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1.
Br J Surg ; 108(8): 1006-1007, 2021 08 19.
Article in English | MEDLINE | ID: covidwho-1665908
3.
Korean J Gastroenterol ; 78(2): 117-128, 2021 08 25.
Article in Korean | MEDLINE | ID: covidwho-1377072

ABSTRACT

Coronavirus disease 2019 (COVID-19), caused by the novel coronavirus, is threatening global health worldwide with unprecedented contagiousness and severity. The best strategy to overcome COVID-19 is a vaccine. Various vaccines are currently being developed, and mass vaccination is in progress. Despite the very encouraging clinical trial results of these vaccines, there is insufficient information on the safety and efficacy of vaccines for inflammatory bowel disease (IBD) patients facing various issues. After reviewing current evidence and international guidelines, the Korean Association for the Study of Intestinal Diseases (KASID) developed an expert consensus statement on COVID-19 vaccination issues for Korean IBD patients. This expert consensus statement emphasizes that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination be strongly recommended for IBD patients, and it is safe for IBD patients receiving immunomodulatory therapy.


Subject(s)
COVID-19 Vaccines , COVID-19/prevention & control , Gastroenterology/standards , Inflammatory Bowel Diseases , Adult , COVID-19/epidemiology , COVID-19/psychology , Consensus , Gastroenterology/methods , Guidelines as Topic , Humans , Immunocompromised Host , Inflammatory Bowel Diseases/drug therapy , Inflammatory Bowel Diseases/immunology , SARS-CoV-2 , Societies, Medical , Vaccination/methods
5.
J Med Virol ; 93(5): 2740-2768, 2021 05.
Article in English | MEDLINE | ID: covidwho-1196532

ABSTRACT

A meta-analysis was performed to identify patients with coronavirus disease 2019 (COVID-19) presenting with gastrointestinal (GI) symptoms during the first and second pandemic waves and investigate their association with the disease outcomes. A systematic search in PubMed, Scopus, Web of Science, ScienceDirect, and EMBASE was performed up to July 25, 2020. The pooled prevalence of the GI presentations was estimated using the random-effects model. Pairwise comparison for the outcomes was performed according to the GI manifestations' presentation and the pandemic wave of infection. Data were reported as relative risk (RR), or odds ratio and 95% confidence interval. Of 125 articles with 25,252 patients, 20.3% presented with GI manifestations. Anorexia (19.9%), dysgeusia/ageusia (15.4%), diarrhea (13.2%), nausea (10.3%), and hematemesis (9.1%) were the most common. About 26.7% had confirmed positive fecal RNA, with persistent viral shedding for an average time of 19.2 days before being negative. Patients presenting with GI symptoms on admission showed a higher risk of complications, including acute respiratory distress syndrome (RR = 8.16), acute cardiac injury (RR = 5.36), and acute kidney injury (RR = 5.52), intensive care unit (ICU) admission (RR = 2.56), and mortality (RR = 2.01). Although not reach significant levels, subgroup-analysis revealed that affected cohorts in the first wave had a higher risk of being hospitalized, ventilated, ICU admitted, and expired. This meta-analysis suggests an association between GI symptoms in COVID-19 patients and unfavorable outcomes. The analysis also showed improved overall outcomes for COVID-19 patients during the second wave compared to the first wave of the outbreak.


Subject(s)
COVID-19/drug therapy , COVID-19/physiopathology , Gastroenterology/methods , Ageusia/epidemiology , Anorexia/epidemiology , Databases, Factual , Diarrhea/epidemiology , Dysgeusia/epidemiology , Feces/virology , Hematemesis/epidemiology , Hospitalization , Humans , Nausea/epidemiology , Pandemics , Prevalence , SARS-CoV-2 , Virus Shedding
6.
Lancet Gastroenterol Hepatol ; 6(3): 218-224, 2021 03.
Article in English | MEDLINE | ID: covidwho-1195586

