Perception of the COVID-19 pandemic in patients with achalasia and its impact on gastrointestinal symptoms: a proof-of-concept study.

Background: Currently, no data are available on COVID-19 pandemic perception in patients with achalasia. We evaluated how the COVID-19 lockdown was perceived by these patients and its impact on their upper gastrointestinal symptoms. Methods: COVID-19 perception was assessed in 64 patients with achalasia using a previously published survey. Upper gastrointestinal symptoms were assessed using a standardized questionnaire and the results were compared to those obtained before the COVID-19 pandemic. All questionnaires were administered by telephone/video calls during the second Italian lockdown. Results: Fifty-one patients (79.7%) responded to the survey. For the question "On a 0-100 scale, how worried are you about the COVID-19 pandemic?" the mean score was 72.8±27.1, and 64.7% of patients with achalasia gave a score >60 on a visual analog scale of 0-100. In addition, those who considered themselves more vulnerable or anxious about contracting the infection than the general population, showed a significantly higher score for COVID-19 fear compared to those who felt less vulnerable or anxious (79.7±27.6 vs. 62.5±23.6, P=0.027; 80.9±19.6 vs. 57.1±33.1, P=0.002, respectively). The selected patients (n=29), who had not undergone any change in medical/surgical treatment for at least one year before the COVID-19 pandemic, had a significant worsening of the intensity-frequency score of regurgitation, heartburn, odynophagia, water brash, and epigastric burning during the lockdown (P<0.05). Finally, 75% of the patients were very interested in using Telemedicine. Conclusions: The COVID-19 lockdown had a significant impact on the psychological aspects and upper gastrointestinal symptoms of patients with achalasia. Telemedicine might represent a follow-up strategy.

Impact of COVID-19 lockdown on symptoms in patients with functional gastrointestinal disorders: Relationship with anxiety and perceived stress.

BACKGROUND: Psychological stress and anxiety, such those generated by forced quarantine, affect gastrointestinal symptoms course in patients with functional gastrointestinal disorders. Thus, our aim was to assess, in a cohort of patients regularly followed up in a devoted outpatient clinic of Southern Italy, the association between their gastrointestinal symptoms changes, stress, and anxiety reported during the Italian lockdown. METHODS: We recruited patients from the outpatient clinic of the University of Salerno, devoted to functional gastrointestinal disorders, selecting only patients for whom an evaluation was available in the last 6 months before the lockdown. Gastrointestinal symptoms were evaluated at each visit through standardized questionnaire and pooled in a database. On 45th days from the beginning of the lockdown, patients were re-assessed by phone with the same questionnaire. Anxiety and stress levels were assessed through a self-administered online questionnaire based on Generalized Anxiety Disorder 7 test and Perceived Stress Scale 10 test. KEY RESULTS: The intensity-frequency scores of several upper gastrointestinal symptoms improved (Wilcoxon test <0.05). Higher anxiety levels had a higher risk of worsening chest pain (OR 1.3 [1.1-1.7]), waterbrash (OR 1.3 [1.0-1.7]), epigastric burning (OR 1.3 [1.0-1.6]), and abdominal pain (OR 1.6 [1.0-2.3]). When compared to the interval preceding the outbreak, half of the patients declared their symptoms remained unchanged, 13.6% worsened, and 36.4% improved. CONCLUSIONS AND INFERENCES: During the COVID-19 quarantine, there was an improvement of the majority of upper gastrointestinal symptoms in our patients, and anxiety seems an important risk of worsening few of them.

Clinical and Psychological Impact of COVID-19 Infection in Adult Patients with Eosinophilic Gastrointestinal Disorders during the SARS-CoV-2 Outbreak.

Eosinophilic gastrointestinal diseases (EGIDs) are chronic gastrointestinal conditions requiring corticosteroid and immunosuppressive therapy for disease control. Patients with EGIDs usually report impaired quality of life. We aimed to report the clinical and psychological impact of COVID-19 infection in EGID patients. In this prospective web-based study we invited all consecutive EGID patients attending the University Hospital of Salerno (Campania) and Padua (Veneto) to fill an ad hoc COVID-19 survey. Moreover, a telemedicine service for direct consultation was organized. Data regarding the occurrence and perception of COVID-19 infection as well as clinical information were recorded. The study population included 102 EGID patients (mean age 36.6 years, 34 females), of whom 89 had eosinophilic esophagitis, nine had gastroenteritis, and four had colitis. No patient was diagnosed with COVID-19 or had recurrence of his/her primary disease. All of them were adherent to therapy and preventive measures adoption. Most patients were worried because of COVID-19 and social preventing measures but did not consider themselves at major risk or susceptible to COVID-19 or other infections due to their chronic condition or therapy. Female gender and low education level were associated to a higher psychological perception of COVID-19 compared to lockdown status or other demographic and clinical factors (p < 0.05). Overall, COVID-19 had a limited clinical impact on patients with EGIDs. The degree of education and sex, but not the fact of living in a lockdown area, influenced the perception of SARS-CoV-2 infection.