ABSTRACT
Background: Inflammatory bowel disease (IBD) patients undergoing treatments that act on the inmune system and present an increased risk of infections. For this reason, we could consider that these patients may have an increased risk of severe SARS-CoV-2 infection, however, it remains unclear. We aimed to analyze the cumulative incidence, the severity of the infection and its influence on the natural history of IBD in patients under biological treatment and also evaluating the possible differences with another group without these therapy. Methods: Retrospective observational study about our IBD patients followed from March 2020 to January 2021 divided into two groups: patients on treatment with biological drugs (anti-TNF, vedolizumab, ustekinumab and tofacitinib) and patients without biological drugs (thiopurines or 5-ASA). We evaluated: the cumulative incidence in 10 months for COVID-19 in the 2 cohorts;clinical variables considered risk factors for the infection, the infection severity and influence on the course of IBD employing Harvey-Bradshaw index in Crohn's disease and Mayo partial index in ulcerative colitis before and after infection. Results: It collected 755 IBD patients. 89 were infected by SARSCOV-2, 43 in the biological group and 46 in non biological group. The cumulative incidence in 10 months was 10.85% in the first group (figure 1) and 12.81% in the second group with no significant differences. We verified comparability of the groups discarded the existence of statistical differences in all of the risk factors (sex, age, hypertension, diabetes, dyslipidemia, cardiovascular disease and BMI). In most cases, the infection was mild (94.4%) and the required treatment was symptomatic in 86.4% of the total (Figure 2), without significant differences between groups. Pneumonia was diagnosed in 5 patients, whose required hospital admission (3 belonged to the biological group and 2 to the other). The maximum respiratory support required was FIO2 36%, no patient required admission to ICU and there were no deaths. Additionally, the course of IBD was not affected because of COVID-19, considering no significant differences were observed in clinical scores in each group before and after infection, even taking into account 14 patients discontinued biological therapy temporarily during infection. Conclusion: Our study suggests that IBD patients under biological therapy do not have an increased incidence of SARS-COV-2 infection and also do not have a higher risk of severe disease than IBD patients without this therapy. Furthermore, COVID-19 does not affect the natural history of IBD. These data go in the same direction as those published to date, however, we need multicentre registries with a larger sample size in the future.
ABSTRACT
Introduction: SARS-CoV2 pandemic has greatly impacted endoscopy units worldwide, due to concerns about transmission, shortage of PPE in the first wave of the disease and the need to dedicate the staff to the assistance of COVID patients (1, 2). This fact forced us to call off every nonurgent endoscopic procedure, as well as the ones with a high suspicion of neoplasms, scheduled in March and April 2020. As hospital began to improve their situation, scientific societies established guidelines to resume endoscopic activity with prioritization systems (3, 4). At this point, we begun to prioritize our patients under strict clinical criteria, and we implemented a telemedicine system that established a real time connection between gastroenterologists and Family physicians. Aims & Methods: The aim of our study is to evaluate diagnosis delay in colorectal cancers (CRC) in 2020, comparing the referrals made before and after the telehealth tool and the prioritization system. This is a retrospective study that studies new colorectal cancers diagnoses throughout 2020. We studied demographic, clinical, precedence of the referral, date of referral and tumor characteristics (location and TNM). Main outcome was diagnosis delay, so considered from the referral to colonoscopy. Descriptive, bivariate and multiple non-parametric means comparison tests (Kurskall-Wallis) were performed. Results: 87 CRC were diagnosed in out endoscopy unit in 2020, 61 males (70.1%), mean age 66.22. Median diagnostic delay was 30.50 days. We observed a longer diagnostic delay in 2019 referrals when compared with the ones made throughout 2020 (125 vs. 28 days;p<0.0001). When comparing the exact dates in which the referral for colonoscopy was made?, the first-wave lock down lead to longer delays when compared to the resuming of activity, as expected (median 56 vs. 52 days;p=0.006). Diagnosis delay was different