Adaptation of the British Society of Gastroenterology guidelines on the management of acute severe ulcerative colitis in the context of the COVID-19 pandemic: a RAND appropriateness panel

Shahida Din, Alexandra Kent, Richard C. Pollok, Susanna Meade, Nicholas A Kennedy, Ian Arnott, Mark R. Beattie, Felix Chua, Rachel Cooney, Robin Dart, James Galloway, Daniel R Gaya, Subrata Ghosh, Mark Griffiths, Laura Hancock, Richard Hansen, Ailsa Hart, Christopher A. Lamb, Charlie W. Lees, Jimmy K LimdiJames O. Lindsay, Charlie Murray, Kamal Patel, Nick Powell, Chris Probert, Tim Raine, Christian Selinger, Shaji Sebastian, Philip J. Smith, Philip J. Tozer, Andrew Ustianowski, Lisa Younge, Mark A Samaan, Peter Irving

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Abstract

Objective
Management of acute severe ulcerative colitis (ASUC) during the novel coronavirus 2019 (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.
ResultsPanellists recommended that patients with ASUC should be isolated throughout theirhospital stay and should have a SARS-CoV-2 swab performed on admission. Patientswith a positive swab should be discussed with COVID-19 specialists.As per BSG guidance, intravenous hydrocortisone was considered appropriate asinitial management; only in patients with COVID-19 pneumonia was their use deemeduncertain. In patients requiring rescue therapy, infliximab with continuing steroidswas recommended. Delaying colectomy because of COVID-19 was deemedinappropriate.Steroid tapering as per BSG guidance, was deemed appropriate for all patients apartfrom 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 post-discharge to be appropriate inpatients with a positive SARS-CoV-2 swab.
ConclusionWe have suggested COVID-19-specific adaptations to the BSG ASUC guideline using a RAND Panel. 
Original languageEnglish
JournalGut
Publication statusPublished - 8 Jun 2020

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