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2.
Lancet Gastroenterol Hepatol ; 6(3): 218-224, 2021 03.
Article in English | MEDLINE | ID: covidwho-1049904

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)
/pharmacology , Inflammatory Bowel Diseases , /epidemiology , Disease Transmission, Infectious/prevention & control , Gastroenterology/methods , Gastroenterology/trends , Humans , Immunocompromised Host , Inflammatory Bowel Diseases/immunology , Inflammatory Bowel Diseases/therapy , Societies, Medical , United Kingdom , Vaccination/methods
3.
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)
Gastroenterology/methods , Gastrointestinal Diseases , /complications , /therapy , 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
4.
J Crohns Colitis ; 14(Supplement_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 , Gastroenterology/organization & administration , Gastroenterology/trends , Global Health , Humans , Inflammatory Bowel Diseases/complications , Practice Patterns, Physicians'/standards , Telemedicine/organization & administration , Telemedicine/trends
5.
Am J Gastroenterol ; 115(10): 1575-1583, 2020 10.
Article in English | MEDLINE | ID: covidwho-737627

ABSTRACT

The American Neurogastroenterology and Motility Society Task Force recommends that gastrointestinal motility procedures should be performed in motility laboratories adhering to the strict recommendations and personal protective equipment (PPE) measures to protect patients, ancillary staff, and motility allied health professionals. When available and within constraints of institutional guidelines, it is preferable for patients scheduled for motility procedures to complete a coronavirus disease 2019 (COVID-19) test within 48 hours before their procedure, similar to the recommendations before endoscopy made by gastroenterology societies. COVID-19 test results must be documented before performing procedures. If procedures are to be performed without a COVID-19 test, full PPE use is recommended, along with all social distancing and infection control measures. Because patients with suspected motility disorders may require multiple procedures, sequential scheduling of procedures should be considered to minimize need for repeat COVID-19 testing. The strategies for and timing of procedure(s) should be adapted, taking into consideration local institutional standards, with the provision for screening without testing in low prevalence areas. If tested positive for COVID-19, subsequent negative testing may be required before scheduling a motility procedure (timing is variable). Specific recommendations for each motility procedure including triaging, indications, PPE use, and alternatives to motility procedures are detailed in the document. These recommendations may evolve as understanding of virus transmission and prevalence of COVID-19 infection in the community changes over the upcoming months.


Subject(s)
Coronavirus Infections/prevention & control , Gastroenterology/standards , Gastrointestinal Diseases/diagnosis , Infection Control/standards , Laboratories/standards , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Advisory Committees/standards , Betacoronavirus/pathogenicity , Clinical Laboratory Techniques/standards , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Gastroenterology/methods , Gastrointestinal Diseases/physiopathology , Gastrointestinal Motility/physiology , Humans , Infection Control/instrumentation , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Infectious Disease Transmission, Professional-to-Patient/prevention & control , Patient Selection , Personal Protective Equipment/standards , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Prevalence , Societies, Medical/standards , Triage/standards , United States/epidemiology
6.
World J Gastroenterol ; 26(29): 4182-4197, 2020 Aug 07.
Article in English | MEDLINE | ID: covidwho-732795

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 , 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 , Smartphone
7.
Indian J Gastroenterol ; 39(3): 220-231, 2020 06.
Article in English | MEDLINE | ID: covidwho-710811

ABSTRACT

The world is witnessing a serious public health threat in the wake of the third corona virus pandemic, a novel corona virus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]). The Corona Virus Disease-19 (COVID-19) is not limited to the respiratory system but has widespread involvement including the gastrointestinal (GI) tract and liver, with evidence of prolonged fecal shedding and feco-oral transmission. This finding has stirred up a hornet's nest of not only a newer modality of the spread of the virus but also a risk of the unpredictable duration of the infective potential of the shedders. We reviewed the literature on fecal shedding and possible implications on prevention and surveillance strategies. The pandemic is changing the management of underlying chronic diseases such as inflammatory bowel disease (IBD) and other diseases. Moreover, for the gastroenterologist, doing endoscopic procedures in this COVID-19 era poses a high risk of contamination, as it is an aerosol-generating procedure. There is a daily influx of data on this disease, and multiple societies are coming up with various recommendations. We provide a comprehensive review of all the reported GI manifestations of COVID-19 infection and the side effects of confounding drugs. We have summarized the management recommendations for diseases such as IBD with COVID-19 and nutritional recommendations and provided a concise review of the endoscopy guidelines by the various societies. This review provides a comprehensive account and a lucid guide covering various aspects of gastroenterology practice during this COVID-19 pandemic.


Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections , Disease Transmission, Infectious/prevention & control , Endoscopy, Gastrointestinal , Feces/virology , Gastroenterology , Inflammatory Bowel Diseases , Pandemics , Pneumonia, Viral , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Disease Management , Endoscopy, Gastrointestinal/adverse effects , Endoscopy, Gastrointestinal/methods , Gastroenterology/methods , Gastroenterology/trends , Gastrointestinal Tract/virology , Humans , Inflammatory Bowel Diseases/epidemiology , Inflammatory Bowel Diseases/therapy , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission
9.
Hepatology ; 72(5): 1819-1837, 2020 11.
Article in English | MEDLINE | ID: covidwho-691225

ABSTRACT

The severe acute respiratory syndrome coronavirus 2 pandemic has drastically altered all facets of clinical care and research. Clinical research in hepatology has had a rich tradition in several domains, including the discovery and therapeutic development for diseases such as hepatitis B and C and studying the natural history of many forms of chronic liver disease. National Institutes of Health, foundation, and industry funding have provided important opportunities to advance the academic careers of young investigators while they strived to make contributions to the field. Instantaneously, however, all nonessential research activities were halted when the pandemic started, forcing those involved in clinical research to rethink their research strategy, including a shift to coronavirus disease 2019 research while endeavoring to maintain their preexisting agenda. Strategies to maintain the integrity of ongoing studies, including patient follow-up, safety assessments, and continuation of investigational products, have included a shift to telemedicine, remote safety laboratory monitoring, and shipping of investigational products to study subjects. As a revamp of research is being planned, unique issues that face the research community include maintenance of infrastructure, funding, completion of studies in the predetermined time frame, and the need to reprogram career path timelines. Real-world databases, biomarker and long-term follow up studies, and research involving special groups (children, the homeless, and other marginalized populations) are likely to face unique challenges. The implementation of telemedicine has been dramatically accelerated and will serve as a backbone for the future of clinical research. As we move forward, innovation in clinical trial design will be essential for conducting optimized clinical research.


Subject(s)
Biomedical Research/organization & administration , Coronavirus Infections/prevention & control , Gastroenterology/methods , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Telemedicine/organization & administration , Coronavirus Infections/epidemiology , Delivery of Health Care , Female , Forecasting , Humans , Male , Needs Assessment , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Program Development , Program Evaluation , Research Design , United States
10.
United European Gastroenterol J ; 8(7): 798-803, 2020 08.
Article in English | MEDLINE | ID: covidwho-630426

ABSTRACT

Since December 2019, a novel coronavirus disease, COVID-19, has occurred in China and has spread around the world rapidly. As an acute respiratory infectious disease, COVID-19 has been included in type B infectious diseases and managed according to the standard of type A infectious disease in China. Given the high risk of COVID-19 infection during endoscopic procedures via an airborne route, the Chinese Society of Digestive Endoscopy issued a series of recommendations to guide the endoscopy works in China during the pandemic. To the best of our knowledge, no new infectious case of COVID-19 resulting from endoscopic procedures has been reported in China to date. Here, these recommendations are integrated to provide guidance about the prevention of COVID-19 for endoscopists. The recommendations include advice about postponing non-urgent endoscopies, excluding the possibility of COVID-19 in patients undergoing endoscopy, protection of medical staff from coronavirus infection, and cleaning of endoscopy centres.


Subject(s)
Coronavirus Infections/prevention & control , Endoscopy, Gastrointestinal/standards , Infection Control/organization & administration , Pandemics/prevention & control , Personal Protective Equipment/standards , Pneumonia, Viral/prevention & control , Practice Guidelines as Topic , Betacoronavirus/isolation & purification , Betacoronavirus/pathogenicity , China/epidemiology , Clinical Laboratory Techniques/standards , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Coronavirus Infections/virology , Endoscopy, Gastrointestinal/instrumentation , Equipment Contamination/prevention & control , Gastroenterology/methods , Gastroenterology/standards , Gastrointestinal Diseases/diagnosis , Gastrointestinal Diseases/therapy , Health Personnel/standards , Humans , Infection Control/instrumentation , Infection Control/standards , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Infectious Disease Transmission, Professional-to-Patient/prevention & control , Operating Rooms/standards , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Pneumonia, Viral/virology , Preoperative Care/standards , Societies, Medical/standards
11.
World J Gastroenterol ; 26(22): 2987-2999, 2020 Jun 14.
Article in English | MEDLINE | ID: covidwho-617243

