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Irritable Bowel Syndrome (IBS)


Irritable bowel syndrome (IBS) is a disorder that affects your lower GI (gastrointestinal) tract. This includes the small intestine and large intestine (colon). It is diagnosed when a person has belly pain or spasm associated with a change in the appearance or frequency of their bowel movements. It causes:

  • Belly cramps
  • Gas
  • Swelling or bloating
  • Changes in your bowel habits, such as diarrhea or constipation

When you have IBS, your colon looks normal. But it does not work the way it should.

Health experts have not been able to find an exact physical cause for IBS. It is often thought that stress is one cause. Stress may make IBS symptoms worse.

IBS is a long-term, chronic condition. It can be painful. But it doesn’t cause lasting harm to your intestines. And it doesn’t lead to serious disease such as cancer.

There is no link between IBS and Crohn’s disease, ulcerative colitis, or other inflammatory bowel diseases. However, people with inflammatory bowel disease can also have IBS.

What causes IBS?

The exact cause of IBS isn’t known. There are many possible causes of IBS, and they differ from person to person. This means that some people can have the same symptoms, but different causes of their IBS. Some experts think that if you have IBS, your colon or small intestine may be more sensitive than normal. That means it has a strong reaction to things that should not normally affect it.

When you have IBS, your colon muscles begin to move and tighten uncontrollably (spasm) after only mild stimulation or after normal events such as:

  • Eating
  • Swelling or bloating from gas or other material in the colon
  • Some medicines
  • Some foods

Women with IBS seem to have more symptoms during their periods. This could mean that the chemicals (reproductive hormones) released during a woman’s menstrual cycle may increase IBS symptoms.

Some things can make IBS symptoms worse. The 2 things most likely to make your IBS symptoms worse are the foods you eat and having emotional stress.

  • Diet. Eating makes your colon muscles move or contract. This normally gives you an urge to have a bowel movement 30 to 60 minutes after a meal. Having fat in your diet can cause contractions in your colon after a meal. With IBS, the urge may come sooner. You may also have cramps or diarrhea. Common foods that cause IBS are dairy products with lactose and poorly digested carbohydrates called FODMAPs.
  • Stress. If you have IBS, stress can make your colon move uncontrollably or spasm. Experts don’t fully understand why. But they believe this happens because the colon is partly controlled by the brain and spinal cord (nervous system). The nervous system controls how your body moves and reacts to things. Going for counseling or therapy and trying to reduce your stress can help to ease IBS symptoms. But this doesn’t mean that IBS is caused by a mental or emotional disorder. IBS is caused in part because of a problem with how the muscles of the colon move.

Who is at risk for IBS?

You are more likely to be at risk for IBS if you:

  • Are young. Most people first get IBS before they are 45 years old.
  • Are a woman. Women get IBS almost twice as often as men.
  • Have had recent gastroenteritis

What are the symptoms of IBS?

Each person’s symptoms may vary. Some of the most common symptoms include:

  • Having belly pain
  • Having painful constipation or diarrhea
  • Going back and forth between having constipation and having diarrhea
  • Having mucus in your stool

The symptoms of IBS may look like other health problems. Always see your healthcare provider to be sure. IBS does not cause rectal bleeding. Discuss any bleeding with your healthcare provider.

How is IBS diagnosed?

Your healthcare provider will look at your past health and give you a physical exam. You may not need any specific testing. Your provider will decide how much testing you need depending on your age and symptoms. They will also do lab tests to check for infection and for redness and swelling (inflammation).

There are usually no physical signs to tell for sure that you have IBS. There are also no exact tests for IBS.

Your healthcare provider will do lab tests and imaging tests to make sure that you don’t have other diseases. These tests may include the following:

