COVID-19 is not associated with worse long-term inflammatory bowel disease outcomes: a multicenter case–control study

Simon J. Hong, Sumona Bhattacharya, Aiya Aboubakr, Devika Nadkarni, Diana Lech, Ryan C. Ungaro, Manasi Agrawal, Robert P. Hirten, Ruby Greywoode, Anjali Mone, Shannon Chang, David P. Hudesman, Thomas Ullman, Keith Sultan, Dana J. Lukin, Jean Frederic Colombel, Jordan E. Axelrad

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1 Scopus citations


Background: Inflammatory bowel disease (IBD) is not associated with worse coronavirus disease 2019 (COVID-19) outcomes. However, data are lacking regarding the long-term impact of severe acute respiratory syndrome coronavirus 2 infection on the disease course of IBD. Objectives: We aimed to investigate the effect of COVID-19 on long-term outcomes of IBD. Design: We performed a multicenter case–control study of patients with IBD and COVID-19 between February 2020 and December 2020. Methods: Cases and controls were individuals with IBD with presence or absence, respectively, of COVID-19-related symptoms and confirmatory testing. The primary composite outcome was IBD-related hospitalization or surgery. Results: We identified 251 cases [ulcerative colitis (n = 111, 45%), Crohn’s disease (n = 139, 55%)] and 251 controls, with a median follow-up of 394 days. The primary composite outcome of IBD-related hospitalization or surgery occurred in 29 (12%) cases versus 38 (15%) controls (p = 0.24) and on multivariate Cox regression, COVID-19 was not associated with increased risk of adverse IBD outcomes [adjusted hazard ratio (aHR): 0.84, 95% confidence interval [CI]: 0.44–1.42]. When stratified by infection severity, severe COVID-19 was associated with a numerically increased risk of adverse IBD outcomes (aHR: 2.43, 95% CI: 1.00–5.86), whereas mild-to-moderate COVID-19 was not (aHR: 0.68, 95% CI: 0.38–1.23). Conclusion: In this case–control study, COVID-19 did not have a long-term impact on the disease course of IBD. However, severe COVID-19 was numerically associated with worse IBD outcomes, underscoring the continued importance of risk mitigation and prevention strategies for patients with IBD during the ongoing COVID-19 pandemic.

Original languageEnglish (US)
JournalTherapeutic Advances in Gastroenterology
StatePublished - 2022


  • COVID-19
  • inflammatory bowel disease
  • long term
  • outcomes

ASJC Scopus subject areas

  • Gastroenterology


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