ABSTRACT
Background: Celiac disease (CeD) is an autoimmune disorder characterized by an inflammatory immune response against gluten and increased susceptibility to bacterial and viral infections. After the coronavirus disease 2019 (COVID-19) pandemic began, several studies showed no difference in infections rates of SARS-CoV-2 between patients with CeD and the general population. However, all studies were based on diagnosed CeD patients who are likely on a gluten-free diet;the immune system of these patients is similar to the general population, which is not likely to show an increased risk of COVID-19. On the contrary, individuals with undiagnosed CeD are likely to be susceptible to viral infections due to abnormally overactivity of the immune system. We aimed to evaluate the frequency of SARSCoV- 2 positivity and related to hospitalization in hidden CeD patients and diagnosed CeD and compare the vaccination rate in these groups. Methods: Based on the previous community cohort of subjects who were tested for CeD serology, we categorized them into three groups: hidden CeD, diagnosed CeD, and seronegative controls. Data of COVID-19 were obtained from January 2020 through September 2021, utilizing polymerase chain reaction (PCR) test results for SARS-CoV-2 and corresponding hospitalization records. Results: A total of 207 hidden celiac disease, 68 diagnosed CeD, and 22,213 seronegative controls were included in the study. Table 1 summarizes the COVID-19 PCR tests, positivity rate, hospitalization, and vaccination rate. Remarkably, about two thirds of the community in the study population were tested for SARS-CoV-2. SARS-CoV-2 PCR tests were more frequently conducted in the diagnosed CeD group (78%), compared to the undiagnosed CeD (68%) or seronegative group (63%) (p=0.01). The positivity rate among subjects tested for SARSCoV- 2 was higher in the seronegative group (15.3%) than that of undiagnosed CeD (14.3%) or diagnosed CeD (7.5%), but it was not statistically significant. Of 2,125 subjects with positive SARS-CoV-2 results in the seronegative group, about 8.1% (n=172) were hospitalized, while only one patient with undiagnosed CeD (out of 20 positive cases) was hospitalized. Interestingly, vaccination rates among the three groups were similar (48% in the seronegative group, 49% in the undiagnosed CeD, and 53% in the diagnosed CeD). Conclusions: This study demonstrated no difference in susceptibility to SARS-CoV-2 infection in undiagnosed or diagnosed CeD. Testing rate is higher in diagnosed CeD, which is likely to be related to health-seeking behavior. (Table Presented)
ABSTRACT
INTRODUCTION: Reliable, non-invasive biomarkers are important in the management of inflammatory bowel disease (IBD) to minimize colonoscopies, especially in the era of the COVID-19 pandemic. Many studies have demonstrated that fecal calprotectin (FCP) can be used as a biomarker for active inflammation. Indeed, FCP has been shown to have superior sensitivity compared to serum C-reactive protein (CRP). Although FCP is a useful marker in the management of IBD patients, we observed that patients often do not complete this test when requested. In this study, we assessed completion rates for FCP in our tertiary referral center for IBD as compared to other routine tests. METHODS: We identified all patients with ICD 9/10 codes for IBD. 3,082 IBD patients were found with at least one FCP test ordered. We determined the mean completion rate for FCP. A subset of 1564 patients who also had at least one order for CRP, complete blood count (CBC), and Clostridium difficile (CDIFF) was also identified. R Studio was used to prepare the data for statistical analysis using SPSS. RESULTS: In the 3,082 patients initially identified, the mean completion rate for FCP was 49.7%. When subgroup analysis was performed for the 1564 patients with FCP, CDIFF, CRP and CBC tests, mean completion rates for these tests were noted to be 53.9%, 61.4%, 72.6% and 74.2%, respectively. We found statistically fewer patients adhering to tests involving collection of stool than blood. There was a statistical difference in FCP completion rates between age groups, with older patients having generally higher completion rates than younger patients. There was no statistical difference in completion of FCP tests based on gender or ethnicity. A similar pattern was also found for CDIFF testing. With blood tests, including the serum biomarker of CRP, no statistical difference was noted between completion rates based on age, gender or ethnicity. CONCLUSION: Although FCP is a sensitive marker for intestinal inflammation, patients are less likely to perform the test, especially compared to blood tests. Younger patients are the least likely to complete FCP and other stool tests. These results suggest that patients may have an aversion to stool based tests and/or have a reduced understanding of their value. These results also indicate the continued need to develop better serum biomarkers that reflect intestinal inflammation with greater sensitivity and specificity. Knowledge of these high rates of non-adherence may improve the discussion with patients.