ABSTRACT

Severe pulmonary disease caused by the novel coronavirus [severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)], has devastated many countries around the world. It has overwhelmed the medical system. The priorities of many institutions have changed to manage critically ill corona virus infectious disease-2019 (COVID-19) patients, which affected the working style of many departments. Hepatologists and transplant surgeons look after a very sensitive patient group. Patients with liver disease need special attention and continuous follow-up. Similarly, transplant candidates also need special care. Healthcare professionals in the field of hepatology face the overwhelming task of taking care of COVID-19 patients with hepatic complications, liver disease or transplant patients who are SARS-CoV-2 positive, and the patients on routine surveillance who do not have COVID-19. This review will evaluate COVID-19 from the perspective of its effect on the liver and its possible effects on patients with liver disease. Furthermore, the level of care for liver transplant recipients during the pandemic will be discussed.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Gastroenterology/methods , Liver Diseases/virology , Liver Transplantation , Pneumonia, Viral/complications , Coronavirus Infections/virology , Humans , Pandemics , Pneumonia, Viral/virology
13.
Neurogastroenterol Motil ; 32(7): e13926, 2020 07.
Article in English | MEDLINE | ID: covidwho-457062

ABSTRACT

BACKGROUND: The COVID-19 pandemic, declared by WHO on March 13, 2020, had a major global impact on the healthcare system and services. In the acute phase, the presence of the SARS-CoV-2 virus in the aerodigestive tract limited activities in the gastroenterology clinic and procedures to emergencies only. Motility and function testing was interrupted and as we enter the recovery phase, restarting these procedures requires a safety-focused approach with adequate infection prevention for patients and healthcare professionals. METHODS: We summarized knowledge on the presence of the SARS-CoV-2 virus in the aerodigestive tract and the risk of spread with motility and functional testing. We surveyed 39 European centers documenting how the pandemic affected activities and which measures they are considering for restarting these measurements. We propose recommendations based on current knowledge as applied in our center. RESULTS: Positioning of catheters for gastrointestinal motility tests carries a concern for aerosol-borne infection of healthcare workers. The risk is low with breath tests. The surveyed centers stopped almost all motility and function tests from the second half of March. The speed of restarting and the safety measures taken varied highly. CONCLUSIONS AND INFERENCES: Based on these findings, we provided recommendations and practical relevant information for motility and function test procedures in the COVID-19 pandemic era, to guarantee a high-quality patient care with adequate infection prevention.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Gastroenterology/methods , Gastrointestinal Motility/physiology , Pandemics , Pneumonia, Viral/epidemiology , Recovery of Function/physiology , Coronavirus Infections/prevention & control , Europe/epidemiology , Gastroenterology/standards , Health Personnel/standards , Humans , Pandemics/prevention & control , Patient Care/methods , Patient Care/standards , Pneumonia, Viral/prevention & control , Practice Guidelines as Topic/standards , Protective Clothing/standards , Surveys and Questionnaires
14.
Clin Gastroenterol Hepatol ; 18(10): 2287-2294.e1, 2020 09.
Article in English | MEDLINE | ID: covidwho-327107

