Clinical Outcomes of Covid-19 in Patients With Inflammatory Bowel Disease: A Nationwide Cohort Study.

BACKGROUND AND AIMS: The COVID-19 risk and disease course in inflammatory bowel disease [IBD] patients remains uncertain. Therefore, we aimed to assess the clinical presentation, disease course, and outcomes of COVID-19 in IBD patients. Second, we determined COVID-19 incidences in IBD patients and compared this with the general population. METHODS: We conducted a multicentre, nationwide IBD cohort study in The Netherlands and identified patients with COVID-19. First, we assessed the COVID-19 disease course and outcomes. Second, we compared COVID-19 incidences between our IBD study cohort and the general Dutch population. RESULTS: We established an IBD cohort of 34 763 patients. COVID-19 was diagnosed in 100/34 763 patients [0.29%]; 20/100 of these patients [20%] had severe COVID-19 defined as admission to the intensive care unit, mechanical ventilation, and/or death. Hospitalisation occurred in 59/100 [59.0%] patients and 13/100 [13.0%] died. All patients who died had comorbidities and all but one were ≥65 years old. In line, we identified ≥1 comorbidity as an independent risk factor for hospitalisation (odds ratio [OR] 4.20, 95% confidence interval [CI] 1.58-11.17,; p = 0.004). Incidences of COVID-19 between the IBD study cohort and the general population were comparable (287.6 [95% CI 236.6-349.7] versus 333.0 [95% CI 329.3-336.7] per 100000 patients, respectively; p = 0.15). CONCLUSIONS: Of 100 cases with IBD and COVID-19, 20% developed severe COVID-19, 59% were hospitalised and 13% died. A comparable COVID-19 risk was found between the IBD cohort [100/34 763 = 0.29%] and the general Dutch population. The presence of ≥1 comorbidities was an independent risk factor for hospitalisation due to COVID-19.

[Gastrointestinal amyloidosis in a patient with multiple myeloma]. / Gastro-intestinale amyloïdose bij multipel myeloom.

BACKGROUND: Gastrointestinal amyloidosis is characterized by deposition of amyloid in the gastrointestinal mucosa. This can cause an increased risk of malabsorption, obstruction, gastrointestinal bleeding and perforations. CASE DESCRIPTION: A 52-year-old male presented with rectal bleeding. Endoscopic evaluation revealed non-specific red and purple lesions in the sigmoid colon. Histological results were inconclusive. Six weeks later this patient presented at the emergency room with an intestinal perforation. He also had newly developed renal insufficiency. Further analysis led to the diagnosis of multiple myeloma. After 3 doses of bortezomib and dexamethasone the patient was admitted with abdominal pain and rectal bleeding. Revision of our earlier sigmoid biopsies revealed gastrointestinal amyloidosis. The patient died 4 months after initial presentation. CONCLUSION: Gastrointestinal amyloidosis is a rare disease. Due to non-specific symptoms, diagnosis can easily be missed in patients who have not been diagnosed previously with amyloidosis or a related disease.