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1.
Journal of Crohn's and Colitis ; 17(Supplement 1):i344-i345, 2023.
Article in English | EMBASE | ID: covidwho-2277760

ABSTRACT

Background: Delays in diagnosis can be patient and health-system related. Such delays have been reported to increase overall complications in Inflammatory Bowel Diseases (IBD). The aim of our study was to report on the impact of delays on IBD-related adverse outcomes (AOs), as hospitals currently face challenges with long waiting lists in the post-COVID-19 era. Method(s): New patients referred for suspected IBD to a single tertiary care centre between Jan 2013 to Dec 2017 were identified using EMR. A cut-off time was set for each delay-type based on best average hospital waiting times. Reasons for delays until start of treatment and data on pre-defined AOs (steroid & other rescue therapies, hospitalisations, surgery) were recorded for each patient until end of June 2021. Data was analysed using multiple Pearson correlations and Cox proportional Hazard model to determine if there was a difference in survival without AOs between patients with and without delay. Result(s): 105 patients were identified using strict criteria (M=58;median age=32y) with a median follow-up of 55 months. The most frequent presenting complaints were abdominal pain (44, 41.9%), loose stools (40, 38.1%), bloody diarrhoea (37, 35.2%) and bleeding perrectum (33, 31.4%). 65, 27 and 13 patients had a final diagnosis of Ulcerative colitis, Crohn's disease and Unclassified colitis respectively, and were analysed jointly. The longest delay-types noted: Patients seeking medical attention (median= 4 months;range 1 to 84 months);arranging gastroenterology clinic review after GP referral (median=5 weeks;1 to 30 weeks);and waiting for index endoscopy (median=3 weeks;1 to 36 weeks). Patient stratification based on delay-type, using specific cut-off times for each showed a statistically significant difference in survival without AOs for all (when comparing delay vs no delay). - delay in seeking medical attention (cut-off=1m;p=0.004) (Fig 1A) - delay in GP referral to specialty review (cut-off=1w;p=0.048) - delay in index endoscopy (cut-off=4w;p=0.01) (Fig 1B) - delay in starting treatment (cut-off=4w;p=0.03) Conclusion(s): Several bottlenecks of delays increase AOs in IBD over the follow-up period. A delay as short as a week, between GP referral to specialty review, is significant in determining AOs, relevant for specialist IBD centres particularly in the post-Covid period. Endoscopy units should prioritise suspected IBD patients to reduce AOs, which is likely to have implications on service delivery and planning. Long delays observed in patients seeking medical attention highlights the need for better patient education in the community.

2.
Gut ; 71:A5-A6, 2022.
Article in English | EMBASE | ID: covidwho-2005338

ABSTRACT

Background Delays in diagnosis could be patient-related and health-system related. It has been reported that such delays increase overall complications in Inflammatory Bowel Diseases (IBD). The aim of our study was to report on the impact of delays on IBD-related adverse outcomes (AOs), as most hospitals currently face challenges with long waiting lists in the post-Covid-19 era. Methods New patients referred for suspected IBD to a single tertiary care centre between Jan 2013 to Dec 2017 were identified using EMR. For purposes of the study, a cut-off time was set by investigators for each delay-type based on best average hospital waiting times. The reasons for delays in patient journey until start of treatment and data on predefined AOs (steroid & other rescue therapies, hospitalisations, surgery) were recorded for each patient until end of June 2021. The data were analysed using multiple Pearson correlations and Cox proportional Hazard model to determine whether there is a difference in survival without AOs between patients with and without a delay. Results Total of 105 patients were identified using stringent criteria (M=58 ;median age=32y) with a long median followup of 55 months. The most frequent presenting complaints were abdominal pain (44, 41,9%), loose stools (40, 38,1%), bloody diarrhoea (37, 35,2%) and bleeding per-rectum (33, 31,4%) and only 16% declared a family history. 65, 27 and 13 patients had final diagnosis of Ulcerative colitis, Crohn's disease and Unclassified colitis respectively, and analysed collectively. In our cohort, the longest delay-types noted were - patients seeking medical attention (median= 4 months;range 1 to 84 months), arranging gastroenterology clinic review after referral from primary care (median=5 weeks;range 1 to 30 weeks), and waiting for index endoscopy (median=3 weeks;1 to 36 weeks). Patient stratification based on delay-type, using specific cutoff times for each showed a statistically significant difference in survival without AOs for all (when comparing delay v/s no delay). 1. delay in seeking medical attention (cut-off=1m;p=0.004) (figure 1A) . delay in GP referral specialty review (cut-off=1w;p=0.048) . delay in index endoscopy (cut-off= 4w;p=0.01) (Fig 1B) . delay in starting treatment (cut-off= 4w;p=0.03) Conclusion . Several bottlenecks of delays increase AOs in IBD over the follow-up period. . A delay as short as a week, between GP referral specialty review, is significant in determining AOs;this has implications on specialist IBD centres particularly in the post-Covid period. . Endoscopy units should prioritise suspected IBD patients to reduce AOs, which is likely to have implications on service delivery and planning. . Long delays observed in patients seeking medical attention highlights the need for both primary and secondary care to undertake patient education in the community.