  • Blood tests. These are done to see if you are lacking healthy red blood cells (anemia), have an infection, or have an illness caused by inflammation or irritation.
  • Urinalysis and urine culture. These help to see if you have an infection in any part of your urinary system (urinary tract infection or UTI). This includes your kidneys, the tubes that send urine from the kidneys to the bladder (ureters), your bladder, and the urethra, where urine leaves your body.
  • Stool culture. This test checks for any abnormal bacteria or parasites in your digestive tract that may cause diarrhea and other problems. To do this, a small stool sample is taken and sent to a lab. Other infections can also be evaluated by a stool sample.
  • Stool testing for blood (fecal occult blood test). This test checks for hidden blood in your stool that can only be seen with a microscope. A small amount of stool is tested in a a lab. If blood is found, it may mean you have redness and swelling (inflammation) in your GI (gastrointestinal) tract.
  • Upper endoscopy, also called EGD (esophagogastroduodenoscopy). This test looks at the inside or lining of your food pipe (esophagus), stomach, and the top part of your small intestine (duodenum). This test uses a thin, lighted tube, called an endoscope. The tube has a camera at one end. The tube is put into your mouth and throat. Then it goes into your esophagus, stomach, and duodenum. Your healthcare provider can see the inside of these organs. He or she can also take a small tissue sample (biopsy), if needed.
  • Abdominal X-rays. This test makes images of your internal tissues, bones, and organs.
  • Abdominal ultrasound. If your symptoms seem like they may be coming from the liver or gallbladder area, an ultrasound can check. It can also check how blood is flowing through different blood vessels.
  • Colonoscopy. This test looks at the full length of your large intestine. It can help check for any abnormal growths, red or swollen tissue (inflammation), sores (ulcers), or bleeding. A long, flexible, lighted tube called a colonoscope is put into your rectum up into the colon. This tube lets your healthcare provider see the lining of your colon and take out a tissue sample (biopsy) to test it. They may also be able to treat some problems that may be found.
  • Breath test. This test may diagnose bacterial overgrowth that some believe can lead to IBS.

How is IBS treated?

Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.

Treatment for IBS may include:

  • Changes in your diet. Eating a proper diet is important if you have IBS. In some cases, a high-fiber diet can reduce symptoms. Some people get symptoms from lactose and should eat lactose-free dairy products. Some people get symptoms from poorly digestible carbohydrates and fructose. Some people are intolerant to gluten although they may not have celiac disease. Many people get symptoms from large and fatty meals. Keep a list of foods that cause you pain, and talk about this with your healthcare provider. Also talk with your healthcare provider about FODMAPs and ways to reduce and eliminate them from your diet.
  • Medicines. Your healthcare provider may prescribe fiber supplements or have you take something now and then to loosen your stool (a laxative). Different medicines are used for IBS, depending on your symptoms. They include medicines to prevent constipation, diarrhea, pain, and spasm.
  • Antibiotic. A poorly absorbed antibiotic is used in certain situations to improve IBS symptoms, especially symptoms of bloating, distention, and loose stool.
  • Natural supplements. Some people feel better on various natural supplements called probiotics. Others get relief with peppermint oil capsules.
  • Manage stress. Hypnosis, acupuncture, cognitive behavioral therapy, yoga, regular exercise, relaxation, and other mindfulness activities can help some people with IBS.

Good fiber sources may include:

FoodsModerate fiberHigh fiber
BreadWhole-wheat bread, granola bread, wheat bran muffins, waffles, popcorn
CerealWhole-wheat cerealsWhole-bran cereals
VegetablesBeets, broccoli, Brussels sprouts, cabbage, carrots, corn, green beans, green peas, acorn and butternut squash, spinach, potato with skin, avocado
FruitsApples with peel, dates, papayas, mangos, nectarines, oranges, pears, kiwis, strawberries, applesauce, raspberries, blackberries, raisinsCooked prunes, dried figs
Meat substitutesPeanut butter, nutsBaked beans, black-eyed peas, garbanzo beans, lima beans, pinto beans, kidney beans, chili with beans, trail mix

What are possible complications of IBS?

The diarrhea and constipation that happen with IBS can cause hemorrhoids. If you already have hemorrhoids, they may get worse.

Your quality of life may be affected by IBS, because the symptoms may limit your daily activities.

What can I do to prevent IBS?

Health experts don’t know what causes IBS. They also don’t know how to stop it from happening.

Living with IBS

IBS symptoms can affect your daily activities. It’s important to work with your healthcare provider to manage the disease. You may need a plan to deal with issues such as diet, work, lifestyle, and emotional or mental health.

When should I call my healthcare provider?

Call your healthcare provider right away if your symptoms get worse or if you have new symptoms.

