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BACKGROUND: Inflammatory bowel disease (IBD) care and education might differ around Europe. Therefore, we conducted this European Variation In IBD PracticE suRvey (VIPER) to investigate potential differences between countries. METHODS: This trainee-initiated survey, run through SurveyMonkey®, consisted of 47 questions inquiring basic demographics, IBD training, and clinical care. Results were compared according to gross domestic product (GDP) per capita, for which countries were divided into 2 groups (low/high income, according to the World Bank). RESULTS: The online survey was completed by 1285 participants from 40 European countries, with a majority of specialists (65.3%) working in academic institutions (50.4%). Significant differences in IBD-specific training (55.9% vs. 38.4%), as well as availability of IBD units (58.4% vs. 39.7%) and multidisciplinary meetings (73.2% vs. 40.1%) were observed between respondees from high and low GDP countries (p<0.0001). In high GDP countries, IBD nurses are more common (85.9% vs. 36.0%), also mirrored by more nurse-led IBD clinics (40.6% vs. 13.7%; p<0.0001). IBD dieticians (33.4% vs. 16.5%) and psychologists (16.8% vs. 7.5%) are mainly present in high GDP countries (p<0.0001). In the current COVID era, telemedicine is available in 73.2% vs. 54.1% of the high/low GDP countries respectively (p<0.0001). Treat-to-target approaches are implemented everywhere (85.0%), though access to biologicals and small molecules differs significantly. CONCLUSION: Much 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 standardize IBD care and training across Europe.
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OBJECTIVES: The long-term consequences of COVID-19 infection on the gastrointestinal tract remain unclear. Here, we aimed to evaluate the prevalence of gastrointestinal symptoms and post-COVID-19 disorders of gut-brain interaction after hospitalisation for SARS-CoV-2 infection. DESIGN: GI-COVID-19 is a prospective, multicentre, controlled study. Patients with and without COVID-19 diagnosis were evaluated on hospital admission and after 1, 6 and 12 months post hospitalisation. Gastrointestinal symptoms, anxiety and depression were assessed using validated questionnaires. RESULTS: The study included 2183 hospitalised patients. The primary analysis included a total of 883 patients (614 patients with COVID-19 and 269 controls) due to the exclusion of patients with pre-existing gastrointestinal symptoms and/or surgery. At enrolment, gastrointestinal symptoms were more frequent among patients with COVID-19 than in the control group (59.3% vs 39.7%, p<0.001). At the 12-month follow-up, constipation and hard stools were significantly more prevalent in controls than in patients with COVID-19 (16% vs 9.6%, p=0.019 and 17.7% vs 10.9%, p=0.011, respectively). Compared with controls, patients with COVID-19 reported higher rates of irritable bowel syndrome (IBS) according to Rome IV criteria: 0.5% versus 3.2%, p=0.045. Factors significantly associated with IBS diagnosis included history of allergies, chronic intake of proton pump inhibitors and presence of dyspnoea. At the 6-month follow-up, the rate of patients with COVID-19 fulfilling the criteria for depression was higher than among controls. CONCLUSION: Compared with controls, hospitalised patients with COVID-19 had fewer problems of constipation and hard stools at 12 months after acute infection. Patients with COVID-19 had significantly higher rates of IBS than controls. TRIAL REGISTRATION NUMBER: NCT04691895.
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INTRODUCTION: Gastrointestinal (GI) symptoms in coronavirus-19 disease (COVID-19) have been reported with great variability and without standardization. In hospitalized patients, we aimed to evaluate the prevalence of GI symptoms, factors associated with their occurrence, and variation at 1 month. METHODS: The GI-COVID-19 is a prospective, multicenter, controlled study. Patients with and without COVID-19 diagnosis were recruited at hospital admission and asked for GI symptoms at admission and after 1 month, using the validated Gastrointestinal Symptom Rating Scale questionnaire. RESULTS: The study included 2036 hospitalized patients. A total of 871 patients (575 COVID+ and 296 COVID-) were included for the primary analysis. GI symptoms occurred more frequently in patients with COVID-19 (59.7%; 343/575 patients) than in the control group (43.2%; 128/296 patients) (P < 0.001). Patients with COVID-19 complained of higher presence or intensity of nausea, diarrhea, loose stools, and urgency as compared with controls. At a 1-month follow-up, a reduction in the presence or intensity of GI symptoms was found in COVID-19 patients with GI symptoms at hospital admission. Nausea remained increased over controls. Factors significantly associated with nausea persistence in COVID-19 were female sex, high body mass index, the presence of dyspnea, and increased C-reactive protein levels. DISCUSSION: The prevalence of GI symptoms in hospitalized patients with COVID-19 is higher than previously reported. Systemic and respiratory symptoms are often associated with GI complaints. Nausea may persist after the resolution of COVID-19 infection.
