P47 Setting up a regional home calprotectin service during the COVID-19 pandemic offering hospital-based testing to local and regional paediatric IBD patients in Wessex

BackgroundThe first wave of the COVID-19 pandemic in the UK severely restricted our regional paediatric GI outpatient services affecting our ability to assess patients in hospital, further compounded by distance of travel of patients (An audit form 2019 showed 70% of patients endoscoped were from outside the local, rather than Southampton area). The issue was further compounded by some DGH’s, who stopped offering the calprotectin test due to COVID-19 infection risk to the staff. Although home based calprotectin kits are also available, families using them have reported their use cumbersome and difficult to process tests at home. In addition, calprotectin results from other laboratories may be difficult to access. These limitations led to the development of a new regional service, in which samples taken at home are posted to the hub hospital laboratory (where the IBD clinic is based) for Calprotectin testing. AimTo study the benefits of offering a service for posting faecal samples for calprotectin testing to a hub laboratory.MethodsChildren (0–18 years) with IBD in the Wessex region, UK needing a calprotectin test were given postal faecal calprotectin packs (PFCP), either by hand in clinic or posted to their home. Each PFCP contained a labelled specimen bottle with immunology request form, bio-packaging box, sealable return bag (UN3373 compliant) with attached freepost label and instruction sheet. A Calprotectin cut off level of <200 was used as normal.Results63 patients (M=34, 54% & F=29, 46%) were given PFCP between 27th July & 5th of Nov 2020 with 52.4% posted PFCP and 47.6% given PFCP by hand in the paediatric GI clinic. The patients resided at a mean distance of 41.6 miles (1 SD = 24.1 miles) as the crow flies from the hospital. A mean of 25 days (1SD = 10 days) were taken from posting/handing of PFCP to the lab test result being obtained.The PFCP was returned by 50 patients (79.4% compliance) with a diagnosis of Crohn’s disease 34.9%, UC 28.6%, IBDU 7.9%, oral ulcers 4.8% and 23.8% of patients referred for endoscopy with IBD like symptoms. 30% of the patients with IBD (15/50) posting the PFCP had an abnormal test result. This led to a change in management in 40% of the patients. In the patient group referred with suspected IBD only 1/15 patients had an abnormal calprotectin test. 70% of patients with a normal test were able to be reassured without further investigation. ConclusionThis is the first reported series, offering to a large region a robust method for samples to be taken at home and posted to a central hub laboratory for calprotectin testing during the COVID-19 pandemic. Test results were readily available, being performed in the same hospital site as the IBD clinic. Compliance with the new PFCP remains high with 80% using the new PFCP service, with value in early identification of patients who may not have much in terms of symptoms and avoidance of endoscopy in others with a normal calprotectin.

The impact of national lockdown on nutritional status of children with inflammatory bowel disease.

BACKGROUND: The COVID-19 pandemic has had wide-reaching primary and secondary health implications. The UK government implemented a national lockdown to slow the rate of infection at the end of March 2020, lasting until early summer 2020. The results from a UK nationwide survey suggest the majority of inflammatory bowel disease patients were followed up using technology-enabled care services (TECS) during this time. We therefore aimed to explore the impact of the pandemic on nutritional status of children with inflammatory bowel disease, focusing on the effect of national lockdown from March to early summer 2020. METHODS: A retrospective study was conducted. All patients with a diagnosis of inflammatory bowel disease, aged <18 years, and under the care of Southampton Children's Hospital were eligible for inclusion. Those patients who attended an outpatient appointment during time period 1 (November 2019 to February 2020), and following the period of national lockdown, time period 2 (July to November 2020), were included in the analysis. RESULTS: In total, 116 patients had paired measures. Using the World Health Organization criteria of nutritional status, 19% (n = 22/116) were mildly malnourished with a body mass index Z score (BMIZ) < -1. In this group, the mean BMIZ was -1.3 ± 0.9 at time point 1 versus -1.9 ± 0.9 at time point 2 (p = 0.03). The mean BMIZ score of those children who were overweight at time point 1 was 1.2 ± 1.2 versus 1.6 ± 1.4 at time point 2 (p = 0.2) During the period of lockdown, 27% of malnourished children (n = 6/22), 2% of normally nourished children (BMIZ > -1 to < 1) (n = 1/51) (p ≤ 0.0001) and none of the overweight children (BMIZ > 1) (n = 0/43) children (p ≤ 0.0001) had a TECS nutrition review. CONCLUSIONS: Dietetic reviews were severely restricted during the first national lockdown. Patients with low BMIZ prior to lockdown became more malnourished. During the ongoing pandemic, it is important to identify those children with nutrition risk, focusing support on this group of children.

Impact of COVID-19 on diagnosis and management of paediatric inflammatory bowel disease during lockdown: a UK nationwide study.

BACKGROUND: COVID-19 has impacted on healthcare provision. Anecdotally, investigations for children with inflammatory bowel disease (IBD) have been restricted, resulting in diagnosis with no histological confirmation and potential secondary morbidity. In this study, we detail practice across the UK to assess impact on services and document the impact of the pandemic. METHODS: For the month of April 2020, 20 tertiary paediatric IBD centres were invited to contribute data detailing: (1) diagnosis/management of suspected new patients with IBD; (2) facilities available; (3) ongoing management of IBD; and (4) direct impact of COVID-19 on patients with IBD. RESULTS: All centres contributed. Two centres retained routine endoscopy, with three unable to perform even urgent IBD endoscopy. 122 patients were diagnosed with IBD, and 53.3% (n=65) were presumed diagnoses and had not undergone endoscopy with histological confirmation. The most common induction was exclusive enteral nutrition (44.6%). No patients with a presumed rather than confirmed diagnosis were started on anti-tumour necrosis factor (TNF) therapy.Most IBD follow-up appointments were able to occur using phone/webcam or face to face. No biologics/immunomodulators were stopped. All centres were able to continue IBD surgery if required, with 14 procedures occurring across seven centres. CONCLUSIONS: Diagnostic IBD practice has been hugely impacted by COVID-19, with >50% of new diagnoses not having endoscopy. To date, therapy and review of known paediatric patients with IBD has continued. Planning and resourcing for recovery is crucial to minimise continued secondary morbidity.