COVID-19 and Celiac Disease Dr Donald Duerksen Chair Professional Advisory Committee Canadian Celiac Association
COVID-19 Canada April 27, 2020
COVID-19 Information Overload!
COVID-19 is found in the stool There are ACE receptors in the GIT that the virus uses to infect cells The virus is shed in the stool for a median of 22 days after infection (BMJ April 23, 2020) COVID-19 GI Symptoms Common In COVID infection Lack of Appetite (78.6%) and the GI Diarrhea (35%) Vomiting (3.9%) Tract Abdominal Pain (1.9%) In some cases, patients present with GI symptoms (18.6%) rather than respiratory symptoms or fever Excludes lack of Appetite AJG April 14, 2020
Aerosol Generating Medical Procedure (AGMP) a medical or health-care procedure that results in the production of airborne particles or respiratory droplets, which may be pathogenic. COVID-19 and In the case of COVID infection, this may result in spread of the virus. Endoscopy Because a gastroscopy could provoke coughing, particularly during insertion of the endoscope, it can be considered an AGMP
Aerosol Generating Medical Procedure (AGMP) What are the implications? COVID-19 If a gastroscopy is being performed, this must be done with special PPE including an N-95 mask and in an area where and there is negative pressure ventilation or special filtration. Endoscopy During COVID crisis it is advised to limit gastroscopy as much as possible Decreased potential for spread of the virus amongst staff Decrease potential spread of virus amongst patients Conserve PPE
What about gastroscopy for the diagnosis of Celiac Disease Diagnosis of Celiac Disease Biopsy still recommended for diagnosis of celiac disease COVID-19 and During COVID Endoscopy All Elec ective Proc oced edures es Shou ould Be Delayed ed Urge gent/Eme merge gent Proce cedure res Shou ould Not ot Be Be Del elayed ed The major GI Societies in Canada and USA advocate delaying biopsy in the case of suspected celiac disease
Gastroscopy for the diagnosis of Celiac Disease COVID-19 and The prioritization of gastroscopy for celiac diagnosis once Endoscopy COVID-19 risk has diminished needs to be worked out.
COVID-19 and GI disorders
What do we know about COVID-19 and Inflammatory Bowel Disease Disease caused by “immune imbalance”. Example of an autoimmune disease Patients on different Immune suppressing drugs Large world-wide database collecting information on patients with IBD COVID-19 and IBD So Far….... 0ver 700 patients in database 1) Patients with IBD not at increased risk of getting COVID-19 2) Patients with IBD do not have a worse outcome if they contract COVID-19 3) Avoid prednisone use if possible
Individuals with Celiac Disease are not considered at increased risk of getting COVID-19 COVID-19 Individuals with Celiac Disease do not have a worse and Celiac outcome if they get COVID-19 infection. Disease Individuals with celiac disease best protection to prevent acquiring this infection are social distancing measures (similar to everyone else).
There is a worldwide database collecting information on celiac disease. COVID-19 and Celiac Disease
Strategies for Individuals Who Are Serologically Positive and are unable to get a biopsy during COVID If minimally symptomatic, continue gluten ingestion COVID-19 If symptomatic, reduce gluten ingestion but continue to have some gluten exposure and Celiac Disease If very symptomatic, adopt a GFD and consider gluten challenge once crisis is over. *** I If conc ncerne ned a about ut t the he possibil ilit ity o of ha having ing celia liac disease, g get t serol olog ogical ally te tested p prior or to to empirical ally s star tarting a glut luten f fre ree d die iet.
Diagnosi sis s of Celiac D Dise sease se COVID-19 Some cases are complicated and many different factors need to be considered. and Celiac Each case needs to be considered on its merit. Disease Primary Care Physicians and Gastroenterologists are available for virtual/telephone consultations to give guidance in challenging cases.
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