All posts by Raffi Maurer

Can people with Crohn’s or Colitis have the COVID-19 vaccine?

Can people with Crohn’s or Colitis have the COVID-19 vaccine?

Yes, unless you are under 16, or have certain other health conditions – ask your healthcare professional for more details.

Having Crohn’s or Colitis, or taking any medicine to treat your condition, will not stop you from being able to have the COVID-19 vaccine.

All of the available vaccines are suitable for people on biologics, steroids and immunosuppressants.

You are still able to have vaccines that are not ‘live’ vaccines, no matter what medicine you take for your Crohn’s or Colitis. None of the COVID-19 vaccines are classed as live, including the vaccine made by Oxford.

Visit the NHS website for general information about the vaccine and how it will be delivered : https://www.nhs.uk/conditions/coronavirus-covid-19/coronavirus-vaccination/coronavirus-vaccine/ .

For information specific to Crohn’s and Colitis please visit: https://www.crohnsandcolitis.org.uk/news/latest-coronavirus-vaccine-for-people-with-crohns-or-colitis.

Baked Sweet Potato and Parsnip Latke

If you love a latke and are trying to get more veggies into your diet then these baked delicacies are just what you need.

Ingredients

  • 500 g sweet potatoes, peeled and grated
  • 400 g parsnips, peeled and grated
  • 1 onion, grated
  • 3 large eggs, beaten
  • 100 g ground almonds
  • sea salt
  • white pepper

Tahini sauce

  • 4 tbsp tahini
  • 4 tbsp apple juice
  • ½ – 1 tbsp lemon juice
  • 1 tbsp agave nectar
  • sea salt

INSTRUCTIONS

  • Pre-heat the oven to 350°F, gas mark 4, 180°C (200°C fan-assisted).
  • Line two baking trays with “My Relationship with Food” silicon baking mats or parchment paper – don’t be tempted to skip this part or your latkes will most probably stick to the tray.
  • Combine the grated sweet potatoes, parsnips and onion in a large bowl and mix well so that the vegetables are evenly distributed.
  • Season the beaten eggs generously with sea salt and white pepper then pour into grated vegetables and mix in.
  • Gradually add the ground almonds, folding them in until they’re thoroughly incorporated into the vegetable mix. At this stage, the mixture should be loose and quite wet.
  • Using either your hands or 2 large spoons, divide the mixture between the baking trays, forming firmly packed circular mounds – you want each one to be around 4 inches in diameter and ½ inch high (see tip below).
  • Place the trays into the pre-heated oven and bake for 20 minutes then remove and, using a spatula, carefully turn the patties over (they will be very soft so be careful) and bake for a further 10 minutes or until they’re lightly browned. Remove from the oven– they will still be quite soft as this point – and leave them on the baking trays for 10 minutes to firm up before moving or serving them.
  • For the tahini sauce, place all the ingredients into a bowl and whisk with a fork until smooth and creamy.
  • Serve the latkes with apple sauce and drizzled with the tahini sauce!
  • Enjoy!
  • When making this recipe, I’d LOVE to see how you get on so either send me a photo to lisa@myrelationshipwithfood.com or post a picture to Instagram using the #myrelationshipwithfood and tag @myrelationshipwithfood

NOTES

LISA’S TIP – Once I’ve made my latke mixture, I use my scales to divide it into 12 equal sized latkes – not only does it make sure they’re all the same size but it also ensures they all take the same amount of time to bake and that they bake evenly.

Sweet Potato Latke with Poached Eggs

{makes 10 Latkes}

Ingredients

675g Maris Piper potatoes (approx. 3 large) grated

250g sweet potato, grated

1 white onion, grated

60g fine cornmeal flour sifted

1⁄2 tsp baking powder, (gluten-free)

1 large egg

1 large egg yolk only

sea salt and white pepper

500ml sunflower oil

Garnish

4 tbsp crème fraiche

225g smoked salmon

4 large eggs

2 tsp vinegar

Small handful chives, chopped sprig of dill

 

Preparation time – 60 mins, cooking time – 20 mins

Grate the potatoes using the coarse side of the grater or a food processor. Place in a clean tea towel and squeeze out as much liquid as you can, then place the potato in a bowl (you want your moisture from other ingredients, not the potato).

Grate the sweet potato and onion and place in the same bowl as the white potato. In a separate bowl, beat the whole egg, and egg yolk. Season generously with sea salt and white pepper and mix well with potato mixture.

