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.

Autor:	Din S; Department of Gastroenterology, Western General Hospital, Edinburgh, UK.; Gastroenterology and Hepatology Unit, University of Edinburgh, Edinburgh, UK., Kent A; Department of Gastroenterology, King's College Hospital NHS Foundation Trust, London, UK.; Faculty of Life Sciences & Medicine, King's College London, London, UK., Pollok RC; Department of Gastroenterology, St George's Healthcare NHS Trust, London, UK.; Institute of Infection and Immunity, St George's University Hospitals NHS Foundation Trust, London, UK., Meade S; Department of Gastroenterology, Guy's and Saint Thomas' Hospitals NHS Trust, London, UK., Kennedy NA; Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.; Exeter IBD Research Group, University of Exeter, Exeter, UK., Arnott I; Department of Gastroenterology, Western General Hospital, Edinburgh, UK., Beattie RM; Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK., Chua F; Interstitial Lung Disease Unit, Department of Respiratory Medicine, Royal Brompton Hospital, London, UK., Cooney R; Department of Gastroenterology, Queen Elizabeth Hospital Birmingham, Birmingham, UK., Dart RJ; Department of Gastroenterology, Royal Free Hospital, London, UK., Galloway J; Department of Rheumatology, King's College Hospital, London, UK., Gaya DR; Gastroenterology Unit, Glasgow Royal Infirmary, Glasgow, UK., Ghosh S; Department of Gastroenterology, Queen Elizabeth Hospital Birmingham, Birmingham, UK., Griffiths M; Peri-operative Medicine, Barts Health NHS Trust, London, UK.; Faculty of Medicine, National Heart and Lung Institute, London, UK., Hancock L; Department of General Surgery, Manchester University NHS Foundation Trust, Manchester, UK., Hansen R; Paediatric Gastroenterology and Nutrition, Royal Hospital for Children, Glasgow, UK., Hart A; IBD Unit, St Mark's Hospital, London, UK.; Antigen Presentation Research Group, Imperial College London, London, UK., Lamb CA; Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.; Department of Gastroenterology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK., Lees CW; Department of Gastroenterology, Western General Hospital, Edinburgh, UK.; Centre for Genomic and Experimental Medicine, University of Edinburgh, Edinburgh, UK., Limdi JK; Department of Gastroenterology, Pennine Acute Hospitals NHS Trust, Manchester, UK.; Manchester Academic Health Science Centre, Manchester, UK., Lindsay JO; Department of Gastroenterology, Barts Health NHS Trust, London, UK., Patel K; Department of Gastroenterology, St George's Healthcare NHS Trust, London, UK., Powell N; Division of Digestive Diseases, Imperial College London, London, UK., Murray CD; Department of Gastroenterology, Royal Free Hospital, London, UK., Probert C; Gastroenterology Research Unit, Department of Cellular and Molecular Physiology, University of Liverpool Institute of Translational Medicine, Liverpool, UK., Raine T; Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK., Selinger C; Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK., Sebastian S; Department of Gastroenterology, Hull University Teaching Hospitals NHS Trust, Hull, UK.; Department of Immunuology and Inflammation, Hull York Medical School, Hull, Kingston upon Hull, UK., Smith PJ; Department of Gastroenterology, Royal Liverpool University Hospital, Liverpool, UK., Tozer P; IBD Unit, St Mark's Hospital, London, UK., Ustianowski A; Department of Infectious Disease, North Manchester General Hospital, Manchester, UK., Younge L; IBD Unit, St Mark's Hospital, London, UK.; Crohn's and Colitis UK, Saint Albans, UK., Samaan MA; Department of Gastroenterology, Guy's and Saint Thomas' Hospitals NHS Trust, London, UK., Irving PM; Department of Gastroenterology, Guy's and Saint Thomas' Hospitals NHS Trust, London, UK peter.irving@gstt.nhs.uk.; Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, UK.
Jazyk:	angličtina
Zdroj:	Gut [Gut] 2020 Oct; Vol. 69 (10), pp. 1769-1777. Date of Electronic Publication: 2020 Jun 08.
DOI:	10.1136/gutjnl-2020-321927
Abstrakt:	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. (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.)
Databáze:	MEDLINE
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