ABSTRACT

SARS-CoV-2 has caused a global health crisis and mass vaccination programmes provide the best opportunity for controlling transmission and protecting populations. Despite the impressive clinical trial results of the BNT162b2 (Pfizer/BioNTech), ChAdOx1 nCoV-19 (Oxford/AstraZeneca), and mRNA-1273 (Moderna) vaccines, important unanswered questions remain, especially in patients with pre-existing conditions. In this position statement endorsed by the British Society of Gastroenterology Inflammatory Bowel Disease (IBD) section and IBD Clinical Research Group, we consider SARS-CoV-2 vaccination strategy in patients with IBD. The risks of SARS-CoV-2 vaccination are anticipated to be very low, and we strongly support SARS-CoV-2 vaccination in patients with IBD. Based on data from previous studies with other vaccines, there are conceptual concerns that protective immune responses to SARS-CoV-2 vaccination may be diminished in some patients with IBD, such as those taking anti-TNF drugs. However, the benefits of vaccination, even in patients treated with anti-TNF drugs, are likely to outweigh these theoretical concerns. Key areas for further research are discussed, including vaccine hesitancy and its effect in the IBD community, the effect of immunosuppression on vaccine efficacy, and the search for predictive biomarkers of vaccine success.


Subject(s)
COVID-19 Vaccines/pharmacology , COVID-19/prevention & control , Inflammatory Bowel Diseases , COVID-19/epidemiology , Disease Transmission, Infectious/prevention & control , Gastroenterology/methods , Gastroenterology/trends , Humans , Immunocompromised Host , Inflammatory Bowel Diseases/immunology , Inflammatory Bowel Diseases/therapy , SARS-CoV-2 , Societies, Medical , United Kingdom , Vaccination/methods
7.
World J Gastroenterol ; 26(29): 4182-4197, 2020 Aug 07.
Article in English | MEDLINE | ID: covidwho-1146681

ABSTRACT

Mobile health apps (MHAs) and medical apps (MAs) are becoming increasingly popular as digital interventions in a wide range of health-related applications in almost all sectors of healthcare. The surge in demand for digital medical solutions has been accelerated by the need for new diagnostic and therapeutic methods in the current coronavirus disease 2019 pandemic. This also applies to clinical practice in gastroenterology, which has, in many respects, undergone a recent digital transformation with numerous consequences that will impact patients and health care professionals in the near future. MHAs and MAs are considered to have great potential, especially for chronic diseases, as they can support the self-management of patients in many ways. Despite the great potential associated with the application of MHAs and MAs in gastroenterology and health care in general, there are numerous challenges to be met in the future, including both the ethical and legal aspects of applying this technology. The aim of this article is to provide an overview of the current status of MHA and MA use in the field of gastroenterology, describe the future perspectives in this field and point out some of the challenges that need to be addressed.


Subject(s)
Gastroenterology/methods , Mobile Applications , Self-Management , Telemedicine , Wearable Electronic Devices , Betacoronavirus , COVID-19 , Computer Literacy , Computer Security , Coronavirus Infections/epidemiology , Delivery of Health Care , Electronic Health Records , Ethics, Medical , Health Behavior , Humans , Pandemics , Patient Education as Topic , Physician-Patient Relations , Pneumonia, Viral/epidemiology , SARS-CoV-2 , Smartphone
8.
Dig Liver Dis ; 53(6): 682-688, 2021 06.
Article in English | MEDLINE | ID: covidwho-1120261

