Following Pediatric and Adult IBD Patients through the COVID-19 Pandemic: Changes in Psychosocial Burden and Perception of Infection Risk and Harm over Time

Abstract

Background: COVID-19-associated restrictions impact societies. We investigated the impact in a large cohort of inflammatory bowel disease (IBD) patients. Methods: Pediatric (pIBD) and adult patients and pIBD parents completed validated questionnaires for self-perceived stress (Perceived Stress Questionnaire, PSQ) and quality of life from July to October 2020 (1st survey) and March to April 2021 (2nd survey). Analyses were stratified by age groups (6–20, >20–40, >40–60, >60 years). Perceived risk of infection and harm from COVID-19 were rated on a 1–7 scale. An index for severe outcome (SIRSCO) was calculated. Multivariable logistic regression analysis was performed. Results: Of 820 invited patients, 504 (62%, 6–85 years) patients and 86 pIBD parents completed the 1st, thereof 403 (80.4%) the 2nd survey. COVID-19 restrictions resulted in cancelled doctoral appointments (26.7%), decreased physical activity, increased food intake, unintended weight gain and sleep disturbance. PSQ increased with disease activity. Elderly males rated lower compared to females or younger adults. PSQ in pIBD mothers were comparable to moderate/severe IBD adults. Infection risk and harm were perceived high in 36% and 75.4%. Multivariable logistic models revealed associations of higher perceived risk with >3 household members, job conditions and female gender, and of perceived harm with higher SIRSCO, unintended weight change, but not with gender or age. Cancelled clinic-visits were associated with both. SARS-CoV-2 antibodies prior 2nd infection wave were positive in 2/472 (0.4%). Conclusions: IBD patients report a high degree of stress and self-perceived risk of complications from COVID-19 with major differences related to gender and age. Low seroprevalence may indicate altered immune response.

SARS-CoV-2 Infection and Outcomes in Children with Inflammatory Bowel Diseases: A Systematic Review

“…Of the 14 studies included in our systematic review, 12 were observational studies [ 8 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ] (9 cohort studies, 2 cross-sectional studies, and 1 case-control study), while the other 2 were case report/series [ 23 , 24 ]. All studies included patients with PIBD with adequate data about SARS-CoV-2 infection.…”

“…All studies included patients with PIBD with adequate data about SARS-CoV-2 infection. In certain studies, the population included adults, children, and adolescents; however, specific and well-defined data regarding pediatric patients were provided [ 14 , 15 , 17 , 18 , 20 ]. Unfortunately, due to many plausible reasons for extreme heterogeneity such as different aims of the included studies (and consequently inclusion and exclusion criteria), different populations, and different medical treatment used for IBD across studies (but absence of individual patient data to take this important information into account), a meta-analysis was not deemed appropriate.…”

“…Koletzko et al [ 17 ] investigated the impact of COVID-19 on patients with IBD and identified a total of 25 cases of confirmed infection in a total of 89 patients with PIBD, none of which required hospitalization. Queiroz et al [ 18 ] reported outcomes of patients from Latin America enrolled in the SECURE-IBD registry, including 18 children infected with the virus, with only 1 of them requiring hospitalization but without admission to the PICU.…”

“…On the contrary, patients receiving anti-TNF were reported to exhibit mild symptoms [ 29 ]. There was no apparent harmful association between anti-TNF treatment and severe COVID-19, ICU admission, or death [ 13 , 17 ]. All the above conclusions are drawn from the meta-analysis of Tripathi et al [ 25 ] in adult patients with IBD and COVID-19, suggesting that the use of biologics leads to a favorable outcome due to reduction of cytokine storm.…”

Effects of psychosocial function in pediatric-onset inflammatory bowel disease during the coronavirus disease 2019 pandemic

“…Due to the chronic and recurrent characteristics of IBD itself, PIBD is often associated with more psychological and social complications ( 10 ), and is more vulnerable to a decrease in quality of life (QOL), anxiety, depression, sleep disorder, and social dysfunction. During the COVID-19 pandemic, factors such as poor access to medical care, fear of disease, and panic of the pandemic may have had an impact on emotions and QOL ( 11 – 13 ). However, research on this topic is limited.…”