Impact of covid-19 pandemic in patients with a first consultation for suspected inflammatory bowel disease

ABSTRACT

Background: During the COVID-19 pandemic, outpatient activity and the performance of complementary tests have been limited in order to optimize health care resources in patients with SARS-CoV2 infection according to the incidence of cases in each time period. The aim of this study was to determine the impact of the measures implemented by the COVID-19 pandemic on the diagnosis, initiation of treatment, and follow-up of patients referred for suspected inflammatory bowel disease (IBD) at different times during the pandemic. Methods: Retrospective multicenter study comparing three cohorts of patients who were referred for evaluation in IBD consultation during three time periods pre-pandemic pre-COVID19 (pC), from March to May 2019;during health alert alert-COVID19 (aC), from March to May 2020;and during a recent post-pandemic alert period post-COVID19 alert (p-aC), from January 2021 to March 2021. All patients referred with suspected IBD (first time consultation) were included. Epidemiological and clinical variables were recorded from the onset of digestive symptoms and up to a follow-up of 6 months after consultation. Results: A total of 114 first-time consultations were recorded 47 in pC (age 45.3, SD 2.6 years;63.83% female), 24 in aC (age 48.3, SD 3.3;male 54.2%) and 43 in p-aC (age 44.5, SD 2.4;male 53.4%). Significant differences were determined in terms of the reason for consultation between the periods (recent diagnosis of IBD 25.5% pC vs 41.7% cD vs 53.5% a-pC;p= 0.03 and suspicion of IBD 74.5% pC vs 58.3% aC vs 46.5% in p-aC;p = 0.03). The diagnosis of IBD was confirmed in 44.6% of patients in the pC period, 66.6% in aC and 67.4% in p-aC, (p=0.06). There were no significant differences between the three periods in terms of time from suspicion of the disease to evaluation at the first visit and time to completion of complementary tests. However, there were significant differences in the time between diagnosis and initiation of treatment among the pC group (mean 1.7, SD 1.05 months), in contrast to 4.36 months (SD 2.03) in aC and 3.82 months (SD 1.3) in p-aC (p= 0.05). There were also no differences in the management (treatment and request for complementary tests) of the sucessive consultation, except for the number of hospital admissions in the six months following the first consultation (5 cases in pC vs. no admissions in aC and p-aC,p=0.03). Conclusion: During the COVID19 pandemic,the ability to diagnose patients with IBD has been maintained with no delays in the performance of complementary tests at participating centers. However, a delay in the initiation of treatment that could negatively impact the health of IBD patients is currently being maintained.