Add the sifted fine cornmeal flour and mix well. Using a 2.5cm round cutter, place a large tablespoon of filling into the cutter, with a chopping board underneath, squeeze the filling until level, lift off the cutter and repeat with the remaining mixture.

Place a large frying pan on the stove, add the oil on a medium/ high heat. Using a spatula carefully slide off the latkes into the hot oil, fry over moderate heat until brown on the underside (approx. 3-4 minutes), then flip over using a fork and spatula (approx. 3-4 minutes) until crisp and golden.

Remove from the pan, drain on paper towel and serve hot. Keep a lined tray ready for the latkes to keep warm in the oven as you make more batches… They’ll also cook through a little more in the oven. Don’t stack! You can’t leave the latkes in the frying pan too long because the natural sugar content of the sweet potato it will blacken easily – which is why it’s important you don’t have your stovetop heat on too high.

Poach the eggs to your liking in simmering water with a little vinegar for 3-4 minutes, then dry on paper towels.

Stack two potato pancakes per person with the egg on top. Add a spoonful of crème fraiche, with a sprig of dill and a smoked salmon flower (roll the smoked salmon and crunch together by the sides), and sprinkle with the chives.

 

LISA’S TIP

Always use fresh eggs when poaching and add a little vinegar to the water. This holds the egg’s protein together. Another trick is to break the eggs into a cup first, then add to the simmering water.

Follow @myrelationshipwithfood for more great gluten free recipes!

 

 

 

 

COVID-19: Latest advice – 7th June 2020

By Dr Steven Mann,  Consultant Gastroenterologist, 7th June 2020

Implications of having Inflammatory Bowel Disease during the Covid-19 pandemic.

In the UK, there are over 0.5 million people with IBD, namely Crohn’s disease or ulcerative colitis. Many of these patients will be on immunosuppressant drugs to control the gut inflammation. Over the last 3 months, patients have expressed concerns about the impact that IBD or the medication may have on their vulnerability to Covid-19 or its complications, or the impact that Covid may have on their own IBD. These have also been challenging times for patients being able to access their local IBD service due to service reconfiguration, cessation of face to face clinics, redeployment of staff to Covid duties, sick leave or isolation for health care professionals, etc.

Medication in IBD and Covid

The established risk factors for a worse outcome in Covid infection include older age, male sex, diabetes, obesity, and underlying cardiac or respiratory diseases. IBD per se does not increase the risk of acquiring Covid-19. The drugs used to treat IBD such as azathioprine, mercaptopurine, methotrexate or any of the biologics do not seem to confer any greater risk to the patient and the BSG and ECCO both advise patients to continue their medication. On the contrary, active disease does confer an increased risk of infection both in the community and in hospital, so stopping any medication should be discouraged to avoid the risk of a flare-up.

Do patients need to be shielded?

It appears that many patients have had letters or text messages form NHS sources advising them to shield for 12 weeks. The BSG has categorised patients into mild, moderate and high risk and these guidelines were published early in the outbreak and still hold true today. Most patients fall into moderate or lowest risk groups.

Low Risk- ‘social distancing’ as advised for the population in general.

Patients on the following medications:

► 5-ASA

► Rectal therapies

► Orally administered topically acting steroids (budesonide or beclometasone)

► Antidiarrhoeals (eg, loperamide)

Moderate Risk- ‘stringent social distancing’

  1. Patients on the following medications

– Anti-TNF (infliximab, adalimumab, golimumab, certolizumab) monotherapy

– Biologic plus immunomodulator in stable patients

– Ustekinumab

– Vedolizumab

– Thiopurines (azathioprine, mercaptopurine)

– Methotrexate

– Janus kinase (JAK) inhibitors (tofacitinib)

– Prednisolone less than 20mg/day

  1. Patients with moderate to severe disease activity not on the medication listed here

Highest Risk- ‘shielding’

  1. IBD patients who either have a comorbidity (respiratory, cardiac, hypertension or diabetes mellitus) and/or are ≥70 years old and are on any ‘moderate risk’ therapy for IBD (per middle column) and/or have moderate to severely active disease
  1. IBD patients of any age regardless of comorbidity and who meet one or more of the following criteria:

– Intravenous or oral steroids ≥20mg prednisolone or equivalent per day (only while on this dose)

