ABSTRACT
Background: Severe acute respiratory syndrome coronavirus 2 is the novel coronavirus that caused the coronavirus disease 2019 (COVID- 19) outbreak. Studies have increasingly reported the involvement of other organs, including the gastrointestinal system, in addition to the respiratory system. Ulcerative colitis is an inflammatory bowel disease with an unknown cause. Emerging data suggest that the gastrointestinal system may be influenced by COVID-19 via the expression of angiotensin-converting enzyme-2, but data on the association between COVID-19 and ulcerative colitis, are lacking. Method(s): In 6-month time (June to December 2021) 49 ulcerative colitis (UC) outpatients from Riga East Clinical University Hospital were included in a cross-sectional study. All patients were divided into groups according to medically proven COVID-19 status (COVID-19+ vs COVID- 19-) in the last 6 months. Information about diet, IBD medications, food supplements, vitamins, sports activities, marital status, education level, and income level was collected. Data were analyzed with SPSS 20.0. Result(s): Out of 49 patients, 33(63.3%) were males and 13(36.7%) were females, median age was 38.0 [IQR=17] years. Fourteen patients (28.6%: 7(50%) in each gender) were Covid-19+ within last 6 months. Median time patients suffered from COVID-19 was 7 [IQR=15.3] days. The most common symptoms were: 11(19.6%) fever, 6(10.7%) rhinitis and 5(8.9%) weakness. The most common diet among all patients was IBD diet 33(67.3%) from those 12(21.4%) were COVID-19- and 4(78.6%) were COVID-19+, p=0.00. Out of 49 patients, 25(44.6%) were using food supplements (fish oil, curcumin, collagen, zinc, calcium) of those 17(30.4%) patients were COVID-19-, 8(14.3%) COVID-19+, p=0.00. Most commonly used vitamins were vitamin D 18(64,3%), from those 15(42.9%) were COVID-19-, 3(21.4%) COVID-19+, p>0.5;vitamin C - 7(32,8%), from those 4(11.4%) were COVID- 19-, 3(21.4%) COVID-19+, p>0.5. Twenty-four (49%) were doing sports, of those 18(51.4%) were COVID-19-, 6 (42.9%) COVID+;p>0.5. Most common sports activities were cycling 8(16.3%), running 8(16.3%) and fitness 6(12.2%). Most commonly used IBD medications were mesalazine 35(71.4%), azathioprine 7(14.3%) and biologics 4(8.16%), there were no statistically significant differences between COVID-19+ and COVID-19-. There were no statistically significant differences between marital status, education level, and income regarding COVID-19 status. Conclusion(s): COVID-19 was less common among patients who were using food supplements and followed IBD diet.
ABSTRACT
Introduction: More than 2.5 million people in Europe are diagnosed with inflammatory bowel diseases (IBD). IBD affects the quality of life, but also has important consequences for health systems. It remains unknown if variations in IBD care and education differs across Europe and to help address this question, we conducted this European Variation In IBD PracticE suRvey (VIPER) to study potential differences. Aims & Methods: This trainee-initiated survey, run through SurveyMonkey ®, consisted of 47 questions inquiring basic demographics, IBD training and clinical care. The survey was distributed through social media and national GI societies from December 2020 - January 2021. Results were compared according to GDP per capita, for which countries were divided into 2 groups (low/high income, according to the World Bank). Differences between groups were calculated using the chi2 statistic. Results: The online survey was completed by 1268 participants from 39 European countries. Most of the participants are specialists (65.3 %), followed by fellows in training (>/< 3 years, 19.1%, 15.6 %). Majority of the responders are working in academic institutions (50.4 %), others in public/ district hospitals (33.3 %) or private practices (16.3 %). Despite significant differences in access to IBD-specific training between high (56.4%) and low (38.5%) GDP countries (p<0.001), majority of clinicians feels comfortable in treating IBD (77.2% vs 72.0%, p=0.04). GDP was not a factor that dictated confidence in treating patients. IBD patients seen per week, IBD boards and especially IBD specific training were factors increasing confidence in managing IBD patients. Interestingly, a difference in availability of dedicated IBD units could be observed (58.5% vs 39.7%, p<0.001), as well as an inequality in multidisciplinary meetings (72.6% vs 40.2%, p<0.001), which often take place on a weekly basis (53.0%). In high GDP countries, IBD nurses are more common (86.2%) than in low GDP countries (36.0%, p<0.001), which is mirrored by differences in nurse-led IBD clinics (40.6% vs 13.8%, p<0.001). IBD dieticians (32.4% vs 16.6%) and psychologists (16.7% vs 7.5%) are mainly present in high GDP countries (p<0.001). In the current COVID era, telemedicine is available in 58.4% vs 21.4% of the high/low GDP countries respectively (p<0.001), as well as urgent flare clinics (58.6% vs 38.7%, p<0.001) and endoscopy within 24 hours if needed (83.0% vs 86.7% p=0.1). Treat-to-target approaches are implemented everywhere (85.0%), though access to biologicals and small molecules differs significantly. Almost all (94.7%) use faecal calprotectin for routine monitoring, whereas half also use intestinal ultrasound (47.9%). Conclusion: A lot of 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 standardise IBD care across Europe.