Adaptations to the British Society of Gastroenterology guidelines on the management of acute severe UC in the context of the COVID-19 pandemic: a RAND appropriateness panel

Shahida Din, Alexandra Kent, Richard C Pollok, Susanna Meade, Nicholas A Kennedy, Ian Arnott, R Mark Beattie, Felix Chua, Rachel Cooney, Robin J Dart, James Galloway, Daniel R Gaya, Subrata Ghosh, Mark Griffiths, Laura Hancock, Richard Hansen, Ailsa Hart, Christopher Andrew Lamb, Charlie W Lees, Jimmy K LimdiJames O Lindsay, Kamal Patel, Nick Powell, Charles D Murray, Chris Probert, Tim Raine, Christian Selinger, Shaji Sebastian, Philip J Smith, Phil Tozer, Andrew Ustianowski, Lisa Younge, Mark A Samaan, Peter M Irving

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVE: Management of acute severe UC (ASUC) during the novel COVID-19 pandemic presents significant dilemmas. We aimed to provide COVID-19-specific guidance using current British Society of Gastroenterology (BSG) guidelines as a reference point.

DESIGN: We convened a RAND appropriateness panel comprising 14 gastroenterologists and an IBD nurse consultant supplemented by surgical and COVID-19 experts. Panellists rated the appropriateness of interventions for ASUC in the context of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. Median scores and disagreement index (DI) were calculated. Results were discussed at a moderated meeting prior to a second survey.

RESULTS: Panellists recommended that patients with ASUC should be isolated throughout their hospital stay and should have a SARS-CoV-2 swab performed on admission. Patients with a positive swab should be discussed with COVID-19 specialists. As per BSG guidance, intravenous hydrocortisone was considered appropriate as initial management; only in patients with COVID-19 pneumonia was its use deemed uncertain. In patients requiring rescue therapy, infliximab with continuing steroids was recommended. Delaying colectomy because of COVID-19 was deemed inappropriate. Steroid tapering as per BSG guidance was deemed appropriate for all patients apart from those with COVID-19 pneumonia in whom a 4-6 week taper was preferred. Post-ASUC maintenance therapy was dependent on SARS-CoV-2 status but, in general, biologics were more likely to be deemed appropriate than azathioprine or tofacitinib. Panellists deemed prophylactic anticoagulation postdischarge to be appropriate in patients with a positive SARS-CoV-2 swab.

CONCLUSION: We have suggested COVID-19-specific adaptations to the BSG ASUC guideline using a RAND panel.

Original languageEnglish
Pages (from-to)1769-1777
Number of pages9
JournalGut
Volume69
Issue number10
DOIs
Publication statusPublished - 7 Sep 2020

Keywords

  • Acute Disease
  • Betacoronavirus
  • COVID-19
  • Colitis, Ulcerative/diagnosis
  • Coronavirus Infections/epidemiology
  • Gastroenterology
  • Humans
  • Infection Control/organization & administration
  • Pandemics/prevention & control
  • Patient Selection
  • Pneumonia, Viral/epidemiology
  • Practice Guidelines as Topic
  • SARS-CoV-2
  • Societies, Medical
  • United Kingdom

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