COVID-19 NICE Guidance - patients with gastrointestinal and liver conditions

The purpose of this guideline is to maximise the safety of children and adults who have gastrointestinal or liver conditions treated with drugs affecting the immune response during the COVID-19 pandemic. It also aims to protect staff from infection and enable services to make the best use of NHS resources.

1. Communicating with patients and minimising risk

• Communicate with patients, their families and carers, and support their mental wellbeing to help alleviate any anxiety and fear they may have, signpost to charities such as Crohns+Colitis UK or the British Liver Trust
• Provide patients, their families and carers with information that meets their communication needs
• Some patients will have received a letter telling them they are at high risk of severe illness from COVID-19 – inform them to follow guidance on shielding
• Telephone, email or text patients booked for appointments and inform them:
  • Not to stop or change their medications without discussion with the medical teams
  • They can continue taking aminosalicylates and that these drugs do not affect the immune response
  • To write down a list of the medicines they take and any conditions they have to give to health care staff if they need to seek treatment for COVID-19
• Minimise face-to-face contact
• If patients need to attend face-to-face appointments, request that they come to the appointment alone (or with one parent as applicable) avoid using public transport if possible
• Inform patients, and their families and carers that they should contact the NHS111 online service if they believe that have COVID-19. In an emergency, they should call 999
  

  
  2. Patients not known to have COVID-19

• Minimise time in the waiting area
• Be aware that worsening gastrointestinal symptoms and deteriorating liver function tests could be associated with COVID-19
• Be aware that patients taking drugs that affect the immune response may have atypical presentations of COVID-19
• Be aware that patients with decompensated liver disease may be at higher risk of severe COVID-19 when taking drugs affecting the immune response
• Balance the risks of drugs that affect the immune system with the risks of active disease
  

  3. Patients known or suspected to have COVID-19

• If patients with symptoms of COVID-19 need to attend departments follow appropriate UK government guidance on infection prevention and control
• If COVID-19 is later diagnosed in a patient not isolated from admission or presentation follow UK Government guidance
• Do not suddenly stop oral or rectal corticosteroids – contact the medical teams for advice
• When deciding whether to stop treatment, discuss the risks and benefits with the patient or their parents/carers
  

  4. Modifications to usual care

• Think about how to modify usual care to reduce patient exposure to COVID-19
• Defer all non-essential monitoring, surveillance and interventional procedures
• Only use endoscopy or liver biopsy when needed to make urgent management decisions
• Provide advice and guidance to GPs to avoid unnecessary emergency department attendances and admissions
• Put plans in place to manage potential disruptions to the supply of medicines during the COVID-19 pandemic.
  

  5. Healthcare workers

• All healthcare workers should follow UK government guidance
• If a member of staff needs to self-isolate, ensure that they can continue to help in a non-patient facing role
• Support staff to keep in touch as much as possible to support their mental wellbeing
• Provide all staff with visible leadership and supportive messaging to maintain morale