Key points about IBS

  • IBS is a disorder that affects your lower GI tract. This includes the small intestine and large intestine (colon).
  • It is a long-term, chronic disorder.
  • The exact cause of IBS is not known. There are probably many different causes in different people.
  • When you have IBS your colon looks normal. But it does not work the way it should.
  • The things most likely to worsen symptoms of IBS are diet and emotional stress.
  • Treatment may include changing your diet and taking medicines.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.

Research

Can vitamin D really prevent Covid-19? Here’s what the evidence says.


Vitamin D supplement sales have soared amid the pandemic as people try to curb their risk of contracting the novel coronavirus—but some experts are urging caution, noting that not enough research has been done to establish a definitive relationship between taking the supplement and fending off Covid-19.

What the research says about vitamin D and Covid-19

According to Sabyasachi Sen, a professor of endocrinology and medicine at George Washington University (GW), deficiencies of vitamin D are “not rare” and are especially common in older adults, obese people, and people with darker skin—some of the same populations most affected by Covid-19.

While vitamin D is known for protecting bone health, it also helps with the immune system, Sen said. It’s believed that vitamin D improves the function of certain cells, including T cells, which fight off pathogens and can assist in modulating inflammatory responses.

In addition, Sen continued, research has found vitamin D deficiencies have been associated with an increased risk of infection. “Now, what is unknown is whether it’s a cause and effect rather than an association,” he said.

According to the Washington Post, researchers studying the relationship between vitamin D and Covid-19 outcomes are interested in precisely that question: whether there’s a cause and effect relationship, or merely an association.

For example, one study, published in JAMA Network Open, looked at the health records of 489 people in Chicago and found patients with a vitamin D deficiency in the year prior to testing for Covid-19 were 77% more likely to test positive for the disease than those with normal vitamin D levels. Taking a converse approach, another study looked at a small group of Covid-19 patients in Italy who had been hospitalized with acute respiratory failure and found that 81% of them had a vitamin D deficiency.

Meanwhile, an experimental study in France at a nursing home with 66 people found that taking vitamin D supplements was “associated with less severe Covid-19 and a better survival rate.” Similarly, a study in South Korea of 200 people found that a deficiency of vitamin D could “decrease the immune defenses against Covid-19 and cause progression to severe disease.” And a small study in Spain involving 76 hospitalized Covid-19 patients found that those treated with calcifediol—an activated version of vitamin D, distinct from the over-the-counter supplement—seemed to curb the severity of the disease.

On the flipside, however, a recent paper considered by the National Institute for Health and Care Excellence in the United Kingdom looked at vitamin D levels from up to 14 years ago and didn’t find any correlation between vitamin D levels and Covid-19 mortality. And while the lead author of that study has in other papers called for further research on the link between vitamin D and Covid-19 outcomes, the researchers concluded, “For now, recommendations for vitamin D supplementation to lessen Covid-19 risks appear premature and, although they may cause little harm, they could provide false reassurance leading to changes in behaviour that increase risk of infections.”

Similarly, a double-blind randomized controlled trial of 240 patients in Brazil, which has yet to be peer-reviewed, found that one large dose of vitamin D didn’t reduce hospital stay length or mortality rates among patients with a severe case of Covid-19 compared with those in a placebo group.

Correlation—not necessarily causation

“We do know that people who have lower blood levels of vitamin D tend to have a higher risk of being infected with Covid-19 and having severe Covid-19 illness,” JoAnn Manson, chief of the Division of Preventive Medicine at Brigham and Women’s Hospital, said. “But as we say in epidemiology, ‘Correlation doesn’t prove causation.’ We don’t know for sure that the low vitamin D level is causing an increased risk of Covid-19.”

According to Natasha Chida, an infectious disease expert and assistant professor of medicine at Johns Hopkins University, people who have a vitamin D deficiency typically have other health factors that could affect how likely they are to develop a severe case of Covid-19—and people who do develop diseases such as Covid-19 often experience a drop in vitamin D levels.

“Unless you take into account all those factors and separate all those out and look at just vitamin D … it’s really hard to make any inferences about what vitamin D is doing here,” she said.

Chida added that there’s “some biologic plausibility” that vitamin D could help Covid-19 patients. “It’s just that despite years of research into the use of vitamin D in respiratory tract infections, there still hasn’t really been a clear, slam-dunk answer that there’s a benefit.”

Research into the relationship is ongoing, however. According to the Washington Times, about 70 clinical trials assessing vitamin D and Covid-19 have been filed in the U.S. National Library of Medicine database.

