IBD in the Times of COVID-19

To the editor:

We are witnessing historically unprecedented moments that have shed light onto new social etiquette guidelines and concomitant fluid quarantine regulations. With these changes have come protocols and literature regarding COVID-19. Early on in the pandemic, guides for endoscopists; ¹ practice recommendations via joint position papers by the North American Society for Pediatric Gastroenterology, Hepatology & Nutrition and the European Society for Paediatric Gastroenterology, Hepatology and Nutrition; ² and clinical considerations for transplant patients³ became available. The Surveillance Epidemiology of Coronavirus Under Research Exclusion (SECURE-IBD) database also provides a platform to capture data to determine the outcomes of patients with inflammatory bowel disease (IBD) with COVID-19, which has unequivocally served to answer both patient and health care provider questions around the world. How do we adapt?

Coronavirus has brought turmoil to our way of practicing medicine and compelled us to adopt the frequent use of telemedicine. Providers have focused on learning this novel patient access instrument, with videoconference now providing leeway for many patient and colleague interactions. However, how does this pandemic affect our patients? What are its acute psychological consequences? How are patients with IBD coping with COVID-19?

To answer these questions, we created and distributed a questionnaire for pediatric patients with IBD that aimed to identify patient attitudes and knowledge regarding telemedicine, treatment options, and COVID-19. Whereas half of our patient population felt very informed, the other half reported uneasiness because of a lack of knowledge regarding coronavirus. Parents and patients understood the importance of continuing immunosuppressors but reported high levels of anxiety regarding their potential adverse effects. None reported difficulty obtaining medication refills. Caretakers were familiar with the concept of telemedicine and were amenable to trying it to address concerns regarding COVID-19 and IBD. However, all patients preferred telemedicine to in-person clinic visits. One hundred percent of patients also requested frequent updates regarding COVID-19 from their gastroenterologist.

To this day, news regarding coronavirus continues to be scattered and nonuniform. We propose using telemedicine as a means to introduce and/or provide continuity of care with a multidisciplinary team. For example, our center provides hypnotherapy for patients with functional abdominal pain, but techniques used by these providers can benefit other patient groups such as those with IBD. Coping with anxiety by incorporating a support system is a means to ease the difficulty inherent with incomplete guidance. Other interventions to consider include the creation of short, need-to-know email updates for patients. Useful information to incorporate in these messages includes at-home exercise regimens, because many children report being more sedentary and feeling fatigued, and a list of open radiology centers available in nearby neighborhoods.

Telemedicine may serve as a bridge to communicate with patients for now, but in the future it can facilitate patient communication with more providers in small care centers and optimize treatment compliance and welfare.

Disclaimer: This work has not been presented at any scientific meeting or conference. We also have not submitted it elsewhere while it was undergoing consideration. It has not been published elsewhere. The 2 authors involved in this specific submission are uniquely responsible for this article and have substantially contributed to the concept, design, analysis, interpretation of data, drafting, and revision. All authors have International Committee of Medical Journal Editors criteria for authorship. All authors have approved the article for submission.

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