Abstract
Abstract Background The COVID-19 pandemic disrupted healthcare systems globally, exacerbating disease severity and delaying management of chronic conditions like inflammatory bowel disease (IBD). This multicentre study investigates the pandemic’s impact on clinical presentation, treatment patterns, and outcomes of ulcerative colitis (UC) and Crohn’s disease (CD) patients at two UK district hospitals. Methods A retrospective study was conducted between July 2017–June 2022 at two district hospitals, comparing pre- and post-COVID outcomes in UC and CD patients. Factors analyzed included disease extent, inflammatory markers, treatment patterns, diagnostic investigations, and patient outcomes, such as emergency surgery. Results Among 602 IBD patients (52.2% UC, 47.8% CD), the median age was 41 years (IQR 29), and 51.3% were male. Post-COVID, UC patients presented with more severe disease: UC E3 (Extensive Colitis) increased from 24.0% to 32.8% (p=0.01), while UC E1 (Proctitis) decreased from 18.4% to 7.4% (p=0.004). Median hospital stays rose from 4 to 6 days (p=0.03), with inflammatory markers showing significant increases—median CRP levels rose from 25 to 35 mg/L (p=0.016), and faecal calprotectin levels increased from 600 to 1800 µg/g (p<0.0001). Treatment patterns shifted, with reduced 5-ASA (77.6% to 59.3%, p=0.001) and immunosuppressant use (19.2% to 9.0%, p=0.004) but increased biologic therapy (27.2% to 31.7%, p=0.001). In CD, disease localization shifted significantly: terminal ileum involvement (CD L1) rose from 30.6% to 46.8% (p=0.001), while ileocolonic disease (CD L3) decreased from 45.9% to 31.1% (p=0.01). Imaging utilization nearly doubled, with CT/MRI use increasing from 36.7% to 71.6% (p<0.001). Post-COVID CD patients were younger, with median age decreasing from 42 to 39 years (p=0.05). Untreated cases in the younger cohort of age <43 years rose from 64% to 84% (p=0.004). Emergency surgery rates in both UC and CD and ITU admission rates remained unchanged pre- and post-COVID. Conclusion Post-COVID, UC patients presented with more extensive colitis, higher inflammatory markers, and longer hospital stays. CD patients showed shifts in disease localization, increased imaging use, and a younger, less-treated demographic. Delayed access to care likely fostered disease progression, compounded by pandemic-related psychological stress and immune dysregulation. Strengthening healthcare systems with robust referral pathways and timely IBD treatment is essential to mitigate impacts of any future systemic disruptions.
Published Version
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