Crohn’s disease is a chronic inflammatory bowel condition that can affect any part of the digestive tract, from the mouth to the anus. It involves the body’s immune system mistakenly attacking healthy tissue, leading to persistent swelling and irritation, most commonly in the small and large intestines. Symptoms can include abdominal pain, diarrhea, fever, fatigue, and weight loss, which may vary in severity and present as periods of flare-ups and remission. The respiratory illness known as COVID-19 is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, which emerged in late 2019. This article explores the intersection of these two conditions, examining how they interact and providing current information for individuals navigating both diagnoses.
Crohn’s Disease and COVID Risk
Having Crohn’s disease does not appear to increase a person’s risk of contracting SARS-CoV-2 infection. However, the impact of Crohn’s disease on COVID-19 severity has been observed. Data from large registries have largely mitigated initial concerns about higher risks for individuals with inflammatory bowel disease (IBD), which includes Crohn’s. While IBD patients might be more likely to be hospitalized with COVID-19 compared to the general population, their risk of severe COVID-19, defined as requiring intensive care or death, is not necessarily higher.
Certain factors can influence COVID-19 outcomes in individuals with Crohn’s disease. Older age and multiple underlying health conditions are associated with more severe outcomes in this population, similar to the general population. Active Crohn’s disease and corticosteroid use have also been linked to an increased risk of severe COVID-19. Therefore, maintaining Crohn’s disease in remission through appropriate treatment helps reduce COVID-19 risks.
How COVID Affects Crohn’s Activity
A COVID-19 infection can influence the course of Crohn’s disease. While COVID-19 itself does not cause Crohn’s, it may trigger new symptoms or worsen existing ones during or after recovery. The systemic inflammation from the COVID-19 immune response may play a role in this effect on the gastrointestinal system.
Viral infections, including COVID-19, can increase the risk of Crohn’s disease flares. The stress and widespread inflammation caused by COVID-19 can impact the gut’s balance, potentially worsening Crohn’s symptoms. It can be challenging to differentiate between a Crohn’s flare and COVID-19 symptoms, as both can present with abdominal pain, diarrhea, and low-grade fever. An at-home COVID-19 test can help clarify the cause of symptoms.
Crohn’s Medications and Immune Response
Many medications for Crohn’s disease modulate the immune system, impacting the body’s response to infections like COVID-19. Immunosuppressants and biologics reduce the overactive immune response that causes inflammation. These therapies can alter the immune system’s ability to fight off viruses, potentially affecting COVID-19 severity.
Anti-tumor necrosis factor (anti-TNF) drugs suppress inflammatory proteins. Research indicates that infliximab might blunt the body’s antibody response to COVID-19 infection. However, other studies suggest anti-TNF therapy may enhance T-cell activity in vaccinated individuals, offering protection against severe COVID-19. Corticosteroids suppress the immune system, and their use is associated with an increased risk of severe COVID-19 outcomes. Patients are generally advised to continue prescribed Crohn’s medications unless instructed otherwise by their healthcare provider, as stopping treatment can lead to a flare-up, which is a risk factor for severe COVID-19.
Vaccination Guidelines for Crohn’s Patients
COVID-19 vaccination is recommended for individuals with Crohn’s disease. The vaccines do not contain live virus particles, making them safe, even for those on immunosuppressive therapies. There is no evidence that COVID-19 vaccination causes a Crohn’s disease flare-up.
While patients with Crohn’s disease, especially those on certain immunosuppressants or high-dose corticosteroids, might have a reduced antibody response, most still mount a protective immune response. This reduced response does not mean the vaccine is ineffective; it still offers substantial protection against severe illness. Healthcare providers often recommend timing the vaccine to avoid the two days prior to certain biologic infusions to minimize side effects. Individuals with Crohn’s disease should discuss their vaccination plan with their gastroenterologist for personalized guidance based on their medication regimen and disease activity.