COVID-19 update on shielding: 24th June 2020

The Government has announced a relaxation of its guidelines for those individuals that are shielding. These changes come into effect on the 6th July and include removing the need to social distance within a household, meeting individuals from other households outdoors and forming support bubbles. The shielding programme is expected to be paused at the end of July.

For further details please refer to the Crohn’s and Colitis UK website here: https://crohnsandcolitis.org.uk/news/advice-for-people-with-crohns-and-colitis-self-isolation-social-distancing#new-shielding (“What do the new shielding guidelines mean for me?”) and the Government website here: https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19.

The guidance is different for those that are deemed ‘clinically vulnerable’ and ‘clinically extremely vulnerable’.

It is important that all individuals remain to be careful and diligent about social distancing and hand hygiene.

Guidance is continually evolving. If you are uncertain about how to interpret the guidelines it is important to seek advice from your GP and/or IBD nurse/doctor. Alternatively, feel free to contact Jewish Digest and we will try and assist you.

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

Grain-Free Chocolate Coconut Banana Pancakes

pancakes
Makes 6 pancakes
Ingredients
Garnish
Instructions
  1. Put all the ingredients except for the coconut oil into a bowl and blend together with a hand stick blender.
  2. Melt the coconut oil on a gentle heat and put into a separate bowl.
  3. Heat your pancake or frying pan over a medium heat and take a square of kitchen roll, dab it into the oil and then wipe your pancake or frying pan with the oil.
  4. Once the oil is hot, take ¾ ladle of the pancake mixture and pour into the pancake pan.
  5. Cook until golden brown on the underside (approx. 1 minute), then flip over and cook until golden brown on the other side (about 30 seconds).
  6. Once you’ve cooked all 6 pancakes, stack them back on top of each other in a set of 3 to warm through in the hot pan and flip over to warm the other side.
  7. Serve warm with a drizzle of agave nectar, sliced bananas, toasted coconut chips and chocolate shavings on top.

LISA’S TIP – After you have poured in the pancake mixture, shake the pan gentle to ensure the mixture is evenly spread. It’s hard to believe that you don’t need flour, milk or refined sugar to create a lovely, light and kid-approved pancake. Although delightful, don’t be expecting your run-of-the-mill carb-filled pancake. These have more of an eggy crepe-like texture, which is equally appealing.  If you’re used to eating clean healthy foods, you will more than likely LOVE these. Low-calorie, high-protein, gluten-free and wheat-free…. what’s not to love? Not only do they make a quick and easy breakfast, but they’re also the perfect pre or post-workout fuel, you can even add your favourite protein powder.

100 GLUTEN-FREE RECIPES AT YOUR FINGERTIPS ❤ The My Relationship with Food cookbook is available on the iBooks Store for just £2.99 (normally £9.99) until the end of February!!

If you’ve not got your hands on a copy yet (or if you’d like a virtual copy as well as a hard copy – perfect for on the go) then why not take advantage of this limited time offer and quickly and easily download the book onto the Apple device of your choice today! Hit the link in my profile 👉🏻 @myrelationshipwithfood Or visit

https://nam10.safelinks.protection.outlook.com/?url=https%3A%2F%2Fbooks.apple.com%2Fgb%2Fbook%2Fmy-relationship-with-food%2Fid1221468096&data=02%7C01%7C%7C1bb8135c5cee4a47f70808d7b30797e6%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637174717494875146&sdata=pIIjS5r3sdkhDXFSzFXAhCN1A27U5W%2BeaO53Q030jv4%3D&reserved=0

Happy downloading!

❤ #myrelationshipwithfood

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.

Salmon Vegetable Parcels (with Nutrition by Sylvie)

Ingredients:
1 fillet of salmon
Herbamare, salt, pepper
Olive oil
Lemon zest of lemon
Fresh thyme and chives
¼ fresh garlic
1 courgette
1 carrot
½ spring onion

Method:
Season the salmon with herbamere, salt and pepper, olive oil and lemon zest.
Add finely peeled strips of courgette and carrots, spring onion, chives and thyme.
Wrap up the salmon with the vegetables in baking paper to make a tightly sealed parcel.
Place in oven at 190C for 25 mins

Sauce:
Organic natural yogurt
Flaxseed oil
Chives
Herbamare

Mix all together and serve on side as a healthy alternative to mayonnaise.

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

Banana Muffin Recipe (with Yalda from Eat Burn Sleep)

Baking with Yalda from Eat Burn Sleep some fuss-free, dairy-free, grain-free banana muffins you can whip up in a couple of minutes! #CCAwarenessWeek #IBD #crohns #colitis #chronicillnessawareness

Banana Muffin Recipe (Makes 12 servings)

Ingredients:
2/3 ripe bananas
2 cups or 200g of ground almonds
4 eggs
3/4 cup or 100g of walnuts or chocolate chips
1/3 cup or 70g of melted coconut oil
2/3 cup or 100g of coconut sugar or maple syrup
1 tablespoon of arrowroot powder (optional)
1/2 teaspoon of bicarbonate of soda
1 teaspoon of vanilla extract (optional)
a pinch of salt

Method:
Preheat your oven to 175 C / 350 F. Put the coconut oil in to melt for a few minutes. Mash 2 bananas in a large bowl and whisk in the eggs. Take the coconut oil out of the oven and let it cool down.
Add the coconut sugar/maple syrup, vanilla extract, ground almonds, arrowroot powder, bicarbonate of soda and salt. Combine well before stirring in the coconut oil.
Chop up the walnuts in pieces and mix half of the walnuts/choc chips in the mixture. Pour the mix into muffin tins and decorate with the chopped walnuts/chocolate chips.
Bake for 25 minutes at 175C/350F. Let the banana muffins cool down completely before eating.

Enjoy!

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

Expert Q&A by Dr Mark Furman, Paediatric Gastroenterologist for #CrohnsAndColitisAwarenessWeek #IBD

How can the doctor tell If my child has IBS or IBD if the symptoms are very similar? 00:06
If there is a history of IBD in the family, is there a screening test that my child could have? 01:05
Why is Inflammatory Bowel Disease so prevalent in the Jewish Community? 01:50
How useful is the faecal calprotectin test in assessing inflammation? Are there home kits available now? 02:23
If my child is being put on a liquid diet for Crohn’s, how can I make things easier for them? Do you have any tips? 03:42
Can you tell me about the long term use of immune suppressants ? 04:20
What are the differences in treating children and adults? 05:16
How can I explain to my child’s school about their new diagnosis of IBD and make them aware of the issues that can arise? 05:59
If my child gets stressed during exams, could this cause a flare up of their IBD? 06:36

This video is for general information only. Always check with your doctor if you have any concerns about your condition or treatment.

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

The Crohn's and Colitis Charity

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