depending on symptoms (p=0.014), being higher in patients with a change in their bowel habit (median 117 days) and shorter for those with abdominal pain (median 19 days). We have also observed that diagnostic delay is different depending on the source of the referral, being longer for patients from the traditional Primary Care referral system, but shorter for inhospital patients, as expected (median 110 days vs. 2 days;p=0.007). In this sense, referrals from the Telehealth system had a significant advantage when compared with the old system (median 110 days vs. 19 days;p=0.002). Patients with T1-T2 stages had longed delays when compared with T3-T4 CRCs (median 48 days vs. 27.5 days;p=0.047). Conclusion: The pandemic has meant a major change in endoscopy units. In our case the threat has allowed us to establish new prioritizing and communication tools between different health levels leading to a substantial reduction in delays for CCR diagnosis, with a median of 30 days, remarkably better than in pre-pandemic times. This fact enhances the need for an adequate prioritizing and communication system to achieve a rational management of the increasing demands of endoscopic procedures. Telehealth systems reduced the diagnostic delay of CRC with respect to the traditional referral from Primary care. Our results portray the usefulness of those new tools for CRC diagnosis, especially in pandemic waves, allowing a direct real-time communication between family practitioners and Gastroenterologists.
ABSTRACT
Introduction: Inflammatory bowel disease (IBD) patients undergoing treatment with drugs that act on the immune system present an increased risk of infections in general1. For this reason, we could consider that these patients may have an increased risk of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, however, it remains unclear2. We aimed to analyze the cumulative incidence, the severity of the SARS-COV2 infection and its influence on the natural history of IBD in patients under biological treatment, also evaluating the possible differences with another group without these treatments. Aims & Methods: Retrospective observational study about our IBD patients followed between March 2020 and January 2021 divided into two groups: patients on treatment with biological drugs (anti-TNF, vedolizumab, ustekinumab and tofacitinib) and patients without biological therapy as thiopurines or mesalamine (5-ASA). We evaluated: the cumulative incidence in 10 months for COVID-19 in the 2 cohorts;clinical variables considered risk factors for the infection (sex, age, hypertension, diabetes, dyslipidemia, cardiovascular disease, body mass index)3,4;the infection severity (visits to the emergency room, need for hospital admission, type of treatment received) and influence on the course of IBD (Harvey- Bradshaw index and Mayo partial in Crohn's disease and ulcerative colitis respectively, before and after COVID-19). Results: It collected 755 IBD patients treated in our centre. Of these, a total of 89 patients were infected by SARS-COV-2, 43 belonged to the biologics group and 46 were to 5-ASA and thiopurines group treatment. Only 3 patients out of 89 were being treated with corticosteroids. We verified the groups' comparability discarded the existence of statistical differences in age, sex distribution and the rest of the risk factor's. The cumulative incidence in 10 months was 10.85% in the biologics group and 12.81% in the group without biologics, with no incidence significant differences. In most cases, the infection was mild (94.4%) and the required treatment was symptomatic in 86.4% of the total, without significant differences between groups. Pneumonia was diagnosed in 5 patients, whose required hospital admission (3 belonged to the biological group and 2 to the other). Only 18 patients (20,2%) required one emergency room visit and the rest none. The maximum respiratory support required was FIO2 36%, no patient required admission to the intensive care unit and there were no deaths. Additionally, the course of IBD was not affected as a result of COVID-19, considering no significant differences were observed in clinical scores in each group before and after infection, even though 14 of the patients in the biological group discontinued these medications temporarily during infection (mean 2.87 weeks). None of the patients in the thiopurines and 5-ASA group discontinued the drug Conclusion: Our study suggests that IBD patients under biological treatment do not have an increased incidence of SARS-COV-2 infection and also do not have a higher risk of severe disease than IBD patients with other treatments (5-ASA or thiopurines).