3.
Gastroenterology ; 160(6):S-332, 2021.
Article in English | EMBASE | ID: covidwho-1594794

ABSTRACT

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causativeagent of COVID-19 pandemic, is affecting the health care system globally. Patients withinflammatory bowel disease (IBD), such as those with Ulcerative Colitis (UC) and Crohn’sDisease (CD), may be prone to have more severe COVID-19 infection, as compared tohealthy individuals. As a result, widespread concern exists among gastroenterologists andIBD patients, especially those on immunosuppressive therapy, regarding risks of COVID-19 and it's complications. In this study we aim to consolidate the current evidence on therisk and clinical outcomes of COVID-19 in IBD patients by meta-analysis methods.METHODS: We searched multiple databases from inception through June 2020 to identifystudies that reported on outcomes of COVID-19 in patients with IBD. Outcomes from theincluded studies were pooled to estimate the risk of COVID-19 infection and its clinical outcomes.RESULTS: A total 1773 IBD patients with COVID-19 were analyzed from eight studies.Average age was 46.6 (7-86) years. 54% were males. While 53% patients had UC and 43%patients had active disease. 10.5% patients were on combination therapy, 20.7% on salicylicacid derivatives, 11.2% on steroids, 9% on immunomodulators and 54.7% on biologics.Most common presenting symptoms were fever, cough and dyspnea. Five studies provideddata that enabled the calculation of COVID-19 incidence in IBD patients. The pooledincidence of COVID-19 was 1.1% (95% CI 0.1-8.5;I2=98%). Variation to the pooled ratewas observed when sensitivity analysis was performed by removing one study at a time.The pooled values ranged from 0.5% to 1.6%. Four studies provided information on thecumulative COVID-19 incidence in the general population at the time the studies wereconducted. Incidence of COVID-19 in IBD patients was similar to the general population,and the pooled odds ratio (OR) was 1.3 (95% CI 0.5-3.7;I2=69%),p=0.6.The pooled rate of IBD patients admitted to hospital due to COVID-19 was 27.3% (95%CI 20.5-35.3;I2=60%), while rate of ICU admission was 5.7% (95% CI 4.7-6.9;I2=3%).The pooled rate of death in IBD patients due to COVID-19 was 5% (95% CI 2.5-9.5;I2=46%), whereas fatality among IBD patients admitted to ICU was 61.1% (95% CI 51.1-70.3;I2=0%). Meta-regression analysis based on IBD type, disease activity and immunosuppressanttherapy did not demonstrate significant effect on the pooled rates of clinical outcomes.CONCLUSION: Risk of COVID-19 in IBD patients is not increased when compared to thecumulative COVID-19 incidence in the general population. Rates of hospitalization, ICUadmission and death due to COVID-19 seem favorable compared to the general population.Meta-regression analysis seems to suggest that IBD patients need not change their immunosuppressanttherapy due to the ongoing COVID-19 pandemic.(Image Presented)(Image Presented)

4.
Lancet Gastroenterology & Hepatology ; 6(3):E2-E2, 2021.
Article in English | Web of Science | ID: covidwho-1194968
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