Should you take vitamin D supplements?

As of now, experts say people who know they have vitamin D deficiencies should continue their treatment, and those thinking about taking supplements should talk to their health care provider first, given there’s no firm evidence that vitamin D supplements curb people’s risk of infection or serious Covid-19 illness.

“People should be wary of taking mega doses of vitamins or unproven interventions specifically for Covid-19, because we don’t have good quality data yet to suggest that this is of any help,” Hana Akselrod, an infectious disease specialist at GW, said.

Instead of supplements, people can add more vitamin D to their lives by being outdoors for 15 or 20 minutes a day, Akselrod added. And some foods, such fatty fish or fortified dairy products, could also improve vitamin D levels, Manson said.

“There are all of the positive confluences around nutrition and outdoor exercise that aren’t just limited to the number of how many units of vitamin D you get every day,” Akselrod said. “And on top of that, people absolutely need to continue all the other safety precautions, like masking and safe distancing and avoiding gatherings, because we’re in the most dangerous phase of the pandemic yet”.

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COVID-19 will likely be with us forever. Here’s how we’ll live with it.

As COVID-19 continues to run its course, the likeliest long-term outcome is that the virus SARS-CoV-2 becomes endemic in large swaths of the world, constantly circulating among the human population but causing fewer cases of severe disease. Eventually—years or even decades in the future—COVID-19 could transition into a mild childhood illness, like the four endemic human coronaviruses that contribute to the common cold.

“My guess is, enough people will get it and enough people will get the vaccine to reduce person-to-person transmission,” says Paul Duplex, director of the University of Pittsburgh’s Center for Vaccine Research. “There will be pockets of people who won’t take [the vaccines], there will be localized outbreaks, but it will become one of the ‘regular’ coronaviruses.”

But this transition won’t happen overnight. Experts say that SARS-CoV-2’s exact post-pandemic trajectory will depend on three major factors: how long humans retain immunity to the virus, how quickly the virus evolves, and how widely older populations become immune during the pandemic itself.

Depending on how these three factors shake out, the world could be facing several years of a halting post-pandemic transition—one marked by continued viral evolution, localized outbreaks, and possibly multiple rounds of updated vaccinations.

“People have got to realize, this is not going to go away,” says Roy Anderson, an infectious disease epidemiologist at Imperial College London. “We’re going to be able to manage it because of modern medicine and vaccines, but it’s not something that will just vanish out of the window.”

The long road to another common cold

One of the essential factors governing the future of COVID-19 is our immunity to the illness. Immunity to any pathogen, including SARS-CoV-2, isn’t binary like a light switch. Instead, it’s more like a dimmer switch: The human immune system can confer varying degrees of partial protection from a pathogen, which can stave off severe illness without necessarily preventing infection or transmission.

In general, the partial protection effect is one of the reasons why the four known endemic human coronaviruses—the ones that cause a common cold—have such mild symptoms. A 2013 study in BMC Infectious Diseases shows that on average, humans are first exposed to all four of these coronaviruses between the ages of three and five-part of the first wave of infections that young children experience.

These initial infections lay the foundation for the body’s future immune response. As new variants of the endemic coronaviruses naturally evolve, the immune system has a head start in fighting them off—not enough to eradicate the virus instantly, but enough to ensure that symptoms don’t progress much beyond the sniffles.

“The virus is also its own enemy. Every time it infects you, it tops up your immunity,” says Marc Veldhoen, an immunologist at the Portugal’s University of Lisbon.

Past studies make clear that partial immunity can keep people from getting seriously ill, even as coronaviruses successfully enter their systems. Long-term, the same is likely to be true for the new coronavirus. Emory University postdoctoral fellow Jennie Lavine modeled SARS-CoV-2’s post-pandemic trajectory based on the 2013 study’s data, and her results—published in Science on January 12—suggest that if SARS-CoV-2 behaves like other coronaviruses, it will likely morph into mild nuisance years to decades from now.

This transition from pandemic to minor ailment, however, depends on how the immune response to SARS-CoV-2 holds up over time. Researchers are actively examining the body’s “immunological memory” of the virus. A study published in Science on January 6 tracked the immune response of 188 COVID-19 patients for five to eight months post-infection, and while individuals are varied, about 95 percent of patients had measurable levels of immunity.

