COVID-19, IBD, and Telemedicine

The COVID-19 pandemic sharply reduced endoscopic procedures and greatly increased the use of telemedicine in gastroenterology, Miguel Regueiro, MD, reported at the July 25 virtual Advances in Inflammatory Bowel Disease 2020 regional meeting.

Dr Regueiro is professor and chair of gastroenterology, hepatology, and nutrition at the Digestive Diseases and Surgery Institute at the Cleveland Clinic and is a cochair of the AIBD 2020 events.

He reviewed the results of a survey of the New York Society of Gastroenterologists, asking for information on case volume, use of personal protective equipment (PPE), and the exposure of endoscopists to COVID-19.

He noted that 71% of gastroenterologists reported that they were no longer regularly performing endoscopies; 62% reported having performed no endoscopies over the preceding week. Weekly volumes of endoscopy decreased from 57% to 96%. At the time the survey was taken, testing of patients for COVID-19 was being performed in only 54% of the cases.

Dr Regueiro also shared the results of a meta-analysis of the presentation of gastrointestinal symptoms in patients diagnosed with COVID-19, which showed that of more than 4200 patients in 6 countries, 17.6% presented with some type of gastrointestinal (GI) symptom, from anorexia (26.8%) to diarrhea (12.5%) to nausea and vomiting (10.2%). He explained that severe disease was more common in patients who presented with GI symptoms that those who did not (17.1% vs 11.8%.)

In the early phase of the pandemic, physicians and patients worried that those who were being treated with immunosuppressing therapeutics might be at higher risk of contracting COVID-19 and of having worse outcomes if they became infected. However, Dr Regueiro reported that as of May 5, 2020, the SECURE-IBD registry—an international database of COVID-19 cases—showed that “the risk of infection from SARS-CoV-2 is the same in patients with and without IBD.” Further, he noted, “independent of treatment, patients with ulcerative colitis or Crohn disease do not have greater risks of infection than the general population,” and patients with an ostomy or J-pouch are also not at increased risk of infection with the virus.

The guidelines for treating patients with IBD in the COVID-19 era, he explained, recommend that patients who are not infected with the virus to continue their infusions, with the goal of sustaining remission. “Patients should be advised to maintain their current regimens and to avoid relapse due to nonadherence,” Dr Regueiro stressed. A patient with IBD who tests positive for COVID-19 but is asymptomatic should avoid prednisone, and hold thiopurines, methotrexate, and tofacitinib, he explained; patients with IBD who are symptomatic should follow the same guidelines and also hold biologic treatments until the patient has been without a fever for 2 weeks.

The use of telemedicine has grown exponentially since the advent of the pandemic, as well. A survey by the International Organization for the Study of Inflammatory Bowel Diseases (IOIBD) surveyed its members, finding that while the vast majority of patient visits conducted pre-COVID-19 were face-to-face, less than one-fourth of visits were in-office after the pandemic began. Most telemedicine appointments were conducted by telephone, with a smaller proportion conducted by video.

A Twitter poll Dr Regueiro posted revealed that 53% of the gastroenterologists who responded planned to perform fewer telemedicine visits when the pandemic is controlled and safety is no longer as big of an issue, but 41% plan to use telemedicine more often. Among patients, 63% said they would like to have the option of seeing doctors in person and having telehealth appointments, while 25% actually preferred telemedicine to in-office visits.

“The future is now,” he said. “Telemedicine will allow health centers to connect to patients remotely. It will redefine health care.”

—Rebecca Mashaw

Reference:

Regueiro, M. Regional update on COVID-19 and IBD patients. Presented at: Advances in Inflammatory Bowel Disease 2020 regional; July 25, 2020; virtual.