– Commencement of biologic plus immunomodulator or systemic steroids within previous 6 weeks

– Moderate to severely active disease not controlled by ‘moderate risk’ treatments

Drug information for Covid

  1. Steroids

– avoid if possible; shield if on a dose of more than or equal to prednisolone 20mg/day

-consider rapid tapering

-do not stop suddenly

-consider use of Budesonide in both Crohn’s and colitis

-if infected with the SARS-CoV-2, try and reduce prednisolone dose to less than 20mg/day or switch to Budesonide if possible

  1. Immunomodulators

-no evidence for increased risk of Covid-19 infection

-if infected with the SARS-CoV-2,withhold the drug temporarily during the acute illness until 7-14 days after the illness

  1. Anti TNF agents

-no evidence for increased risk of Covid-19 infection

– consider initiation as monotherapy (without addition of azathioprine)

-if infected with the SARS-CoV-2, delay the dose for 2 weeks after the acute illness

  1. Ustekinumab (Stelara)

-no evidence for increased risk of Covid-19 infection

-if infected with the SARS-CoV-2, delay the dose for 2 weeks after the acute illness

  1. Vedolizumab

-no evidence for increased risk of Covid-19 infection

-if infected with the SARS-CoV-2, delay the dose for 2 weeks after the acute illness

  1. Tofacitinib

-no evidence for increased risk of Covid-19 infection

-if infected with the SARS-CoV-2, delay the dose for 2 weeks or until the acute illness has resolved

  1. Mesalazine

-no evidence for increased risk of Covid-19 infection

Could IBD Therapies be protective against Covid-19? 

There is some discussion in the literature that the sickest patients who end up on Intensive Care and needing ventilation have a heightened immune reaction the virus, and it is that overreaction that leads to complications. It has been postulated that biologics may protect against this abnormal immune response by dampening down the ‘overreaction’. This is under investigation and data being collected on an International Registry may answer this in due course (SECURE-IBD).

If patients wish to avoid attending the hospital or GPs are not doing blood tests, is that a concern on immunomodulators?

Under normal circumstances, patients on azathioprine, mercaptopurine and methotrexate will have blood test monitoring every 3 months or 2 months (methotrexate). In order to reduce the footfall in hospital or GP surgeries and in the interest of patient safety, there is a new extended monitoring recommendation for use during the Covid-19 pandemic. This allows for 6-monthly blood checks for patients on those drugs when they have been on a stable dose for some years or more than 6 months (methotrexate).

When can I have the colonoscopy that was advised before lockdown?

Following the cessation of all non-essential or non-emergency endoscopy in March 2020, hospitals are now working through processes to restart the service. There is a huge backlog of cases including many IBD patients.

Each Trust is responsible for implementing an infection control pathway that minimises any risk to the patient of catching coronavirus, but also of bringing it into the endoscopy unit. Guidelines have been published to facilitate this pathway. The capability and capacity to restore endoscopy practice will vary across different hospitals.

Patients will be screened with questionnaires and many units will swab patients 3-4 days prior to the procedure. Some units will be requesting that patients self isolate for 7 or 14 days pre-procedure.

IBD patients with a suspected new diagnosis will generally be permitted to have their endoscopy during this recovery phase in addition to patients who are being considered for escalation of therapy such as requiring biologics.

Routine surveillance of colitis patients will be deferred to beyond this recovery phase.

Top 10 tips for everyone with inflammatory bowel disease during the COVID-19 pandemic (BSG)

