INCREASED BURDEN OF ALCOHOL-RELATED GASTROINTESTINAL AND LIVER DISEASES DURING THE COVID-19 PANDEMIC: A HOSPITAL SYSTEM-WIDE AUDIT

ABSTRACT

Background: The indirect health impact of COVID-19 caused by delayed access to care and the psychosocial distress of the pandemic is yet to be fully appreciated. METHODS: We conducted a hospital system-wide audit of all inpatient gastrointestinal (GI) consults performed during the lockdown phase (3/23/2020 - 5/10/2020, n = 558) and the reopening phase (6/1/2020 - 7/19/2020, n = 713) of the pandemic and compared against data from 2019 in order to discover any changes in disease burdens. GI diagnoses were derived from the patients' discharge summaries and verified by an indepedent review of the associated GI consult notes. RESULTS: The volume of consults was reduced by 27.7% during the lockdown phase compared to the same period in 2019. Yet, the proportion of consults for alcohol-related GI and liver diseases (alcoholic hepatitis, alcoholic cirrhosis, alcoholic pancreatitis, and alcoholic gastritis) has increased by 59.6% (p = 0.03). In comparison, there was no signi ficant changeinthepro portions of consultsfornon-alcohol-relatedliver diseases, biliary obstruction/injury, inflammatory bowel diseases, or gastrointestinal bleeding. The volume of consults was restored during the reopening phase to 101% of that of the same period in 2019. The proportion of consults for alcohol-related GI and liver diseases remained elevated by 78.7% (p = 0.01), while that of alcoholic hepatitis, in particular, was increased by 127.2% (p < 0.01). The proportion of patients with alcohol-related GI and liver diseases requiring inpatient endoscopic interventions was also significantly higher (34.6% vs. 13.8%, p = 0.04). There was, however, no statistical difference in the average age, Maddrey's discriminant function, or Model for End-Stage Liver Disease score, amongst those patients with alcoholic hepatitis oralcoholic cirrhosis in 2020 compared tothose in2019. CONCLUSIONS: Volumes of inpatient consults had decreased sharply at the onset of the COVID-19 pandemic but have quickly returned to normal levels despite the ongoing infection control restrictions. There is a surge in the demands for inpatient consults and inpatient endoscopic interventions for alcohol-related GI and liver diseases, particularly alcoholic hepatitis. Primary care physicians and gastroenterologists should proactively screen for and aggressively address alcohol use disorder.