ABSTRACT

BACKGROUND: The SARS-CoV-2 pandemic has had a huge impact on healthcare systems, resulting in many routine diagnostic procedures either being halted or postponed. AIMS: To evaluate whether the diagnoses of colorectal, gastric and pancreatic cancers have been impacted by the SARS-CoV-2 pandemic in Italy. METHODS: A survey designed to collect the number of histologically-proven diagnoses of the three cancers in gastroenterology services across Italy from January 1 to October 31 in 2017-2020. Non-parametric ANOVA for repeated measurements was applied to compare distributions by years and macro-areas. RESULTS: Compared to 2019, in 2020 gastric cancer diagnoses decreased by 15.9%, CRC by 11.9% and pancreatic by 9.9%. CRC distributions showed significant differences between all years, stomach cancer between 2018 and 2020 and 2019-2020, and pancreatic cancer only between 2017 and 2019. The 2019-2020 comparison showed fewer CRC diagnoses in the North (-13.7%), Center (-16.5%) and South (-4.1%), fewer stomach cancers in the North (-19.0%) and South (-9.4%), and fewer pancreatic cancers in the North (-14.1%) and Center (-4.7%), with an increase in the South (+12.3%). Distributions of CRC and gastric cancer were significantly different between all years in the North. CONCLUSIONS: This survey highlights the concerning effects of the COVID-19 pandemic on the diagnostic yield of gastroenterology services for stomach, colorectal and pancreatic cancers in Italy.


Subject(s)
COVID-19 , Delivery of Health Care , Digestive System Neoplasms , Early Detection of Cancer , COVID-19/epidemiology , COVID-19/prevention & control , Delivery of Health Care/organization & administration , Delivery of Health Care/trends , Diagnostic Techniques, Digestive System , Digestive System Neoplasms/diagnosis , Digestive System Neoplasms/epidemiology , Early Detection of Cancer/methods , Early Detection of Cancer/trends , Gastroenterology/methods , Gastroenterology/statistics & numerical data , Humans , Infection Control/methods , Italy/epidemiology , Organizational Innovation , SARS-CoV-2 , Surveys and Questionnaires
12.
Curr Opin Gastroenterol ; 37(1): 23-29, 2021 01.
Article in English | MEDLINE | ID: covidwho-1031398

ABSTRACT

PURPOSE OF REVIEW: The COVID-19 pandemic has impacted the practicing gastroenterologist in several ways. Although majority of COVID-19 patients present with respiratory symptoms, gastrointestinal symptoms are also seen. COVID-19 has also disrupted gastrointestinal endoscopy services in numerous ways. There are also concerns regarding the impact of these changes on gastrointestinal cancer screening and management of chronic gastrointestinal diseases. The purpose of this review is to provide an overview of the implications of COVID-19 for the practicing gastroenterologist. RECENT FINDINGS: COVID-19 patients can have gastrointestinal symptoms including diarrhea, nausea and vomiting, abdominal pain and anorexia. Separate from the management of COVID-19 patients, there has been a reduction in endoscopy volume worldwide. This has also resulted in reduction/cessation of in-person clinic visits and an increasing use of telemedicine services. In addition, patients with certain chronic diseases like chronic liver disease or inflammatory bowel disease may have worse outcomes during the COVID-19 pandemic. SUMMARY: Gastroenterologists need to rapidly adapt to the challenges being faced and need to make both systems and practice-based changes to the endoscopy unit and outpatient clinic practices. Gastroenterologists should stay up-to-date with the rapidly evolving literature regarding gastrointestinal symptoms in COVID-19 patients as well as its impact on chronic gastrointestinal illnesses.


Subject(s)
COVID-19 , Gastroenterology/methods , Gastrointestinal Diseases , COVID-19/complications , COVID-19/diagnosis , COVID-19/therapy , COVID-19 Testing , Chronic Disease , Endoscopy, Gastrointestinal/methods , Gastroenterology/organization & administration , Gastrointestinal Diseases/diagnosis , Gastrointestinal Diseases/therapy , Gastrointestinal Diseases/virology , Global Health , Health Care Rationing/methods , Health Services Accessibility , Humans , Infection Control/methods , Practice Patterns, Physicians' , Telemedicine/methods
14.
J Gastroenterol Hepatol ; 36(6): 1627-1633, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-975558

