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Original research
Impact of COVID-19 on diagnosis and management of paediatric inflammatory bowel disease during lockdown: a UK nationwide study
  1. James John Ashton1,2,
  2. Jochen Kammermeier3,
  3. Christine Spray4,
  4. Richard K Russell5,
  5. Richard Hansen6,
  6. Lucy J Howarth7,
  7. Franco Torrente8,
  8. Protima Deb9,
  9. Elizabeth Renji10,
  10. Rafeeq Muhammed11,
  11. Thankam Paul12,
  12. Fevronia Kiparissi13,
  13. Jenny Epstein14,
  14. Maureen Lawson15,
  15. Ben Hope16,
  16. Veena Zamvar17,
  17. Priya Narula18,
  18. Ahmed Kadir19,
  19. David Devadason20,
  20. Hemant Bhavsar21,
  21. Robert Mark Beattie1
  1. 1 Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
  2. 2 Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
  3. 3 Department of Paediatric Gastroenterology, Evelina London Children’s Hospital, London, UK
  4. 4 Department of Paediatric Gastroenterology, Bristol Royal Childrens Hospital, Bristol, UK
  5. 5 Department of Paediatric Gastroenterology, The Royal Hospital for Sick Children, Edinburgh, UK
  6. 6 Department of Paediatric Gastroenterology, Royal Hospital for Children Glasgow, Glasgow, UK
  7. 7 Department of Paediatric Gastroenterology, Oxford University Hospitals, Oxford, UK
  8. 8 Department of Paediatric Gastroenterology, Addenbrookes Hospital, Cambridge, UK
  9. 9 Department of Paediatric Gastroenterology, The Royal London Hospital, Barts Health NHS Trust, London, UK
  10. 10 Department of Paediatric Gastroenterology, Alder Hey Children’s Hospital NHS Foundation Trust, Liverpool, UK
  11. 11 Department of Paediatric Gastroenterology, Birmingham Children’s Hospital, Birmingham, UK
  12. 12 Department of Paediatric Gastroenterology, St. Georges University Hospital NHS Foundation Trust, London, UK
  13. 13 Department of Paediatric Gastroenterology, Great Ormond Street Hospital, London, UK
  14. 14 Department of Paediatric Gastroenterology, Chelsea and Westminster Hospital, London, UK
  15. 15 Department of Paediatric Gastroenterology, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
  16. 16 Department of Paediatric Gastroenterology, King's College London, London, UK
  17. 17 Department of Paediatric Gastroenterology, Leeds Children’s Hospital, Leeds, UK
  18. 18 Department of Paediatric Gastroenterology, Sheffield Children’s NHS Foundation Trust, Sheffield, UK
  19. 19 Department of Paediatric Gastroenterology, Manchester Children’s Hospital, Manchester, UK
  20. 20 Department of Paediatric Gastroenterology, Nottingham University Hospitals NHS Trust, Nottingham, UK
  21. 21 Department of Paediatric Gastroenterology, University Hospitals of Leicester NHS Trust, Leicester, UK
  1. Correspondence to Dr Robert Mark Beattie, Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK; mark.beattie{at}uhs.nhs.uk

Abstract

Background COVID-19 has impacted on healthcare provision. Anecdotally, investigations for children with inflammatory bowel disease (IBD) have been restricted, resulting in diagnosis with no histological confirmation and potential secondary morbidity. In this study, we detail practice across the UK to assess impact on services and document the impact of the pandemic.

Methods For the month of April 2020, 20 tertiary paediatric IBD centres were invited to contribute data detailing: (1) diagnosis/management of suspected new patients with IBD; (2) facilities available; (3) ongoing management of IBD; and (4) direct impact of COVID-19 on patients with IBD.

Results All centres contributed. Two centres retained routine endoscopy, with three unable to perform even urgent IBD endoscopy. 122 patients were diagnosed with IBD, and 53.3% (n=65) were presumed diagnoses and had not undergone endoscopy with histological confirmation. The most common induction was exclusive enteral nutrition (44.6%). No patients with a presumed rather than confirmed diagnosis were started on anti-tumour necrosis factor (TNF) therapy.

Most IBD follow-up appointments were able to occur using phone/webcam or face to face. No biologics/immunomodulators were stopped. All centres were able to continue IBD surgery if required, with 14 procedures occurring across seven centres.

Conclusions Diagnostic IBD practice has been hugely impacted by COVID-19, with >50% of new diagnoses not having endoscopy. To date, therapy and review of known paediatric patients with IBD has continued. Planning and resourcing for recovery is crucial to minimise continued secondary morbidity.

  • gastroenterology
  • health services research

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/archdischild-2020-319751

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    Footnotes

    • Twitter @james__ashton, @RMBeattie50

    • Contributors JJA, JK and RMB designed the study. JJA, JK, CS, DD, FT, TP and RMB designed, or inputted, to the survey questions. All authors contributed data. JJA wrote the manuscript with JK and RMB. All authors commented on the manuscript and approved the final version for submission.

    • Funding The study was supported by the British Society of Paediatric Gastroenterology, Hepatology and Nutrition IBD working group. JJA is funded by an action medical research training fellowship and by an ESPEN fellowship. RH is supported by a National Health Service Research Scotland Career Researcher Fellowship.

    • Competing interests RH has received consultancy or speaker’s fees and travel support from Nutricia and 4D pharma. All remaining authors declare no competing interests related to this manuscript.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. All available data are available in the manuscript.