“Immunity is waning, but certainly not gone, and I think this is key,” says Lavine, who wasn’t involved with the study.

In fact, it’s even possible that one of the cold-causing coronaviruses sparked a serious outbreak in the 1800s before fading into the litany of mild, commonplace human pathogens. Based on the spread of its family tree, researchers estimated in 2005 that the endemic coronavirus OC43 entered humans sometime in the late 19th century, likely the early 1890s. The timing has led some researchers to speculate that the original version of OC43 may have caused the “Russian flu” pandemic of 1890, which was noted for its unusually high rate of neurological symptoms—a noted effect of COVID-19.

“There’s no hard proof, but there are a lot of indications that this wasn’t an influenza pandemic but a corona-pandemic,” Veldhoen says.

The crucible of evolution

Though the carnage of past coronaviruses has faded over time, the road to a relatively painless coexistence between humans and SARS-CoV-2 will likely be bumpy. In the medium-term future, the impact of the virus will depend largely on its evolution.

SARS-CoV-2 is spreading uncontrollably around the world, and with every new replication, there’s a chance for mutations that could help the virus more effectively infect human hosts.

The human immune system, while protecting many of us from a serious illness, is also acting as an evolutionary crucible, putting pressure on the virus that selects for mutations that make it bind more effectively to human cells. The coming months and years will reveal how well our immune systems can keep up with these changes.

New SARS-CoV-2 variants also make widespread vaccination and other transmission-blocking measures, such as face masks and distancing, more crucial than ever. The less the virus spreads, the fewer opportunities it has to evolve.

We’re going to be able to manage it because of modern medicine and vaccines, but it’s not something that will just vanish out of the window.

ROY ANDERSONIMPERIAL COLLEGE LONDON

Current vaccines should still work well enough against emerging variants, such as the B.1.1.7 lineage first found in the United Kingdom, to prevent many cases of serious illness. Vaccines and natural infections create diverse swarms of antibodies that glom onto many different parts of SARS-CoV-2’s spike protein, which means that a single mutation can’t make the virus invisible to the human immune system.

Mutations may produce future variants of SARS-CoV-2 that partially resist current vaccines, however. In a preprint posted on November 19 and updated on January 19, Duplex and his colleagues show that mutations that delete parts of the SARS-CoV-2 genome’s spike protein region prevent certain human antibodies from binding.

“What I’ve learned from our own work is how deviously beautiful evolution is,” Duplex says.

Other labs have found that mutations in 501Y.V2, the variant first found in South Africa, are especially effective at helping the virus elude antibodies. Out of 44 recovered COVID-19 patients in South Africa, blood extracts from 21 of the patients didn’t effectively neutralize the 501Y.V2 variant, according to another preprint published on January 19. Those 21 people had mild to moderate cases of COVID-19, however, so their antibody levels were lower, to begin with, perhaps explaining why their blood did not neutralize the 501Y.V2 variant.

So far, currently authorized vaccines—which spur the production of high levels of antibodies—seem to be effective against the most concerning variants. In a third preprint published on January 19, researchers showed that antibodies from 20 people who had received the Pfizer-BioNTech or Moderna vaccines didn’t bind quite as well to viruses with the new mutations as they did to earlier variants—but they still bound, suggesting the vaccines will still protect against severe illness.

The new variants bring other threats as well. Some, such as B.1.1.7, appear to be more transmissible than earlier forms of SARS-CoV-2, and if left to spread uncontrollably, these variants could make many more people severely ill, which risks overwhelming healthcare systems around the world and even higher death tolls. Veldhoen adds that new variants also may pose a greater risk of reinfection to recovered COVID-19 patients.

Researchers are closely monitoring the new variants. If vaccines need to be updated in the future, Anderson says that it could be done quickly—in roughly six weeks for currently authorized mRNA vaccines, such as those made by Pfizer-BioNTech and Moderna. That timetable, though, doesn’t account for the regulatory approvals that updated vaccines would need to go through.

Anderson adds that depending on how the evolution of the virus progresses, lineages of SARS-CoV-2 may arise that are distinct enough that vaccines will need to be tailored to specific regions akin to vaccines for pneumococcus. To successfully guard against SARS-CoV-2 going forward, we will need a global monitoring network similar to the worldwide reference laboratories used to collect, sequence, and study variants of influenza.

