Telenutrition for Inflammatory Bowel Disease: A Tipping Point for Dietary Wellness.

Inflammatory bowel disease (IBD), Crohn's disease and ulcerative colitis, cause inflammation of the digestive tract. It is estimated that about three million Americans and, globally, over six million individuals, suffer from IBD. While most physicians, especially gastroenterologists, are experts in the function and pathology of the gastrointestinal tract, factors such as nutrition science education and training, bandwidth, culture, language, and the longitudinal nature of dietary care, represent some of the barriers to receiving optimal nutritional guidance. Remote dietary expert counseling, an emerging solution that has been further highlighted by the COVID-19 pandemic, can improve IBD patients' nutritional status, avoid food triggers, and reduce the frequency and severity of exacerbations.

What constitutes urgent endoscopy? A social media snapshot of gastroenterologists' views during the COVID-19 pandemic.

Background and study aims There is a consensus among gastroenterology organizations that elective endoscopic procedures should be deferred during the COVID-19 pandemic. While the decision to perform urgent procedures and to defer entirely elective procedures is mostly evident, there is a wide "middle ground" of time-sensitive but not technically urgent or emergent endoscopic interventions. We aimed to survey gastroenterologists worldwide using Twitter to help elucidate these definitions using commonly encountered clinical scenarios during the COVID-19 pandemic. Methods A 16-question survey was designed by the authors to include common clinical scenarios that do not have clear guidelines regarding the timing or urgency of endoscopic evaluation. This survey was posted on Twitter. The survey remained open to polling for 48 hours. During this time, multiple gastroenterologists and fellows with prominent social media presence were tagged to disseminate the survey. Results The initial tweet had 38,795 impressions with a total of 2855 engagements. There was significant variation in responses from gastroenterologists regarding timing of endoscopy in these semi-urgent scenarios. There were only three of 16 scenarios for which more than 70 % of gastroenterologists agreed on procedure-timing . For example, significant variation was noted in regard to timing of upper endoscopy in patients with melena, with 44.5 % of respondents believing that everyone with melena should undergo endoscopic evaluation at this time. Similarly, about 35 % of respondents thought that endoscopic retrograde cholangiopancreatography should only be performed in patients with choledocholithiasis with abdominal pain or jaundice. Conclusion Our analysis shows that there is currently lack of consensus among gastroenterologists in regards to timing of semi-urgent or non-life-threatening procedures during the COVID-19 pandemic. These results support the need for the ongoing development of societal guidance for these "semi-urgent" scenarios to help gastroenterologists in making difficult triage decisions.