scholarly journals Impact of COVID-19 on the diagnosis, assessment and management of children with inflammatory bowel disease in the UK: implications for practice

2020 ◽  
Vol 4 (1) ◽  
pp. e000786
Author(s):  
Abbie Maclean ◽  
James J Ashton ◽  
Vikki Garrick ◽  
R Mark Beattie ◽  
Richard Hansen
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Delayed Diagnosis ◽  
High Standard ◽  
Current Evidence ◽  
Faecal Calprotectin ◽  
Paediatric Patients ◽  
Inflammatory Bowel ◽  
Working Practices ◽  
The Impact

The assessment and management of patients with known, or suspected, paediatric inflammatory bowel disease (PIBD) has been hugely impacted by the COVID-19 pandemic. Although current evidence of the impact of COVID-19 infection in children with PIBD has provided a degree of reassurance, there continues to be the potential for significant secondary harm caused by the changes to normal working practices and reorganisation of services.Disruption to the normal running of diagnostic and assessment procedures, such as endoscopy, has resulted in the potential for secondary harm to patients including delayed diagnosis and delay in treatment. Difficult management decisions have been made in order to minimise COVID-19 risk for this patient group while avoiding harm. Initiating and continuing immunosuppressive and biological therapies in the absence of normal surveillance and diagnostic procedures have posed many challenges.Despite this, changes to working practices, including virtual clinic appointments, home faecal calprotectin testing kits and continued intensive support from clinical nurse specialists and other members of the multidisciplinary team, have resulted in patients still receiving a high standard of care, with those who require face-to-face intervention being highlighted.These changes have the potential to revolutionise the way in which patients receive routine care in the future, with the inclusion of telemedicine increasingly attractive for stable patients. There is also the need to use lessons learnt from this pandemic to plan for a possible second wave, or future pandemics as well as implementing some permanent changes to normal working practices.In this review, we describe the diagnosis, management and direct impact of COVID-19 in paediatric patients with IBD. We summarise the guidance and describe the implemented changes, evolving evidence and the implications of this virus on paediatric patients with IBD and working practices.

scholarly journals P262 Trends in the prevalence and severity of anaemia in paediatric patients with inflammatory bowel disease in the last decade

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S281-S281
Author(s):  
S Y Geng ◽  
Z Ridha ◽  
B L Pham ◽  
E Tran ◽  
A Peixoto ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Inflammatory Bowel Disease ◽  
Iron Deficiency ◽  
Disease Severity ◽  
Bowel Disease ◽  
Paediatric Patients ◽  
Intestinal Involvement ◽  
Inflammatory Bowel ◽  
The Impact

Abstract Background Anaemia is one of the most common extraintestinal manifestations in patients with inflammatory bowel disease(IBD) at diagnosis. Studies have shown that anaemia was associated with low levels of quality of life, which improves with the correction of anaemia in adults. Recent data have shown an increase in the incidence and severity of paediatric IBD. We aim to investigate the trends in the prevalence of anaemia in children at diagnosis of IBD in the last decade. The secondary aim was to investigate the associations between haemoglobin (Hb) levels and disease characteristics. Methods Eligible patients (age ≤18 years, diagnosed with IBD from 2009 to 2018) were retrospectively identified through a prospective IBD database maintained at CHU Sainte-Justine, Montreal, Canada. Disease localisation and phenotype were defined according to the Paris Classification of IBD. Anaemia was defined by Hb levels according to WHO targets. The annual prevalence of anaemia was calculated according to subtype (inflammatory vs. iron deficiency). The Pediatric Crohn’s Disease Activity Index(PCDAI) and the Pediatric ulcerative colitis Activity(PUCAI) Index were used to assess the disease severity at diagnosis. Results We included 887 patients (439 females), mean(SD) age of 13.1 (3.4) years. Of these, 519 (58.5%) were identified with anaemia within 30 days of diagnosis. The median (IQR) Hb level at diagnosis was 108 (98 −114) g/dl. Severe anaemia(< 70 g/dl) was present in 1.8 % of patients. The prevalence of anaemia at diagnosis remained relatively stable ranging from 60.2% in 2009 to 60.4% in 2018. The annual proportion of inflammatory vs. iron-deficiency anaemia is displayed in Figure 1. Anaemia was more prevalent in CD (62.2%) than UC (57.9%) or IBD-U(39.6%). The median(IQR) PCDAI and PUCAI were respectively 37.5 (27.5–47.5) and 55.0 (40.0–65.0) in the anaemic group as compared with 27.5 (20.0–37.50) and 35.0 (25.0–55.0) in the non-anaemic group; p < 0.0001. Patients with anaemia had a lower BMI z-score [median(IQR) −0.84(−1.84–0.08)] than the non-anaemic patients[median(IQR) −0.38(−1.21–0.43)]; p < 0.001. The prevalence of anaemia correlated significantly with disease location: upper intestinal involvement [L4a(67.7%) L4b(63.6%) L4aL4b(60.7%) none (52.8%)] p = 0.024 for CD; for UC[E1(21.1%) E2(44.4%) E3(75.0%) E4 (71.1%)] p < 0.0001. A moderate correlation was found between Hb levels and C-reactive protein (r = −0.312, 95% CI: −0.378 to −0.243, p < 0.0001). Conclusion Anaemia remains a prevalent symptom in paediatric patients with IBD, and it is correlated with the extent of intestinal involvement and disease severity. The impact of anaemia at diagnosis and during follow-up on the levels of quality of life and physical activity is currently under investigation.

