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GASTROENTEROLOGY


reported symptoms correlate poorly with mucosal inflammation. 60% of patients who were escalated for treatment did not actually have inflammation and 35% who weren’t escalated or investigated were later shown to have inflammation. Availability of a rapid PoCT fCAL result supports more accurate, immediate treatment that helps improve resource allocation and reduce costs in IBD.


Changes to IBD Clinics During the COVID-19 Pandemic In May 2020, results of a global survey,15 on the views of patients with inflammatory bowel disease during the pandemic, were published in The Lancet online. The data showed that 74% of IBD patients were afraid to go to the hospital or IBD centre for a gastroenterological consultation. A UK survey conducted by Kennedy et


al.16


during the initial stages of the pandemic, evaluated the challenges presented to IBD services and the adaptations required to meet these challenges. It revealed that key tools for monitoring and managing IBD patients were removed or restricted. 35% of respondents reported that all IBD related endoscopy activity had been cancelled, but most reported significant reduction in availability. In addition, 27% of locations reported no access to fCAL testing, while a further 32% reported reduced access.


94% reported an increase in patient contact via the IBD advice line since face-to-face consultations in outpatients, non-emergency endoscopies and elective IBD had been significantly curtailed. There was an increased uptake of telemedicine, virtual multidisciplinary team meetings and non-invasive monitoring of patients. 86% had substituted face to face clinics with telephone consultations and 11% substituted face to face clinics with video consultations.


More consultations are being conducted by telephone. The study concluded that despite these challenging times, opportunities were presented from the rapid adaptation of models of service delivery. Some of these are likely to also be suitable in a post-COVID-19


world, bringing ongoing positive changes in IBD services. A further survey conducted by Charlie Lees17


, consultant gastroenterologist


at the Western General Hospital, explored expectations for the future. The view is that face-to-face consultations will reduce to about 50% in the future. Some of the respondents had been using home fCAL tests (including IBDoc). The publication noted: “Of those that haven’t [used home calprotectin testing], the overwhelming majority replied that this is something they are interested in adopting.”


Remote Monitoring Segal and Moss published a review ‘Implications of Recurrent SARS-CoV-2 Outbreaks for IBD Management’18 summarising the changes in IBD clinical practice that will be required during the ‘post-peak’ phase of viral pandemics. They state: “The ability to detect deteriorations in disease and react remotely will be important”. FCAL should be incorporated into remote monitoring, ideally using home kits for sample acquisition and IBD Apps for recording symptoms.


They also concluded that: “Faecal calprotectin should replace endoscopy as a means to confirm mucosal healing or assess symptom relapse in most cases.” The IBDoc system enables Ulcerative


80 l WWW.CLINICALSERVICESJOURNAL.COM


AUGUST 2021


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