ABSTRACT
Introduction: Dietary therapy for eosinophilic esophagitis (EoE) is an effective first-line treatment aimed at identifying triggers by systematically removing then reintroducing food groups. Success on diet therapy can be augmented by working with a dietitian, but this is not a universal clinical resource. Virtual or telehealth approaches to nutrition care may offer opportunities to implement diet therapy for EoE. We conducted a retrospective study at a tertiary center with six GI dietitians to compare real-world standard in-person versus virtual EoE nutrition practices in terms of access, follow-up< and disease control. Method(s): We identified adults with EoE referred to GI nutrition through query of the electronic medical record by ICD-10 diagnoses and confirmed by chart review. As all nutrition visits prior to the COVID pandemic were performed in-person, standard care was defined as care established in January-December 2019 and virtual care in January-December 2021. Associations were analyzed using Chi-squared and Student's t test (Table). Result(s): A total of 204 patients were included;99 referred for standard in-person and 105 virtual nutrition care. The cohorts did not differ significantly by gender, age at the time of referral, race, and distance lived to our center. Of these, 55.6% (55) standard and 48.6% (51) virtual visits were completed with a dietitian (p=0.341) and 4-food elimination diet was the most commonly planned diet. The majority initiated the diet (80.0% standard, 78.4% virtual, p=0.842) and among them, half successfully attained histologic remission with the elimination phase (63.6% standard, 47.5% virtual, p=0.324). Ultimate treatments plans included remaining on dietary therapy (25.5% standard, 23.5% virtual, p=0.728), no treatment or lost to follow-up (34.6% standard, 25.5% virtual), and medication (25.5% standard, 41.2% virtual). Conclusion(s): There is a growing demand for nutrition care in EoE and in our tertiary practice, we found no differences in the success and response rate on elimination diet or follow-up between patients receiving standard or virtual nutrition care. Virtual approaches to implementing EoE dietary therapy may serve to complement in-person care and offer opportunities for those lacking local dietitian access. However, up to one-third of patients are lost to follow-up or remain untreated, also highlighting a need to identify, understand, and overcome barriers to treatment uptake and disease control .
ABSTRACT
Aims: COVID-19 has exacted a worldwide devastating toll, not only through its direct effects, but also through wide-ranging indirect effects on access to and delivery of healthcare. We conducted a survey to better understand the pandemic's impact in patients with digestive disorders. We also sought to understand the rate of COVID-19 vaccination and barriers to vaccination amongst persons with digestive disorders. Methods: A web-based survey was conducted through the International Foundation for Gastrointestinal Disorders (IFFGD) website. The survey was open, internationally accessible from 8/11/21-11/17/21 and completed via the Alchemer survey tool. There were 57 questions related to demographic variables, classification of GI symptoms/disorders, care delivery and illness experience during the pandemic. Patients were also asked about their vaccination status and opinions toward receiving the vaccine. No compensation was provided. Results: Of the 322 survey responders, 210 reported chronic GI illness and were included in the analysis. Demographics are provided in table 1. Most survey respondents (68%) had disorders of gut-brain interaction (DGBI). Overall, 70% of respondents stated the pandemic impacted their gastroenterological health. Most notably, 40% of respondents reported accessing their provider during the pandemic was somewhat difficult, while 14% found it very difficult. More than half (58%) received less frequent care or access to their provider, and almost 3 in 4 visits (71%) were completed virtually. Virtual care was perceived to be of lesser quality by 38% of respondents. Procedures and/or tests were delayed > 3 months in more than half (54%). Strikingly, nearly a third (30%) reported a decrease in income that made it more difficult to see their provider, purchase a prescription or afford healthy food. In a univariable analysis, non-white participants were more likely to have a loss of income and negative impact on their access to care (p <0.04). While >80% of respondents were vaccinated for COVID-19, one in seven (16%) were unvaccinated. Demographic and disease characteristics of unvaccinated respondents can be found in table 2. Over 80% of the unvaccinated felt well informed about the risks of contracting COVID. Sixty-three percent chose not to be vaccinated because of anxiety about side effects. For unvaccinated respondents, 19% (6/32) were advised by a healthcare professional to not be vaccinated because of their GI illness. Conclusions: This survey shows that the pandemic negatively affected patients with digestive disorder's access to healthcare, disproportionately affecting those who are non-white. Additionally, we identified an important, potentially correctible gap in education surrounding COVID-19 vaccination in those with digestive disorders. (Table Presented) Table 1. Demographic characteristics of survey respondents (n: 210) (Table Presented) Table 2. Demographic characteristics and primary GI conditions of unvaccinated survey respondents (n:32)