ABSTRACT
Introduction: More than 2.5 million people in Europe are diagnosed with inflammatory bowel diseases (IBD). IBD affects the quality of life, but also has important consequences for health systems. It remains unknown if variations in IBD care and education differs across Europe and to help address this question, we conducted this European Variation In IBD PracticE suRvey (VIPER) to study potential differences. Aims & Methods: This trainee-initiated survey, run through SurveyMonkey ®, consisted of 47 questions inquiring basic demographics, IBD training and clinical care. The survey was distributed through social media and national GI societies from December 2020 - January 2021. Results were compared according to GDP per capita, for which countries were divided into 2 groups (low/high income, according to the World Bank). Differences between groups were calculated using the chi2 statistic. Results: The online survey was completed by 1268 participants from 39 European countries. Most of the participants are specialists (65.3 %), followed by fellows in training (>/< 3 years, 19.1%, 15.6 %). Majority of the responders are working in academic institutions (50.4 %), others in public/ district hospitals (33.3 %) or private practices (16.3 %). Despite significant differences in access to IBD-specific training between high (56.4%) and low (38.5%) GDP countries (p<0.001), majority of clinicians feels comfortable in treating IBD (77.2% vs 72.0%, p=0.04). GDP was not a factor that dictated confidence in treating patients. IBD patients seen per week, IBD boards and especially IBD specific training were factors increasing confidence in managing IBD patients. Interestingly, a difference in availability of dedicated IBD units could be observed (58.5% vs 39.7%, p<0.001), as well as an inequality in multidisciplinary meetings (72.6% vs 40.2%, p<0.001), which often take place on a weekly basis (53.0%). In high GDP countries, IBD nurses are more common (86.2%) than in low GDP countries (36.0%, p<0.001), which is mirrored by differences in nurse-led IBD clinics (40.6% vs 13.8%, p<0.001). IBD dieticians (32.4% vs 16.6%) and psychologists (16.7% vs 7.5%) are mainly present in high GDP countries (p<0.001). In the current COVID era, telemedicine is available in 58.4% vs 21.4% of the high/low GDP countries respectively (p<0.001), as well as urgent flare clinics (58.6% vs 38.7%, p<0.001) and endoscopy within 24 hours if needed (83.0% vs 86.7% p=0.1). Treat-to-target approaches are implemented everywhere (85.0%), though access to biologicals and small molecules differs significantly. Almost all (94.7%) use faecal calprotectin for routine monitoring, whereas half also use intestinal ultrasound (47.9%). Conclusion: A lot of variability in IBD practice exists across Europe, with marked differences between high vs low GDP countries. Further work is required to help address some of these inequalities, aiming to improve and standardise IBD care across Europe.
ABSTRACT
Aims During the COVID 19 pandemic, healthcare was predominantly for the treatment of COVID patients. This raisedconcerns about the impact on health care for unrelated illnesses.The aims of this study was to determine if COVID19 hasproduced changes in the incidence and clinical characteristics of non-variceal upper gastrointestinal bleeding (NVUGB)compared to a period of time prior to the pandemic. Methods Upper gastrointestinal endoscopies (UGE) performed during the COVID period and those performed in the sameequivalent period in the previous year were selected from the hospital database of the endoscopy unit. NVUGB was defined:haemorrhage originating proximal to the ligament of Treitz with the presence of melena, hematochezia or rectal bleeding with a potentially bleeding lesion in the endoscopy or active bleeding in the arteriography and/or CT angiography. Clinicaland analytical characteristics were compared with the non-parametric Mann-Whitney U test. A p value <0.05 wasconsidered significant. Results 32 patients were identified (9 during the Covid19 period). The characteristics of the patients and the comparisonbetween the periods are summarized in Table 1. No significant differences were found between the variables compared. Conclusions The incidence of NVUGB was lower in the Covid19 period compared to the non-Covid19 period. However, no significantdifferences were found in the variables analyzed.