  1. We will do everything we can to keep you safe and well during the COVID-19 pandemic. Note that hospitals are undergoing massive reorganisation to prepare to care for those with serious infection.
  2. Don’t stop your medication; preventing disease flares is a priority. We want to keep you out of hospital if possible, but if you are unwell, we will be there for you.
  3. Ensure you have a good supply of medication should you need to self-isolate or shield yourself. Do not take steroids (prednisolone) from your general practitioner without discussing with your local inflammatory bowel disease (IBD) team.
  4. Contact your local IBD team via telephone or email helplines if you are experiencing a flare.
  5. Wash your hands frequently and avoid touching your face; this goes for everyone.
  6. Work from home if possible, and avoid non-essential travel and contact with people who are currently unwell.
  7. Stop smoking, as this increases the risk and severity of COVID-19 infection, and avoid non-steroidal antiinflammatory drugs (eg, ibuprofen).
  8. Government guidelines on self-isolation and social distancing are changing rapidly so please visit www.gov.uk and www.nhs.uk to keep up to date. (If you are unclear on your level of risk, contact your local IBD helpline for further advice).
  9. If you, or a household member, develop a continuous cough, flu-like symptoms OR fever you should:
    a) follow the government’s recommendations about self isolation and household quarantine
    b) if you test positive for COVID-19 you should contact your IBD team
    c) stop taking medicines in the moderate risk column of listed drugs above. Steroids should be tapered with advice from the IBD team and not stopped abruptly. Fourteen days after your symptoms have resolved, or if a household member is affected, the household quarantine period ends, contact your local IBD team for advice regarding restarting your medication.
    d) if you feel you cannot cope with your symptoms at home, or your condition gets worse, or your symptoms do not get better after 7 days, then use the NHS 111 online coronavirus service. If you do not have internet access, call NHS 111. For a medical emergency dial 999.
  10. Take care of yourself but also be kind and considerate to others in these difficult times

Since the infection is dynamic and knowledge and evidence are growing rapidly, some of this guidance will be updated as necessary.

 

Other links:

Crohn’s and Colitis UK have summarised the implications of the new UK government shielding guidelines that came into effect on 1st June 2020. The summary can be found here: https://www.crohnsandcolitis.org.uk/news/advice-for-people-with-crohns-and-colitis-self-isolation-social-distancing#new-shielding.

An international database called ‘Surveillance Epidemiology of Coronavirus Under Research Exclusion (SECURE-IBD)’ (https://covidibd.org/) has been collecting data to assess the impact of COVID-19 infection in patients with IBD. An article has been published in the leading journal Gastroenterology including data from 525 patients with IBD infected with COVD-19. A summary of the article can be found here: https://journalsblog.gastro.org/corticosteroids-but-not-tnf-antagonists-associate-with-adverse-covid-19-outcomes-in-patients-with-inflammatory-bowel-diseases/. Using the database, researchers found that in IBD patients increasing age, comorbidities (having other medical conditions) and corticosteroids but not anti-TNF medications were associated with severe COVID-19 infection. Further research is required to understand how these factors contribute.

Watch a recording of the Catherine McEwan Foundation IBD COVID-19 Q&A with Consultant Gastroenterologist Prof. Charles Lees and IBD Specialist Nurse Janice Fennell from 27th May 2020 here: https://www.facebook.com/watch/?v=563445997698539

COVID-19: Updated advice – 23rd March 2020

The Prime Minister has issued specific COVID-19 guidance for the 1.5million most vulnerable people living with chronic illness in the UK. This advises ‘shielding’ measures to reduce the transmission of COVID-19 infection and the risks from COVID-19 disease.

The British Society of Gastroenterology have placed people with Crohn’s and Colitis into three groups:

  1. Highest risk – the government advises people in this group to follow strict self-isolation guidelines for at least 12 weeks.
  2. Moderate risk – government advice for people in this category is to strictly follow social distance guidelines.
  3. Lower risk – this is the same level of risk as for the general population. Everyone is advised to follow the government’s advice on social distancing, avoiding social gatherings and crowded places and working from home if you can.

You are strongly advised to carry on taking your medication, as stopping your medication will put you at higher risk.

For more details on social distancing and frequently asked questions please visit:
https://www.crohnsandcolitis.org.uk/news/advice-for-people-with-crohns-and-colitis-self-isolation-social-distancing

Expert Q&A with Mr Daren Francis #CrohnsAndColitisAwarenessWeek

Expert Q&A with Mr Daren Francis, Consultant Laparoscopic, Colorectal and General Surgeon for #CrohnsAndColitisAwarenessWeek #IBD #SurgeryforIBD

What are the most common surgeries performed for Crohn’s and colitis? 00:06
Is surgery a cure? 01:36
Is there a difference in surgery for children and for adults? 01:54
Can surgery affect fertility? 02:16
With a reversible stoma, how often do they actually reverse? 02:51
What is the likelihood of relapse post surgery? 03:48
Has the rate of surgery reduced since newer medications have been more successful in treating IBD over the past few years? 04:20
How has surgery changed over the years? 04:51
Are surgeons keen to always do surgery or do they try and avoid it if they can? 05:20
Having performed many surgeries, is the overall feedback from patients positive or negative? 06:40

Thank you to Shimon Video Productions for filming and editing this video.