The use of, and outcomes for, inflammatory bowel disease services during the Covid‐19 pandemic: a nationwide observational study

Abstract

Background Inflammatory bowel disease (IBD) services have been particularly affected by the Covid‐19 pandemic. Delays in referral to secondary care and access to investigations and surgery have been exacerbated. Aims To investigate the use of and outcomes for emergency IBD care during the Covid‐19 pandemic. Methods Nationwide observational study using administrative data for England (2015‐2020) comparing cohorts admitted from 1 January 2015, to 31 January 2020 (pre‐pandemic) and from 1 February 2020, to 31 January 2021 (pandemic). Autoregressive integrated moving average forecast models were run to estimate the counterfactual IBD admissions and procedures for February 2020 to January 2021. Results Large decreases in attendances to hospital for emergency treatment were observed for both acute ulcerative colitis (UC, 16.4%) and acute Crohn’s disease (CD, 8.7%). The prevalence of concomitant Covid‐19 during the same episode was low [391/16 494 (2.4%) and 349/15 613 (2.2%), respectively]. No significant difference in 30‐day mortality was observed. A shorter median length of stay by 1 day for acute IBD admissions was observed (P < 0.0001). A higher rate of emergency readmission within 28 days for acute UC was observed (14.1% vs 13.4%, P = 0.012). All IBD procedures and investigations showed decreases in volume from February 2020 to January 2021 compared with counterfactual estimates. The largest absolute deficit was in endoscopy (17 544 fewer procedures, 35.2% reduction). Conclusion There is likely a significant burden of untreated IBD in the community. Patients with IBD may experience clinical harm or protracted decreases in quality of life if care is not prioritised.

Recent advances in clinical practice: management of inflammatory bowel disease during the COVID-19 pandemic

“…Similar trends were observed in the USA with a reduction of colorectal cancer diagnosis by about 50% 122. Emerging data capturing IBD-related procedures, investigations and hospital attendances continued to show a decrease in volume of these activities during the pandemic compared with prepandemic 123 124…”

“… 122 Emerging data capturing IBD-related procedures, investigations and hospital attendances continued to show a decrease in volume of these activities during the pandemic compared with prepandemic. 123 124 …”

Letter: inflammatory bowel disease services during the Covid‐19 pandemic ‐ authors' reply

“…We thank Mungmunpuntipantip and Wiwanitkit for their correspondence regarding our recent paper on the use of, and outcomes for, inflammatory bowel disease services in England during the Covid‐19 pandemic. 1 , 2 We agree with them that only a proportion of patients with severe inflammatory bowel disease presented during the pandemic. This is likely due to several reasons.…”

“…Declarations of personal and financial interests : The authors' declarations of personal and financial interests are unchanged from those in the original article. 2 …”

Letter: inflammatory bowel disease services during the Covid‐19 pandemic

“…In their recent publication, 1 Deputy et al concluded that “There is likely a significant burden of untreated IBD in the community. Patients with IBD may experience clinical harm or protracted decreases in quality of life if care is not prioritised.” The effect of the COVID‐19 pandemic and subsequent lockdown on the medical care of patients is extensively discussed.…”