Research presentations from Digestive Disease Week's virtual meeting earlier this month addressed how the COVID-19 pandemic has changed clinical practice in gastroenterology.
John Gubatan, MD, chief gastroenterology fellow in the division of gastroenterology and hepatology at Stanford University School of Medicine in California, presented research into changes in GI symptoms, medication use, and health care utilization in patients with three common functional disorders—irritable bowel syndrome (IBS), gastroparesis, and functional dyspepsia—before the COVID-19 pandemic, from September 2019 to March 2020, versus March 2020 to September 2020.
Of 2,592 patients, 83 tested positive for SARS-CoV-2 or had COVID-19 compared to 2,509 patients who did not. Symptoms among patients with functional GI disorders increased during the pandemic, notably increased abdominal pain, nausea, vomiting, diarrhea, constipation, and weight loss during the six months after March 2020 versus the six months before.
Patients with IBS had an overall similar pattern of GI symptom increase compared to the whole functional GI cohort, Dr. Gubatan said. Those with gastroparesis followed a similar pattern, except diarrhea and weight loss were not statistically significant. Functional dyspepsia followed the trend as well. Medications that saw significantly increased use before versus after March 2020 included proton-pump inhibitors and H2 blockers.
“Given the role of the brain-gut interactions and functional GI disorders, it's possible that increased stress and anxiety associated with the COVID-19 pandemic itself may have contributed to exacerbations in these functional GI disorders,” Dr. Gubatan said. “Another possibility is that the pandemic may have altered provider prescribing practices.”
Another speaker from the same session, Nicolette Juliana Rodriguez, MD, a second-year gastroenterology fellow at Brigham and Women's Hospital in Boston, presented findings on telemedicine in the COVID-19 era and its impact on disparities and access to ambulatory care.
“Telemedicine can increase access to health care for some populations. It can simultaneously create barriers to access for others,” she said. “It's important to note that barriers to health care disproportionately affect racial and ethnic underserved populations, including Black and Latinx groups, low-socioeconomic-status groups, and older populations. Considering the role that telehealth will likely play in the future of health care delivery, it is critical that we understand the potential impact that this paradigm shift might have among vulnerable populations in the ambulatory care setting, including some specialty care.”
Dr. Rodriguez reported on the patient characteristics associated with completion of in-person visits and telemedicine visits in a high-volume gastroenterology clinic at a tertiary medical center and all ambulatory GI clinic visits that occurred between April 1 and May 15, 2020. Data from one year prior were obtained from electronic medical records for all GI clinic visits during the study period.
From April 1 to May 15, 2020, there were 2,522 telehealth visits, 958 of which used video and 1,564 which were by phone, compared to a control group of 3,589 in-person visits. Patients who engaged in a video visit had lower odds of being Black or Latinx, lower odds of being publicly insured, and higher odds of having a higher median income and being younger. Among telephone visits compared to an in-person visit, patients were more likely to be Black or Latinx. Patients who used a telephone visit versus a video visit had higher odds of being Black or Latinx, higher odds of being publicly insured, and higher odds of having a lower median income and being older.
“As a result, there are factors to consider when employing telemedicine technology,” Dr. Rodriguez said. “This includes digital health literacy, reliable internet access, including broadband or Wi-Fi, resource availability, and the need for potential additional support.”
Another presenter, ACP Member Ahmad Khan, MD, MS, of West Virginia University's School of Medicine in Charleston, addressed the impact of COVID-19 infection among patients with pre-existing GI cancers.
Researchers identified all adult patients diagnosed with COVID-19 from Jan. 15 to July 15, 2020, in their health system. Patients with COVID-19 and a diagnosis of malignant esophagus, gastric cancer, pancreatobiliary cancer, hepatocellular cancer, or colorectal cancer were included in the GI cancer group. Patients who never had a diagnosis of GI cancer were included in the control group. The main outcomes of the study included 30-day risk for mortality, mechanical ventilation, and hospitalization after adjusting for confounding factors.
COVID-19 patients with pre-existing GI cancers had a significantly higher risk for hospitalization (risk ratio, 2.37), mechanical ventilation (risk ratio, 2.16), and death (risk ratio, 3.8) compared to the control group. However, after propensity-score matching, the risk ratio for hospitalization was calculated as 1.25.
“The conclusion for our study is that COVID-19 patients with pre-existing cancers should be aggressively managed with close monitoring and can be prioritized for COVID-19 vaccination,” Dr. Khan said.