scholarly journals Immunisation status of children and adolescents with a new diagnosis of inflammatory bowel disease

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Timothy Ford ◽  
Margie Danchin ◽  
Alissa McMinn ◽  
Kirsten Perrett ◽  
George Alex ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Risk Groups ◽  
Current Evidence ◽  
Varicella Zoster ◽  
National Immunisation ◽  
Paediatric Patients ◽  
Increased Risk ◽  
Inflammatory Bowel ◽  
Special Risk

Abstract Background Patients with Inflammatory Bowel Disease (IBD) are at increased risk of serious infections, including vaccine preventable diseases. Current evidence suggests uptake of additional recommended special risk vaccinations is low. Identification of IBD patients prior to commencing immunosuppressive therapy allows for optimisation of vaccination, including timely administration of live-attenuated and additional recommended vaccines, such as influenza and pneumococcal vaccines. Methods Paediatric patients (0–18 years) seen at the tertiary Royal Children’s Hospital, Melbourne, Australia, with a recent diagnosis of IBD were referred by the Gastroenterology Unit to our Specialist Immunisation Clinic (SIC) for assessment and provision of routine and special risk vaccines. Data was collected via a standardised REDCap questionnaire completed in or post attendance at the SIC and included serology results where available. Results Sixty-nine paediatric patients were recruited to the study between 2014 and 2017. Median age at IBD diagnosis was 11.25 years (IQR 4.64 years), with median time between diagnosis and SIC review of 0.88 years (IQR 2.84 years). At initial review 84.1% (58/69) of patients were up to date with vaccines on the Australian National Immunisation Program (NIP) schedule. Of those who were tested, serological evidence of immunity was demonstrated in 38.3% (23/60) of patients for Hepatitis B, 66.7% (36/54) for measles, 51.9% (28/54) for rubella and 41.9% (26/62) for Varicella Zoster Virus. Prior to SIC review 47.8% (33/69) had additional vaccinations and 92.8% (64/69) had vaccinations administered in the 12 months following SIC assessment. The Pneumococcal conjugate vaccine (76.8%, 53/69) was the most commonly administered vaccine after SIC review, followed by influenza vaccine (69.6%, 48/69). Within 12 months of SIC review 43.5% (30/69) of patients had completed the schedule and were up-to-date as recommended by the SIC. Conclusions Children with IBD and other special risk groups can benefit from early referral to a SIC team to ensure optimal administration of routine and additionally recommended vaccines, especially live and additional special risk vaccines. The value of optimising immunisations could also be applied to other special risk groups, including adult IBD cohorts, particularly those commencing newer biologic immunosuppressive medications.

scholarly journals Organisational changes and challenges for inflammatory bowel disease services in the UK during the COVID-19 pandemic

2020 ◽  
Vol 11 (5) ◽  
pp. 343-350 ◽  
Author(s):  
Nicholas A Kennedy ◽  
Richard Hansen ◽  
Lisa Younge ◽  
Joel Mawdsley ◽  
R Mark Beattie ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Elective Surgery ◽  
Quality Care ◽  
Faecal Calprotectin ◽  
Telephone Consultation ◽  
Ensure Patient Safety ◽  
Inflammatory Bowel ◽  
The Uk ◽  
The Impact

ObjectiveTo determine the challenges in diagnosis, monitoring, support provision in the management of inflammatory bowel disease (IBD) patients and explore the adaptations of IBD services.MethodsInternet-based survey by invitation of IBD services across the UK from 8 to 14 April 2020.ResultsRespondents from 125 IBD services completed the survey. The number of whole-time equivalent gastroenterologists and IBD nurses providing elective outpatient care decreased significantly between baseline (median 4, IQR 4–7.5 and median 3, IQR 2–4) to the point of survey (median 2, IQR 1–4.8 and median 2, IQR 1–3) in the 6-week period following the onset of the COVID-19 pandemic (p<0.001 for both comparisons). Almost all (94%; 112/119) services reported an increase in IBD helpline activity. Face-to-face clinics were substituted for telephone consultation by 86% and video consultation by 11% of services. A variation in the provision of laboratory faecal calprotectin testing was noted with 27% of services reporting no access to faecal calprotectin, and a further 32% reduced access. There was also significant curtailment of IBD-specific endoscopy and elective surgery.ConclusionsIBD services in the UK have implemented several adaptive strategies in order to continue to provide safe and high-quality care for patients. National Health Service organisations will need to consider the impact of these changes in current service delivery models and staffing levels when planning exit strategies for post-pandemic IBD care. Careful planning to manage the increased workload and to maintain IBD services is essential to ensure patient safety.

