P258 Rates of admission of acute IBD flares during the COVID-19 pandemic in a tertiary healthcare setting

Abstract

BackgroundEnvironmental tiggers are thought to contribute to Inflammatory Bowel Disease flares. The COVID-19 pandemic and resulting lockdown led to an emphasis on outpatient care, fewer presentations to hospital for non-COVID-19-related illnesses, changes in work practices and a reduction in air pollution. Our aim was to determine the impact of these changes on hospital admissions with acute IBD flares.MethodsThe hospital in-patient enquiry (HIPE) department provided records of all patients admitted with acute IBD flares during the first Irish lockdown from March to May 2020 and for the corresponding period in 2017, 2018 and 2019. Electronic patient records were used to assess patient demographics, biochemical markers, imaging, medication use and outcome.Results101 patients were admitted with an acute IBD flare. This was a marked reduction when compared to the corresponding period in the previous three years (p<0.0001). Despite the rates of admission decreasing in this period, rates of colectomy were significantly increased (p<0.0001). (Table 1).Table 1.Patient demographics and biochemical markers, acute IBD flare admissions, total hospital admissions, rescue therapy and colectomy ratesMarch - May2017201820192020TotalTotal patients with acute IBD32262815101Hospital Admissions64436368651947816028Male18(56.3%)14(53.8%)13(46.4%)7(46.7%)52(51.5%)Mean Age (Years)(20 - 82 years)4344504646IBD TypeUlcerative colitis15(46.9%)16(61.5%)16(57.1%)10(66.7%)57(56.4%)Crohn’s disease17(53.1%)10(38.5%)12(42.9%)5(33.3%)44(43.6%)New diagnosis3(9.4%)3(11.5%)2(7.4%)3(20%)11(10.9%)Concurrent biologic therapy4(12.5%)4(15.4%)8(28.6%)10(66.7%)26(25.7%)Hb (g/dl)(11.7–17.5)12.712.612.712.112.5Albumin (g/l)(35–52)3739403738CRP (mg/l)(0–5)48.836.765.859.452.7Rescue Therapy6(18.8%)11(42.3%)11(39.3%)5(33.3%)33(32.7%)Colectomy3(9.4%)0(0%)1(3.57%)3(20%)7(6.93%)ConclusionWe demonstrated a significant decrease in hospital admissions for acute IBD flares during the first wave of the pandemic. We postulate that changes in environmental triggers of IBD such as working from home and reduced stress levels in addition to reduced air pollution may account for this reduction. The increased rate of colectomy likely reflects a more severe presentation of IBD and patients’ reluctance to attend the hospital at an early stage in their disease flare as well as non-adherence to prescribed IBD therapies due to a perceived COVID-19-related risk.