“We’re going to have to live with it, we’re going to have to have constant vaccination, and we’re constantly going to have to have a very sophisticated molecular surveillance program to keep track of how the virus is evolving,” Anderson says.

The promise and challenge of widespread vaccination

Experts agree that transitioning beyond a pandemic depends on the prevalence of immunity, especially among older and more vulnerable populations. Younger people, especially children, will build up immunity to SARS-CoV-2 over a lifetime of exposure to the virus. Today’s adults have had no such luxury, leaving their immune systems naive and exposed.

The exact threshold for achieving population-wide immunity that slows down the virus’s spread will depend on how contagious future variants become. But so far, research of early variants of SARS-CoV-2 suggests at least 60 to 70 percent of the human population will need to become immune to end the pandemic phase.

This immunity can be achieved in one of two ways: large-scale vaccination, or recovery from natural infections. But achieving widespread immunity through uncontrolled spread comes at a terrible cost: hundreds of thousands more deaths and hospitalizations around the world. “If we don’t want to push forward vaccines and champion vaccines, we have to decide collectively how many old people we want to die—and I don’t want to be the one making that decision,” Duplex says.

Jeffrey Shaman, an infectious diseases expert at Columbia University, points out that the global push for vaccines also exposes existing inequities in global health. In a widely shared map from December, The Economist Intelligence Unit estimated that rich countries such as the U.S. will have widely accessible vaccines by early 2022, which may not happen for poorer countries in Africa and Asia until as late as 2023.

Efforts to vaccinate the developing world hinge, in part, on vaccines that can be stored with standard refrigeration, such as the vaccines under development by Oxford/AstraZeneca and Johnson & Johnson. (See the latest on COVID-19 vaccine development around the world.)

As of the week of January 18, according to a World Health Organization estimate, some 40 million COVID-19 vaccine doses have been administered around the world, mostly in high-income countries. In Africa, only two countries, Seychelles and Guinea, have started providing vaccines. And in Guinea, a low-income country, only 25 people have received doses.

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Research

Patients with IBD should receive COVID-19 vaccine, despite concerns

“For patients with IBD we would advocate, based on [International Organization for the Study of Inflammatory Bowel Disease (IOIBD)], that patients get vaccinated, acknowledging that there is a lack of data specifically in IBD patients,” Ryan C. Ungaro, MD, MS, gastroenterologist with Mount Sinai Hospital’s Feinstein IBD Center, told Healio Gastroenterology. “But we think the benefits outweigh the risks and based on prior experience with vaccinations in IBD patients.”

CDC and IOIBD recommend patients with IBD should receive the COVID-19 vaccine.

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According to Ungaro, the CDC recommended immunocompromised patients should get the COVID-19 vaccine. Patients should be counseled that it is not yet known whether the safety and effectiveness of the vaccine in immunocompromised patients are the same compared with the general population.

“The major concern would be certain medications could lead to decreased response to the vaccine,” he said. “That is something that is going to need to be studied but right now the expert consensus is that IBD patients should get vaccinated against COVID-19.”

According to IOIBD recommendations, patients with IBD should receive the COVID-19 vaccine as soon as possible. Messenger RNA vaccines, replication vector vaccines, inactivated vaccines, and recombinant vaccines are safe to be administered in IBD patients, Ungaro said.

Additionally, the IOIBD said vaccines should not be deferred if an IBD patient is receiving immune-modifying therapies.

According to Ungaro, patients with IBD who take corticosteroids and get the vaccine should receive counseling that there may be a decreased systemic response. He said this needs to be studied further.

“Prospective studies are being planned to look at the real-world effectiveness and side effects of the COVID-19 vaccine in IBD patients,” Ungaro said. “This would require cohorts that are vaccinated and followed. Some studies are ongoing for that both in the United States and internationally. [Surveillance Epidemiology of Coronavirus Under Research Exclusion-IBD (SECURE-IBD)] is going to help support some of these efforts as well.”

Ungaro and his team at Mount Sinai in collaboration with the University of North Carolina developed the SECURE-IBD registry early in 2020 to monitor and report outcomes of COVID-19 in patients with IBD.

He said, “Physicians can encourage IBD patients to enroll in the Crohn’s and Colitis Foundation’s IBD Partners, they will be one of the sources for the prospective COVID-19 vaccine studies.”

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