TABLE 2.

IBD management during the COVID-19 pandemic: general recommendations

Aspects of IBD care	Recommendations	Guidance
Medication management	Infusions should be continued at a center with a COVID-19 screening protocol and appropriate safety measures	– IOIBD(33) – AGA(34)
	Intravenous medications should not be switched to a different subcutaneous medication	AGA(33) IOIBD(34)
	IBD therapy should not be held except for corticosteroids which should be tapered or stopped	– IOIBD(32) – AGA(33)
	In case of SARS-CoV-2 infection, immunosuppressive therapy should generally be held for at least 10 days from symptom onset	– IOIBD(35)
Disease monitoring	Telemedicine is encouraged	– IOIBD(36, 37) – ECCO(38)
	Endoscopy: Procedures should be performed according to adequate safety measures and prioritized according to the urgency of their indication
	Laboratory tests: Clinical evaluation combined with fecal calprotectin and serum inflammatory markers can be used as alternative monitoring tools if endoscopy is not readily available
	The implementation of point-of-care biomarkers and home fecal calprotectin tests is encouraged
Hospitalization	Hospitalization should only be pursued if absolutely necessary	– IOIBD(39)
	Endoscopic or radiologic procedures should only be performed if urgently required or if susceptible to change management
	Length of stay should be minimized
Surgery	Preoperative SARS-CoV-2 testing is required prior to surgery	– IOIBD(40) – ECCO(38)
	Surgery should be postponed in uncomplicated IBD
Preventive care	Inactivated influenza vaccine and pneumococcal vaccine are strongly encouraged	– ECCO(38)
COVID-19 prevention	Usual preventive measures should be encouraged: social distancing, hand hygiene, using a mask, avoidance of travel and crowds	AGA(33) – ECCO(38) – CDC(41) – IOIBD(42)
	Non-live COVID-19 vaccine should be recommended to all patients with IBD, regardless of immunosuppressive therapy

Abbreviations: AGA, American Gastroenterological Association; CDC, Centers for Disease Control and Prevention; ECCO, European Crohn’s and Colitis Organisation; IOIBD, International Organization for the study of Inflammatory Bowel Disease