diseases. Nonsteroidal anti-inflammatory drugs (NSAID) use and active smoking were more frequent in controls. IBD patients were more likely treated with vitamin D and vaccinated for seasonal influenza. Highly probable COVID-19 on the basis of symptoms and sign was less frequent in the IBD group (3.8% vs 6.3%; OR 0.45, 95% CI 0.28-0.75, p 0.0018). IBD patients had a lower rate of nasopharyngeal swab-PCR confirmed diagnosis (0.2% vs 1.2%; OR 0.14, 95% CI 0.03-0.67, p 0.024). There was no difference in hospitalization between the groups (0.1% vs 0.6%; OR 0.14, 95% CI 0.02 -1.17, p 0.07). Conclusion: IBD patients do not have an increased risk of COVID-19 or more severe disease compared with a matched gastroenterology patient cohort. Several factors may be protective including higher rates of influenza vaccination, vitamin D levels, decreased NSAID use, lower smoking rates, biologic use and higher compliance to social distancing. Funding Statement: No external funding for this manuscript. Declaration of Interests: All authors have indicated they have no potential conflicts of interest to disclose. Ethics Approval Statement: The study was approved by Luigi Sacco University Hospital ethics committee (Code. n. 2020/ST/062). The identity and privacy of each patient was secured and response to each questionnaire was anonymised.
Published Version
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