Perspective 2020

Find out more at 7 Big Changes to IBD Clinics During the COVID-19 Pandemic In May 2020 results of a global survey1, on the views of patients with inflammatory bowel disease during the COVID-19 pandemic, were published in The Lancet online. The data showed that 74% of IBD patients were afraid to go to the hospital or IBD centre for a gastroenterological consultation. A UK survey conducted by Kennedy et al.2 during the initial stages of the pandemic, evaluated the challenges presented to IBD services and the adaptations required to meet these challenges. It revealed that key tools for monitoring and managing IBD patients were removed or restricted. ■ 35% reported all IBD related endoscopy activity had been cancelled, but most reported significant reduction in availability ■ In addition 27% locations reported no access to faecal calprotectin, whilst a further 32% reported reduced access They also reported a significant reduction in staffing resources for the IBD team. 94% reported an increase in IBD advice line contact. [Figure 1]. Face-to-face consultations in outpatients, non-emergency endoscopies and elective IBD had been significantly curtailed. There was an increased uptake of telemedicine, virtual multidisciplinary team meetings and non-invasive monitoring of patients. ■ 62% reported patient initiated cancellation of some infusions (~10%) due to: □ Self-isolation due to COVID symptoms □ Fears and concerns about therapies ■ 86% substituted face to face clinics with telephone consultations 11% substituted face to face clinics with video consultations The study concluded that despite these unprecedented and challenging times, opportunities were presented from the rapid adaptation of models of service delivery. Some of these are likely to also be suitable in a post-COVID-19 world, bringing positive changes in IBD services resulting from this difficult time. What will IBD Care look like in the ‘New Normal’? A further survey conducted by Charlie Lees, Consultant Gastroenterologist at the Western General Hospital, shows the changes in how IBD clinics have been operating before and during the COVID pandemic and what is anticipated moving forward: [Figure 2] The view is that face-to-face consultations will reduce to about 50% in the future. A small proportion of respondents had been using home faecal calprotectin tests (including IBDoc®). The publication noted: “Of those that haven’t [used home calprotectin testing], the overwhelming majority replied that this is something they are interested in adopting.” Implications of Recurrent SARS-CoV-2 Outbreaks for IBD Management Segal and Moss published a review in Frontline Gastroenterology4 in June 2020 summarising the changes in IBD clinical practice that will be required during the ‘post-peak’ phase of viral pandemics. They state “The ability to detect deteriorations in disease and react remotely will be important: ■ IBD Apps for recording symptoms ■ Faecal calprotectin should be incorporated into remote monitoring, ideally using home kits for sample acquisition” They also concluded that: “Faecal calprotectin should replace endoscopy as a means to confirm mucosal healing or assess symptom relapse in most cases” References 1. Views of patients with inflammatory bowel disease on the COVID-19 pandemic: a global survey. July 2020 PIIS2468-1253(20)30151-5.pdf 2. Kennedy NA, et al. Organisational changes and challenges for inflammatory bowel disease services in the UK during the COVID-19 pandemic. Frontline Gastroenterology 2020;0:1–8. doi:10.1136/flgastro-2020-101520 3. Lees CW et al. Innovation in Inflammatory Bowel Disease Care During the COVID-19 Pandemic: Results of a Global Telemedicine Survey by the International Organization for the Study of Inflammatory Bowel Disease, Gastro Journal, May 28, 2020, 4. Segal JP, Moss AC. Implications of recurrent SARSCoV-2 outbreaks for IBD management, Frontline Gastroenterology. 2020;0:1–6. doi:10.1136/flgastro-2020-101531 Figure 1 - Change in inflammatory bowel disease advice line calls during the COVID-19 era.2 Figure 2 - Stacked bar chart showing proportion of inflammatory bowel disease (IBD) clinics that were conducted face-to-face, by telephone and by video consultation before the coronavirus disease-19 (COVID-19) (top), during the COVID-19 pandemic (middle), and anticipated proportions after COVID-19 (bottom). 2