scholarly journals Mo1810 – Faecal Calprotectin Concentration in Inflammatory Bowel Disease and Controls: the Impact of Storage Time and Freeze-Thaw Cycles

2019 ◽  
Vol 156 (6) ◽  
pp. S-846
Author(s):  
Clara Caenepeel ◽  
Kathleen Machiels ◽  
Sara Vieira-Silva ◽  
Nooshin Ardeshir Davani ◽  
Marc Ferrante ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Storage Time ◽  
Faecal Calprotectin ◽  
Freeze Thaw ◽  
Inflammatory Bowel ◽  
The Impact

P253 The impact of storage time and freeze–thaw cycles on faecal calprotectin concentration in inflammatory bowel disease patients and controls

2019 ◽  
Vol 13 (Supplement_1) ◽  
pp. S223-S223
Author(s):  
C Caenepeel ◽  
K Machiels ◽  
S Vieira-Silva ◽  
N Ardeshir Davani ◽  
M Ferrante ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Storage Time ◽  
Faecal Calprotectin ◽  
Freeze Thaw ◽  
Inflammatory Bowel ◽  
The Impact

scholarly journals The Accuracy of a Home-performed Faecal Calprotectin Test in Paediatric Patients With Inflammatory Bowel Disease

2019 ◽  
Vol 69 (1) ◽  
pp. 75-81
Author(s):  
Tereza Lerchova ◽  
Ondrej Hradsky ◽  
Ivana Copova ◽  
Kristyna Potuznikova ◽  
Lucie Gonsorcikova ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Faecal Calprotectin ◽  
Paediatric Patients ◽  
Inflammatory Bowel

scholarly journals Immunisation Status of Children and Adolescents with a New Diagnosis of Inflammatory Bowel Disease

2020 ◽  
Author(s):  
Timothy Ford ◽  
Margie Danchin ◽  
Alissa McMinn ◽  
Kirsten Perrett ◽  
George Alex ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Risk Groups ◽  
Current Evidence ◽  
Varicella Zoster ◽  
National Immunisation ◽  
Paediatric Patients ◽  
Increased Risk ◽  
Inflammatory Bowel ◽  
Special Risk

Abstract Background:Patients with Inflammatory Bowel Disease (IBD) are at increased risk of serious infections, including vaccine preventable diseases. Current evidence suggests uptake of additional recommended special risk vaccinations is low. Identification of IBD patients prior to commencing immunosuppressive therapy allows for optimisation of vaccination, including timely administration of live-attenuated and additional recommended vaccines, such as influenza and pneumococcal vaccines. Methods:Paediatric patients (0-18 years) seen at the tertiary Royal Children’s Hospital, Melbourne, Australia, with a recent diagnosis of IBD were referred by the Gastroenterology Unit to our Specialist Immunisation Clinic (SIC) for assessment and provision of routine and special risk vaccines. Data was collected via a standardised REDCap questionnaire completed in or post attendance at the SIC and included serology results where available. Results:Sixty-nine paediatric patients were recruited to the study between 2014 and 2017. Median age at IBD diagnosis was 11.25 years (IQR 4.64 years), with median time between diagnosis and SIC review of 0.88 years (IQR 2.84 years). At initial review 84.1% (58/69) of patients were up to date with vaccines on the Australian National Immunisation Program (NIP) schedule. Of those who were tested, serological evidence of immunity was demonstrated in 38.3% (23/60) of patients for Hepatitis B, 66.7% (36/54) for measles, 51.9% (28/54) for rubella and 41.9% (26/62) for Varicella Zoster Virus. Prior to SIC review 47.8% (33/69) had additional vaccinations and 92.8% (64/69) had vaccinations administered in the 12 months following SIC assessment. The Pneumococcal conjugate vaccine (76.8%, 53/69) was the most commonly administered vaccine after SIC review, followed by influenza vaccine (69.6%, 48/69). Within 12 months of SIC review 43.5% (30/69) of patients had completed the schedule and were up-to-date as recommended by the SIC.Conclusions:Children with IBD and other special risk groups can benefit from early referral to a SIC team to ensure optimal administration of routine and additionally recommended vaccines, especially live and additional special risk vaccines. The value of optimising immunisations could also be applied to other special risk groups, including adult IBD cohorts, particularly those commencing newer biologic immunosuppressive medications.

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