Imperial College London
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Dr Nick Powell

Faculty of Medicine, Department of Metabolism, Digestion and Reproduction

Professor of Gastroenterology
 
 
 
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Contact

 

nicholas.powell

 
 
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Assistant

 

Mrs Heather Bones +44 (0)20 7594 2429

 
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Location

 

Commonwealth BuildingHammersmith Campus

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Summary

 

Publications

Citation

BibTex format

@article{Powell:2020:10.1136/gutjnl-2020-321927,
author = {Powell, N},
doi = {10.1136/gutjnl-2020-321927},
journal = {Gut},
pages = {1769--1777},
title = {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},
url = {http://dx.doi.org/10.1136/gutjnl-2020-321927},
volume = {69},
year = {2020}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - ObjectiveManagement of acute severe ulcerative colitis (ASUC) during the novel coronavirus2019 (COVID-19) pandemic presents significant dilemmas. We aimed to provideCOVID-19-specific guidance using current British Society of Gastroenterology (BSG)guidelines as a reference point.DesignWe convened a RAND appropriateness panel comprising 14 gastroenterologists andan IBD nurse consultant supplemented by surgical and COVID-19 experts. Panellistsrated the appropriateness of interventions for ASUC in the context of severe acuterespiratory syndrome coronavirus-2 (SARS-CoV-2) infection. Median scores anddisagreement index (DI) were calculated. Results were discussed at a moderatedmeeting 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 aRAND Panel.
AU  - Powell,N
DO  - 10.1136/gutjnl-2020-321927
EP  - 1777
PY  - 2020///
SN  - 0017-5749
SP  - 1769
TI  - 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
T2  - Gut
UR  - http://dx.doi.org/10.1136/gutjnl-2020-321927
UR  - https://gut.bmj.com/content/69/10/1769
UR  - http://hdl.handle.net/10044/1/79321
VL  - 69
ER  -
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