A Systematic Review and Meta-Analysis: Adverse Inflammatory Bowel Disease Outcomes Following Acute COVID-19

doi:10.1016/j.gastha.2024.10.021

Gastro Hep Advances

Volume 4, Issue 3, 2025, 100581

https://doi.org/10.1016/j.gastha.2024.10.021 Get rights and content

Under a Creative Commons license

open access

Background and Aims

Respiratory viral infections have been implicated in the exacerbation of immune-mediated inflammatory diseases such as inflammatory bowel disease (IBD). To understand the impact of early SARS-CoV-2 variants on the risk of adverse IBD outcomes, we aimed to perform a meta-analysis of high-quality studies.

Methods

Cohort studies investigating adverse IBD outcomes (IBD flares, change in disease activity, change in medication, IBD-related hospitalization, and surgery) following COVID-19 were retrieved from MEDLINE and Embase. The Risk Of Bias In Nonrandomized Studies—of Exposure tool was used to assess risk of bias. Random effects model meta-analysis was used to calculate the hazard ratio (HR) for risk of adverse outcomes. Subgroup analysis was performed to estimate risk of outcomes for ulcerative colitis and Crohn’s disease patients. Metaregression was performed for sex and duration of follow-up.

Results

Of the 3119 identified studies, 5 were included in the meta-analysis. A total of 34,977 IBD patients with COVID-19 and 53,270 IBD patients without recorded COVID-19 infection were identified. Two of the studies showed a high risk of bias. The random effects model did not show a statistically significant increase in the risk of adverse IBD outcomes following COVID infection (HR:1.05 [0.75–1.46]). There was no significant difference in adverse outcomes between Crohn’s disease (HR: 0.91 [0.82–1.02]) and ulcerative colitis patients (HR: 0.83 [0.76–0.90]). Neither the proportion of male participants nor the mean duration of follow-up were found to be significant predictors of effect size.

Conclusion

In this systematic review and meta-analysis, we find that COVID-19 did not increase the risk of adverse IBD outcomes.

Keywords

Inflammatory Bowel Disease (IBD)

COVID-19 Infection

IBD Flares

Abbreviation used in this paper

Crohn’s disease

hazard ratio

IBD

inflammatory bowel disease

IRR

incidence rate ratio

odds ratio

PCR

polymerase chain reaction

PMS

Partial Mayo Score

REM

random effects model

ROBINS-E

Risk Of Bias In Nonrandomized Studies—of Exposure

risk ratio

ulcerative colitis

Cited by (0)

: Conflicts of Interest: These authors disclose the following: Professor Charlie Lees has acted as a speaker and/or consultant to AbbVie, Janssen, Takeda, Pfizer, Galapagos, GSK, Gilead, Vifor Pharma, Ferring, Dr Falk, BMS, Boehringer Ingelheim, Novartis, Sandoz, Celltrion, Cellgene, Amgen, Samsung Bioepis, Fresenius Kabi, Tillotts, Trellus Health and Iterative Health. Professor Tine Jess has acted as a consultant to Pfizer and Ferring Pharmaceuticals. The remaining authors disclose no conflicts.

: Funding: This work was supported by the Danish National Research Foundation (grant no: DNRF148) and the Novo Nordisk grant (grant no: NNF21OC0068631). Professor Charlie Lees is funded by a UKRI Future Leaders Fellowship (MR/S034919/1).

: Ethical Statement: Since this is a meta-analysis of published studies, ethical approval was not required.

: Data Transparency Statement: Data extraction templates, data extracted and used for analysis, analysis codes may be made available upon request. All data used in the study are publicly available.

: Reporting Guidelines: PRISMA.