SARS-CoV-2 has caused a global health crisis and mass vaccination programmes provide the best opportunity for controlling transmission and protecting populations. Despite the impressive clinical trial results of the BNT162b2 (Pfizer/BioNTech), ChAdOx1 nCoV-19 (Oxford/AstraZeneca), and mRNA-1273 (Moderna) vaccines, important unanswered questions remain, especially in patients with pre-existing conditions. In this position statement endorsed by the British Society of Gastroenterology Inflammatory Bowel Disease (IBD) section and IBD Clinical Research Group, we consider SARS-CoV-2 vaccination strategy in patients with IBD. The risks of SARS-CoV-2 vaccination are anticipated to be very low, and we strongly support SARS-CoV-2 vaccination in patients with IBD.Based on data from previous studies with other vaccines, there are conceptual concerns that protective immune responses to SARS-CoV-2 vaccination may be diminished in some patients with IBD, such as those taking anti-TNF drugs. However, the benefits of vaccination, even in patients treated with anti-TNF drugs, are likely to outweigh these theoretical concerns. Key areas for further research are discussed, including vaccine hesitancy and its effect in the IBD community, the effect of immunosuppression on vaccine efficacy, and the search for predictive biomarkers of vaccine success.

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As practitioners working with patients with inflammatory bowel disease, it is important that we have a fundamental understanding of the risk factors associated with nonadherence. Only in doing so will we be able to design an efficacious theory-based intervention to ameliorate nonadherence. However, the question remains as to what to do in the mean time as practitioners to assist our patients in becoming more collaborative and adherent. Motivational interviewing (MI) was first introduced nearly 30 years ago and continues to attract attention among clinicians and researchers. We know very little about the mechanisms for change and how MI can be adapted to these mechanisms, but MI is more than just a behavioural strategy to elicit and reinforce change talk. It is about helping patients lead satisfying lives and choosing activities to help them foster their goals. Although MI might seem like a time-consuming process, it can prove useful in eliciting how we can best help our patients to bring about the change they need.

IntroductionCrohn’s disease is one of the inflammatory bowel diseases and affects around 1 15 000 people in the United Kingdom (UK). The treatment for CD is a rapidly evolving field with substantial healthcare cost. Historically, 5-Aminosalicylic acids (5-ASA) were used in the treatment of CD. However, over the last decade the evidence base has changed and they are no longer recommended for induction or maintenance of remission in CD (Dignass et al, 2010). Our aim was to evaluate the number of CD patients maintained on 5-ASAs in the outpatient setting despite the lack of evidence to support their use and the potential cost implications.MethodWe performed a prospective audit using a predesigned proforma. This included patient demographics, disease location as per the Montreal classification, brand of 5-ASA, dose of the 5-ASA, duration of usage, duration of diagnosis and any other medication the patient was using to treat their CD. The audit was undertaken in the IBD Clinical Nurse Specialist (CNS) clinic for a period of eight weeks.ResultsDuring this period a total of 120 patients were seen in the clinics. More than half (55.8%) had a diagnosis of Ulcerative Colitis (UC) while 53 patients (44.1%) had a diagnosis of CD. Almost half (26=49%) of the patients with CD were using a 5-ASA either as monotherapy or combination therapy with an immunosuppressant (IM) and/or a biologic. The majority of these patients were found to have started the 5-ASA at the time of their diagnosis and despite escalation to IM or biologic therapy; the 5-ASA drug was not withdrawn from the treatment regime. We obtained the annual cost breakdown per patient using the specific brand name of 5-ASA and this was followed by a total annual cost (ć35,067.84) for the 26 patients identified. The average cost for treating one patient with a particular 5-ASA at a dose of 4.8gms daily for one month is ć117.00 with an average total annual cost of ć1,404.00.ConclusionIn view of the lack of evidence for the use of 5-ASA in CD we estimated a cost saving of approximately ć35 000 per annum in this small cohort of patients identified. We plan to re-audit and perform a further retrospective analysis for stopping treatment in those patients using a 5-ASA in CD and evaluate the cost implications of this. As part of the discontinuation process we will counsel our patients and gradually withdraw their 5-ASA therapy.Reference. Dignass A, Van Assche G, Lindsay JO, Lćmann M, Sćderholm J, Colombel JF, Danese S, D’Hoore A, Gassull M, Gomollćn F, Hommes DW, Michetti P, O’Morain C, Oresland T, Windsor A, Stange EF, Travis SP. European Crohn’s and Colitis Organisation (ECCO): The second European evidence-based Consensus on the diagnosis and management of Crohn’s disease: Current management. Journal of Crohn’s and Colitis 2010;4(1):28–62.Disclosure of InterestNone Declared

BACKGROUND: Nursing care in inflammatory bowel disease (IBD) is essential to the success of the treatment. IBD patients need continuous and specialized care and the characterization of health services is necessary to identify the deficiencies for further resolution in the future. The aim of the study is to identify the characteristics of health services that provide nursing care for IBD patients in Brazil. METHODS: A descriptive study was performed. Participants were nurses who treat IBD patients. The identification of nurses was performed through: analysis of national curricula registered with the National Council for Scientific and Technological Development in Brazil, access to the Brazilian IBD Study Group records and referral by colleagues. A specific online survey questionnaire consisting of 37 questions was developed. RESULTS: 74 nurses were identified. Health services are located in the following Brazilian regions: Southeast (66.22%), Northeast (13.51%), South (9.46%), North (6.76%) and Midwest (4.05%). The most frequent services were public hospital (45.95%), IBD outpatient clinic (25.68%), private clinic (21.62%) and infusion center (10.81%). In the infusion centers were identified emergency trolley (45.95%), bathroom for the patient (43.24%), refrigerator for storing medications (43.24%), comfortable chair for infusion (43.24%) and post nursing (40.54%). Health services are integrated with endoscopic dilation service (40.54%), magnetic resonance imaging (52.70%), pathology department (54.05%), urgency and emergency room (58.11%), endoscopy (70.27%), computed tomography (59.46%), surgical inpatient unit (67.57%) and clinical inpatient unit (72.97%). The services have telephone consultation (28.38%) and communication by email (20.27%). The team is composed of nurses (71.62%), coloproctologist (64.86%), gastroenterologist (58.11%), dietician (56.76%), psychologist (41.89%) and stomatherapist (40.54%). CONCLUSION(S): Most health services are located in the southeast region; the type of service provided is public with access to specific tests. Infusion centers have the minimum required resources recommended. Some health services feature telemedicine service. The multidisciplinary team is present in most services. These findings suggest the need for prompt expansion and improvement to the delivery of services and care for all IBD patients across the nation.