ABSTRACT
Objective. No data are available on the effects of SARS-CoV2 infection in patients with celiac disease (CD) in terms of development of related symptoms and antibodies. We aimed to investigate the impact of SARS-CoV2 infection in CD. Design. During lockdown (March-May 2020), celiac patients living in Milano were interviewed about the development of COVID-19 resembling symptoms, adherence to an anti-virus lifestyle and gluten-free diet (GFD), and were asked to reply to a stress questionnaire. The development of anti SARSCoV2 IgG and IgA (anti RBD and N proteins) and the expression of duodenal ACE2 receptor were also investigated. Whenever available, duodenal histology, anti-tissue transglutaminase IgA (tTGA), immunologic comorbidities and GFD adherence were analyzed as possible risk factors. Results. 362 celiac patients have been interviewed and 42 (11%) reported COVID-19 resembling symptoms. The presence of symptoms was not influenced by positivity of tTGA, presence of duodenal atrophy or adherence to GFD. 37% of symptomatic patients showed anti SARS-CoV2 Immunoglobulins (Ig). Globally, 18% of celiac patients had anti SARS-CoV2 Ig vs 25% of non-celiac controls (p=0.18). Levels of anti RBD IgG/IgA and anti N IgG did not differ from non-celiac controls. Celiac patients had significantly lower levels of anti N IgA. ACE2 receptor was detected in the non-atrophic duodenal mucosa of celiac patients;atrophy was associated with a weaker expression of ACE2 receptor. Conclusion. CD patients show an anti SARS-CoV2 Ig positivity/profile similar to non-celiac controls, except for anti-N IgA. Main celiac biomarkers and adherence to the GFD do not influence the development of different antibody profiles.
ABSTRACT
Background and Aim Telehealth includes both health care delivery (often identified as telemedicine) in terms of disease diagnosis or treatment and several other services, such as prevention, education and public health promotion.1 During the recent COVID-19 pandemic, worldwide telemedicine has enabled many patients with chronic diseases to get access to remote assistance, since it has emerged as the ideal solution to overcome the restrictions to perform regular non-urgent follow-up visits to chronic patients and to continue patients’ assistance. Some positive reports on the use of telemedicine in gastroenterology among healthcare providers and patients have been published, but a patient’s trust perspective about video-consultations has been missing to date.2-5 Our study aimed at ascertaining our gastroenterological patients’ trust in video-consultations during the COVID-19 pandemic. Material and Methods At our Gastroenterology Unit in Milan (Italy), which is a tertiary referral center for Inflammatory Bowel Diseases (IBD) and Celiac Disease (CeD), telemedicine was used in place of on-site follow-up visits scheduled but not provided during the COVID-19 pandemic: all IBD and CeD outpatients received a phone call, while video-consultations were performed to patients with mild-to-moderate symptoms, with bio-umoral alterations or as needed for those patients who requested it. The patient’s trust in telemedicine was assessed through an adapted version of the PAtient Trust Assessment Tool (PATAT) question-naire.6 The primary endpoint was expressed as a percentage greater than 75% of patients giving a score of at least 4 out of 5 in a Likert Scale for three selected key statements about telemedicine.Results One hundred eighty-eight out of 218 scheduled (86.2%) video-consultations were performed. Among the 188 visits, 163 (86.7%) questionnaires were compiled. The primary endpoint of trust in the telemedicine service was achieved in 95.2%, 89.7% and 87.3% of the respondents for the three selected key statements (trust the service, its capability to solve clinical problems, ease to use).Conclusion During the COVID-19 pandemic our results showed that most of our IBD and CeD patients accepted and trusted video-consultations as an alternative to the traditional in-person examination.References: 1) Ray Dorsey E et al. N. Engl. J. Med. 2016;375:154–161. 2) Lauren A. G., Raymond K. Current Gastroenterology Reports (2020) 22: 12 3) De Jong, M. J. et al. Clinical Gastroenterology and Hepatology 2020;18:1744–1752 4) Lees CW et al. Gastroenterology. 2020 Sep;159(3):805-808.e1. 5) Allocca M et al. Clin Gastroenterol Hepatol 2020;18:1882–1883. 6) Velsen, L. V. et al, H. Int. J. Med. Inform 2017;97:52–58.(Figure presented)
ABSTRACT
Background and aim: COVID-19 vaccination campaign represents the most relevant way to overcome the pandemic. COVID-19 vac-cines have been developed at the fastest known pace yet;such a fast production has led to concerns among general population wor-ldwide about safety and efficacy of COVID-19 vaccines. Specifically, patients affected by chronic illnesses, such as Celiac Disease (CeD), may have greater apprehension. The immune status of CeD patients has been studied in literature, however the actual risk of infections is not clear, depending on various factors such as suboptimal nutri-tional status. Information on vaccine hesitancy plays a pivotal role in the development of an efficient vaccine campaign. In our study, we aimed at evaluating COVID-19 vaccine hesitancy among CeD patients, its reasons and determinants. Materials and methods: An anonymous validated questionnaire formulated on the EUSurvey web platform was sent to a mailing list of CeD patients followed at our “Celiac Center” of Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico of Milan. The questions focused on socio-demographic data, disease-related and lifestyle data, attitude to vaccinations in general and predisposition to the COVID-19 vaccine. Hesitancy was defined by a negative answer to the question “Would You accept to get vaccinated tomorrow against COVID-19?”