ABSTRACT

BACKGROUND & AIMS: Practices dramatically reduced endoscopy services due to the COVID-19 pandemic. Because practices now are considering reintroduction of elective endoscopy, we conducted a survey of North American practices to identify reactivation barriers and strategies. METHODS: We designed and electronically distributed a web-based survey to North American gastroenterologists consisting of 7 domains: institutional demographics, impact of COVID-19 on endoscopy practice, elective endoscopy resumption plans, anesthesia modifications, personal protective equipment policies, fellowship training, and telemedicine use. Responses were stratified by practice type: ambulatory surgery center (ASC) or hospital-based. RESULTS: In total, 123 practices (55% ASC-based and 45% hospital-based) responded. At the pandemic's peak (as reported by the respondents), practices saw a 90% decrease in endoscopy volume, with most centers planning to resume elective endoscopy a median of 55 days after initial restrictions. Declining community prevalence of COVID-19, personal protective equipment availability, and preprocedure severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing availability were ranked as the 3 primary factors influencing reactivation timing. ASC-based practices were more likely to identify preprocedure testing availability as a major factor limiting elective endoscopy resumption (P = .001). Preprocedure SARS-CoV-2 testing was planned by only 49.2% of practices overall; when testing is performed and negative, 52.9% of practices will continue to use N95 masks. CONCLUSIONS: This survey highlights barriers and variable strategies for reactivation of elective endoscopy services after the COVID-19 pandemic. Our results suggest that more widespread access to preprocedure SARS-CoV-2 tests with superior performance characteristics is needed to increase provider and patient comfort in proceeding with elective endoscopy.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Digestive System Diseases/surgery , Disease Transmission, Infectious/prevention & control , Gastroenterology/methods , Pandemics , Personal Protective Equipment/supply & distribution , Pneumonia, Viral/epidemiology , Coronavirus Infections/complications , Coronavirus Infections/transmission , Cross-Sectional Studies , Digestive System Diseases/complications , Digestive System Surgical Procedures , Humans , Pneumonia, Viral/complications , Pneumonia, Viral/transmission , Surveys and Questionnaires , United States/epidemiology
15.
Dig Liver Dis ; 52(8): 808-815, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-276436

ABSTRACT

BACKGROUND: In Italy, the spread of the COVID-19 pandemic has stressed the entire healthcare system and required a huge re-organization of many Divisions, including those of Gastroenterology. AIMS: to assess the impact of COVID-19 pandemic on Gastroenterology Divisions across Italy. METHODS: All members of the Italian Society of Gastroenterology (SIGE) were invited to answer a web-based survey. RESULTS: Data of 121 hospitals from all 20 Italian regions were analyzed. Overall, 10.7% Gastroenterology Divisions have been converted to Covid Units. Outpatients consultations, endoscopic and ultrasound procedures were limited to urgencies and oncology indications in 85.1%, 96.2% and 72.2% of Units, respectively, and 46.7% of them suspended the screening for colorectal cancer. Moreover, 72.2% of the staff received a training for use of personal protective equipment, although 45.5% did not have sufficient devices for adequate replacement. Overall, 132 healthcare workers in 41 Gastroenterology Divisions were found to be infected. CONCLUSION: This is the first study to evaluate, at a country level, the impact of COVID-19 outbreak on Gastroenterology Divisions. Substantial changes of practice and reduction of procedures have been recorded in the entire country. The long-term impact of such modifications is difficult to estimate but potentially very risky for many digestive diseases.


Subject(s)
Coronavirus Infections/prevention & control , Gastroenterology/methods , Gastroenterology/statistics & numerical data , Gastroenterology/standards , Infection Control/standards , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Betacoronavirus , Coronavirus Infections/transmission , Health Personnel , Hospitals , Humans , Infection Control/methods , Italy/epidemiology , Personal Protective Equipment/standards , Pneumonia, Viral/transmission , Surveys and Questionnaires
17.
Clin Gastroenterol Hepatol ; 18(8): 1673-1681, 2020 07.
Article in English | MEDLINE | ID: covidwho-102150

ABSTRACT

The COVID-19 pandemic seemingly is peaking now in New York City and has triggered significant changes to the standard management of gastrointestinal diseases. Priorities such as minimizing viral transmission, preserving personal protective equipment, and freeing hospital beds have driven unconventional approaches to managing gastroenterology (GI) patients. Conversion of endoscopy units to COVID units and redeployment of GI fellows and faculty has profoundly changed the profile of most GI services. Meanwhile, consult and procedural volumes have been reduced drastically. In this review, we share our collective experiences regarding how we have changed our practice of medicine in response to the COVID surge. Although we review our management of specific consults and conditions, the overarching theme focuses primarily on noninvasive measures and maximizing medical therapies. Endoscopic procedures have been reserved for those timely interventions that are most likely to be therapeutic. The role of multidisciplinary discussion, although always important, now has become critical. The support of our faculty and trainees remains essential. Local leadership can encourage well-being by frequent team check-ins and by fostering trainee development through remote learning. Advancing a clear vision and a transparent process for how to organize and triage care in the recovery phase will allow for a smooth transition to our new normal.


Subject(s)
Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Disease Management , Disease Transmission, Infectious/prevention & control , Gastroenterology/methods , Gastroenterology/organization & administration , Infection Control/methods , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Humans , New York City/epidemiology , Pandemics
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