The coronavirus pandemic amended the practice patterns of colorectal surgeons and gastroenterologists in the treatment of acute severe ulcerative colitis. However, it was related to comparable outcomes to a historical cohort. Despite persistent usage of elevated-dose corticosteroids and biologicals, the coronavirus occurrence within three months was low and not related to adverse coronavirus outcomes. 

A study was carried to explore the alterations to established conventional evidence-based therapy of acute severe ulcerative colitis during the early coronavirus disease (COVID-19) pandemic, the impact on outcomes, and any link with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and serious coronavirus outcomes.

This multicentre, case-control, observational trial (COVID-19 pandemic response of assessment, endoscopy, and treatment in acute severe ulcerative colitis [PROTECT-ASUC]) incorporated 782 adults having either ulcerative colitis or inflammatory bowel disease unclassified, who met the Truelove and Witts criteria and presented with acute severe ulcerative colitis.

The cases and controls were recognized as either admitted or treated in emergency ambulatory care settings during coronavirus pandemic period cohort (n=398) and historical control cohort (n=384) respectively. The percentage of acute severe ulcerative colitis individuals receiving rescue therapy (including primary induction) or colectomy was the major endpoint.

In the pandemic cohort, the percentage of subjects given rescue therapy (including primary induction) or surgery was found to be raised while the time to rescue therapy was found to be minimized when compared to historical cohort. This difference was driven by an elevated usage of rescue and primary induction therapies with tofacitinib, biologicals, or ciclosporin in the coronavirus period cohort vs.  historical control cohort.

During the pandemic, it was observed that more individuals received ambulatory (outpatient) intravenous steroids, fewer individuals received thiopurines and 5-aminosalicylic acids when compared to the historical control period.  Both the groups displayed comparable colectomy rates. But, laparoscopic surgery was less frequently carried out during the pandemic period. 

Notably, 2% (5/253) of subjects tested positive for coronavirus infection during the hospital therapy and 2% (2/103) patients re-tested for coronavirus infection during the three-month follow-up were positive five days and 12 days, respectively, after being discharged from the index admission. Both  patients were found to recover without any severe outcomes.

COVID-19 pandemic modified the practice patterns of gastroenterologists and colorectal surgeons to treat ulcerative colitis. However, it was linked with comparable outcomes to a historical cohort.