ABSTRACT

BACKGROUND AND AIM: Significant human and material resources have been diverted to coronavirus disease 2019 (COVID-19). Healthcare workers are at high risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We assess the impact of the COVID-19 pandemic on gastroenterology and hepatology departments and specialists in Spain. METHODS: This study involves a nationwide survey addressing the impact of COVID-19 on resources, procedures, and physicians of gastroenterology and hepatology departments in 81 hospitals representative of the Spanish National Health Service. RESULTS: Overall, 41.8% of hospital beds and 40.7% of gastroenterology and hepatology beds were allocated to COVID-19 patient care, as well as 24.8% of gastroenterologists and 58.3% of residents. Outpatient visits, abdominal ultrasounds, and endoscopies were reduced by 81.8-91.9%. Nine large university hospitals had 75% and 89% reductions in therapeutic endoscopies and hepatocellular carcinoma surgery, respectively, with cancelation of elective liver transplant and transjugular intrahepatic portosystemic shunt. Prevalence of infected physicians was 10.6% and was dependent on regional population incidence (r = 0.74, P = 0.001), with 11% hospitalized and one physician dying. Up to 63.4% of physicians may have been infected before or shortly after Spain entered lockdown, 57% of them having recently performed endoscopies. Adequate protection was acknowledged in > 80% hospitals, but only 2.9% performed regular SARS-CoV-2 testing. CONCLUSIONS: The impact of the COVID-19 pandemic on healthcare delivery has been massive. A wave of gastroenterology-related complications is expected because of resource diversion. Gastroenterologists have a high prevalence of infection, although they may have been infected during a first phase of lower awareness and protection. Regular SARS-CoV-2 screening, adequate protection, and quick reorganization of healthcare resources are still needed.


Subject(s)
COVID-19 , Gastroenterology , Gastrointestinal Diseases , Health Personnel , Occupational Exposure , Attitude of Health Personnel , COVID-19/epidemiology , COVID-19/prevention & control , Digestive System Surgical Procedures/statistics & numerical data , Endoscopy, Gastrointestinal/statistics & numerical data , Gastroenterology/methods , Gastroenterology/organization & administration , Gastroenterology/statistics & numerical data , Gastrointestinal Diseases/epidemiology , Gastrointestinal Diseases/therapy , Health Care Surveys , Health Personnel/psychology , Health Personnel/statistics & numerical data , Hospital Departments/statistics & numerical data , Humans , Infection Control/methods , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Needs Assessment , Occupational Exposure/prevention & control , Occupational Exposure/standards , Organizational Innovation , SARS-CoV-2 , Spain/epidemiology
15.
Int J Environ Res Public Health ; 17(23)2020 11 26.
Article in English | MEDLINE | ID: covidwho-945824

ABSTRACT

The growing fear of virus transmission during the 2019 coronavirus disease (COVID-19) pandemic has called for many scientists to look into the various vehicles of infection, including the potential to travel through aerosols. Few have looked into the issue that gastrointestinal (GI) procedures may produce an abundance of aerosols. The current process of risk management for clinics is to follow a clinic-specific HVAC formula, which is typically calculated once a year and assumes perfect mixing of the air within the space, to determine how many minutes each procedural room refreshes 99% of its air between procedures when doors are closed. This formula is not designed to fit the complex dynamic of small airborne particle transport and deposition that can potentially carry the virus in clinical conditions. It results in reduced procedure throughput as well as an excess of idle time in clinics that process a large number of short procedures such as outpatient GI centers. We present and tested a new cyber-physical system that continuously monitors airborne particle counts in procedural rooms and also at the same time automatically monitors the procedural rooms' state and flexible endoscope status without interfering with the clinic's workflow. We use our data gathered from over 1500 GI cases in one clinical suite to understand the correlation between air quality and standard procedure types as well as identify the risks involved with any HVAC system in a clinical suite environment. Thanks to this system, we demonstrate that standard GI procedures generate large quantities of aerosols, which can potentially promote viral airborne transmission among patients and healthcare staff. We provide a solution for the clinic to improve procedure turnover times and throughput, as well as to mitigate the risk of airborne transmission of the virus.