Subject(s)
COVID-19/complications , Gastroenteritis/epidemiology , SARS-CoV-2 , Egypt/epidemiology , Europe/epidemiology , Female , Gastroenteritis/etiology , Humans , Interviews as Topic , Male , Middle Aged , Prevalence , Prospective Studies , Russia/epidemiology , Surveys and QuestionnairesABSTRACT
Background. COVID-19 is an infectious respiratory syndrome with a wide range of manifestations and outcomes. Patients with inflammatory bowel disease (IBD) generally have a higher risk of infection, especially if they receive immunosuppressive therapy. Aim - to describe the manifestations of COVID-19 in patients with IBD and to determine the risk factors for severe COVID-19. Methods. The analysis included 68 patients with an established diagnosis of Crohn’s disease (CD) or ulcerative colitis and a confirmed new coronavirus infection. The diagnosis of coronavirus infection was established when SARS-CoV-2 was detected by PCR using nasopharyngeal smears, and computer tomography (CT) of the chest revealed inflammatory changes characteristic of coronavirus lung damage or high IgG and IgM titers based on the results of immunological blood analysis. Results. 68 patients with IBD and COVID-19 were observed in the Department of IBD, including 27 (39.7%) patients with CD, 41 (60.3%) patients with UC. Among patients diagnosed with pneumonia, 100 % of patients received therapy with thiopurines and infliximab. 8 (11.8%) patients were diagnosed with COVID-19 during hospitalization for a severe IBD attack. There was no statistically significant difference between UC and CD patients in terms of disease activity (p = 0.13) during the period of coronavirus infection. In 37 patients (26 - UC, 11 - BC) with pneumonia (100%), there was an exacerbation of IBD. Statistical significance was found between the development of more severe lung damage (CT 3-4) and IBD activity at the time of diagnosis of COVID-19 (p < 0.001), the presence of comorbidities (p < 0.001) and taking GCS (p < 0.001) at the time of detection of COVID-19. However, the use of biological and immunosuppressive therapy was not associated with a higher risk of severe lung damage and the need for a ventilator. It was shown that the age of patients over 65 years was statistically correlated with the need for a ventilator (p = 0.02). Conclusion. The exacerbation of the disease, especially in elderly patients with comorbidities, the use of glucocorticosteroids was associated with negative consequences of COVID-19, while biological and immunosuppressant drugs used for the treatment of IBD did not have such a negative effect. Обоснование. COVID-19 - это инфекционный респираторный синдром с широким спектром проявлений и исходов. Пациенты с воспалительными заболеваниями кишечника (ВЗК) имеют больший риск инфицирования SARS-CoV-2, в особенности если они получают иммуносупрессивную терапию. Цель исследования - описать проявления COVID-19 у пациентов с ВЗК и определить факторы риска тяжелого течения COVID-19. Методы. В анализ были включены 68 пациентов c установленным диагнозом болезни Крона (БК) или язвенного колита (ЯК) и подтвержденной новой коронавирусной инфекцией. Диагноз коронавирусной инфекции устанавливался при выявлении SARS-CoV-2 методом ПЦР назофарингеальных мазков, выявлении при компьютерной томографии (КТ) органов грудной клетки воспалительных изменений, характерных для коронавирусного поражения легких, или высокого титра IgG и IgM по результатам иммунологического анализа крови. Результаты. 68 пациентов с ВЗК и COVID-19 наблюдались в отделении лечения Московского клинического научно-практического центра имени А.С. Логинова, из них 27 (39,7%) пациентов с БК, 41 (60,3%) пациент - с ЯК. Не было выявлено статистически значимого различия между пациентами ЯК и БК в отношении активности заболевания (p = 0,13) в период коронавирусной инфекции. У 37 пациентов (26 - с ЯК, 11 - с БК) с пневмонией (100%) имелось обострение ВЗК. У 8 (11,8%) пациентов был диагностирован COVID-19 во время госпитализации по поводу тяжелой атаки ВЗК. Была выявлена статистическая значимость между развитием более тяжелого поражения легких (КТ 3-4) и активностью ВЗК на момент диагностирования COVID-19 (p < 0,001), наличием сопутствующих заболеваний (p < 0,001) и приемом ГКС (p < 0,001) на момент выявления COVID-19. При этом применение биологической и иммуносупрессивной терапии не было связано с более высоким риском тяжелого поражения легких и потребностью в ИВЛ. Было показано, что возраст пациентов более 65 лет статистически коррелировал с потребностью в ИВЛ (p = 0,02). Заключение. Обострение заболевания, в особенности у пожилых пациентов с сопутствующей патологией, и прием глюкокортикостероидов имели зависимость с негативными последствиями COVID-19, в то время как препараты биологической и иммуносупрессорной терапии, применяемые для лечения ВЗК, не оказывали такого негативного влияния.