. Among the hesitant, COVID-19 vaccine refusing patients were defined as those who answered negatively to the fol-lowing question: “Would You eventually accept it in the future when more data is available?”. We evaluated the reasons and the factors associated (determinants) to hesitancy, by calculating Adjusted Odds Ratio (AdjOR) with 95% confidence intervals (CI). Results: The questionnaire was sent to 346 patients with a response rate of 29.8% (103). Among the respondents, 25.2% of patients were hesitant, with a total refusal rate of 4.8%. The main reason was the fear of adverse events (68.2%). Among the hesitant patients, 23% declared that their opinion was influenced by CeD. A positive atti-tude towards general vaccinations, a perceived good knowledge about COVID-19 and related vaccines and the adherence to GFD were determinants significantly associated to vaccine willingness (respective AdjOR of 16.48, 95% C.I. 3.34–81.31;6.50, 95% C.I. 1.44–29.22;12.71, 95% C.I. 1.82–88.58).(figure presented) Conclusions: Most CeD patients would accept COVID-19 vaccines. Data on the reasons and the determinants of vaccine hesitancy plays a pivotal role in the development of an efficient vaccine campaign
ABSTRACT
Background and aim: During the on-going COVID-19 pandemic telemedicine has enabled many patients with chronic diseases worldwide to get access to remote assistance. Telemedicine has emerged as the ideal solution to overcome the restrictions in place on performing regular non-urgent follow-up visits for chronic patients and continuing patients’ assistance. Some positive reports on the use of telemedicine in gastroenterology among healthcare providers and patients have been published, but a patient’s trust perspective about televisits has so far been unavailable. Our study aimed at ascertaining telemedicine feasibility and gastroenterological patients’ trust in televisits during the COVID-19 pandemic. Materials and methods: At our Gastroenterology Unit in Milan (Italy), which is a tertiary referral center for Inflammatory Bowel Diseases (IBD) and Celiac Disease (CeD), telemedicine was used in place of on-site follow-up visits scheduled but not provided during the COVID-19 pandemic. All IBD and CeD outpatients were contacted by phone and televisits were arranged for patients with mild-to-moderate symptoms, with bio-umoral alterations or as needed for those who requested it. The patients’ trust in telemedicine was assessed through an adapted version of the PAtient Trust Assessment Tool (PATAT) questionnaire. The primary endpoint was expressed patient’s trust as assessed through the questionnaire. The secondary endpoint was feasibility and acceptance of televisits. Results: A total 188 out of 218 scheduled (86.2%) televisits were performed and among these a total of 163 (86.7%) questionnaires compiled was accomplished. The primary endpoint of trust in the telemedicine service was achieved in 95.2%, 89.7% and 87.3% of the respondents for the three selected key statements about trust in the telemedicine service, its capability to solve clinical problems and ease to use, respectively.(figure presented) Conclusions: Our results showed that during the COVID-19 pandemic televisits were feasible for most of our patients with chronic gastroenterological diseases, and that most patients accepted and trusted televisits as an alternative to the traditional in-person examination
ABSTRACT
Background and Aims: Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, telemedicine has been supporting many patients with chronic diseases worldwide. However, data on celiac disease (CeD) nutritional and gastroenterological remote monitoring are scanty. The aims of our study were to verify patients' trust in telemedicine and to evaluate the feasibility of telemedicine in nutritional monitoring. Material and Methods: We used telemedicine in place of the scheduled but not provided follow-up visits during the first lockdown of the COVID-19 pandemic. Patients received a phone call, and televisits were conducted for CeD patients with mild or moderate symptoms and/or with blood alterations. The patient's adherence to the gluten-free diet (GFD) was evaluated according to the Celiac Dietary Adherence Test (CDAT). When gluten contamination was suspected, a point-of-care gluten detection test was prescribed. The patient's trust in telemedicine was assessed, through an adapted version of the Patient Trust Assessment Tool (PATAT) questionnaire, as the percentage of patients giving a score of at least 4 out of 5 on a Likert scale for three selected key statements: "I can trust televisit," "I can trust that possible problems with the telemedicine service will be solved properly," and "I feel at ease when working with this website." Results: One hundred and twelve CeD patients were phone called;among symptomatic patients, 39 out of the 42 scheduled (92.9%) televisits were performed. Among the 39 visits, 34 (87.2%) questionnaires were compiled. The patients included in the study obtained a CDAT score from 7 to 13 (11 +/- 2). Gluten detection tests were prescribed to 11 patients, resulting positive in 2. Trust in the telemedicine service was achieved in 94.1, 88.2, and 97.1% for the three selected key statements of the PATAT questionnaire. Conclusion: During the COVID-19 pandemic, telemedicine showed to be feasible and the majority of patients trusted the combined gastroenterological and nutritional televisits. Gluten detection tests demonstrated to be useful tools for the patient and for the caregiver to confirm adherence to the GFD remotely.