Subject(s)
Aerosols , Air Microbiology , COVID-19/prevention & control , Gastroenterology/methods , Infection Control/methods , Ventilation , Air Pollution , COVID-19/transmission , Humans , Pandemics
16.
Dig Liver Dis ; 53(2): 183-189, 2021 02.
Article in English | MEDLINE | ID: covidwho-885252

ABSTRACT

Coronavirus Disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2, spreading in Italy during the first months of 2020, abruptly changed the way of practicing medicine in this country. As a consequence of the lockdown, the diagnostic and therapeutic management of paediatric chronic conditions, such as inflammatory bowel disease (IBD) has been affected. During the peak of COVID-19 pandemic, elective visits, endoscopies and infusions have been postponed, with potential clinical and psychological impact on disease course and a high likelihood of increasing waiting lists. While slowly moving back towards normality, clinicians need to recognize the best ways to care for patients with IBD, carefully avoiding risk factors for new potential epidemic outbreaks. In this uncertain scenario until the development and spread of COVID-19 vaccine, it is necessary to continue to operate with caution. Hereby we provide useful indications for a safer and gradual restarting of routine clinical activities after COVID-19 peak in Italy.


Subject(s)
COVID-19 , Communicable Disease Control/methods , Gastroenterology , Inflammatory Bowel Diseases , Pediatrics , COVID-19/epidemiology , COVID-19/prevention & control , Child , Gastroenterology/methods , Gastroenterology/organization & administration , Gastroenterology/trends , Humans , Inflammatory Bowel Diseases/epidemiology , Inflammatory Bowel Diseases/therapy , Italy , Organizational Innovation , Pediatrics/methods , Pediatrics/organization & administration , Pediatrics/trends , Risk Adjustment , SARS-CoV-2
17.
J Crohns Colitis ; 14(14 Suppl 3): S780-S784, 2020 Oct 21.
Article in English | MEDLINE | ID: covidwho-883092

ABSTRACT

Before the onset of the COVID-19 pandemic, the majority of care for inflammatory bowel disease patients was provided in-person. The practice of gastroenterology care has since rapidly transformed, with telemedicine emerging as an essential tool to provide medical care to patients while maintaining social distancing and conserving personal protective equipment. This article provides insight into past and current practices among inflammatory bowel disease specialists and shares regulatory, financial and practical considerations for incorporating telemedicine into clinical practice. Continued government and other payer support for telemedicine and ongoing innovation to provide remote objective patient data will help to sustain the use of telemedicine long after the current pandemic subsides.


Subject(s)
Betacoronavirus , Coronavirus Infections/prevention & control , Gastroenterology/methods , Inflammatory Bowel Diseases/therapy , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Practice Patterns, Physicians'/trends , Telemedicine/methods , COVID-19 , Gastroenterology/organization & administration , Gastroenterology/trends , Global Health , Humans , Inflammatory Bowel Diseases/complications , Practice Patterns, Physicians'/standards , SARS-CoV-2 , Telemedicine/organization & administration , Telemedicine/trends
18.
World J Gastroenterol ; 26(36): 5387-5394, 2020 Sep 28.
Article in English | MEDLINE | ID: covidwho-836287

ABSTRACT

The current coronavirus pandemic is imposing unpreceded challenges to the practice of pediatric gastroenterology. These are highlighted in their impact on performing aerosol-generating endoscopy procedures and the need to accommodate longer room turnaround time for disinfection, ensuring appropriate and consistent safety measures for patients, staff and providers, and emphasizing the importance for screening patients for active coronavirus disease (COVID) infection before endoscopy when possible. Pediatric patients are less likely to exhibit severe COVID-related symptoms so survey-based screening would not be a sensitive measure to identify patients with active infections. To address the restrictions of patients coming for face to face clinic encounters, there has been rapid expansion of telehealth services in a very short time period with several difficulties encountered. To survive these challenges, pediatric gastroenterology practices need to adapt and accept flexibility in clinical operations with ongoing commitment to safety for patients and healthcare workers.


Subject(s)
Coronavirus Infections , Gastroenterology/methods , Infection Control/methods , Pandemics , Patient Safety , Pediatrics/methods , Pneumonia, Viral , Betacoronavirus , COVID-19 , Humans , SARS-CoV-2 , Telemedicine/trends
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