COVID-19 pandemi döneminde inflamatuar barsak hastalığı ile kliniğimizde takip edilen hastaların genel özellikleri ve pandemi öncesi ile karşılaştırılması

Giriş ve Amaç: 2019 Aralık ayında ortaya çıkan COVID-19 tüm dünyayı etkileyen bir halk sağlığı problemi haline gelmiştir. İBH tedavisinde kullanılan immünosupresif ve immunmodulatör ilaçların fırsatçı enfeksiyon riskini arttığı bilinmektedir ve bu durum pandemi döneminde bu ilaçların kullanımın güvenirliliği hakkında endişe açığa çıkarmaktadır. Bununla birlikte, İBH hastaların COVID-19 enfeksiyonu için genel popülasyona göre daha yüksek risk taşıyıp taşımadığı bilinmemektedir. Çalışmamızda COVID-19 pandemisinin İBH'li hastaların sağlık bakımı, hastalık yönetimi üzerine etkisini değerlendirmek ve COVID-19 enfeksiyonu açısından risk faktörlerini belirlemek amaçlanmıştır. Gereç ve yöntem: Bu çalışmada; Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi Gastroenteroloji kliniğine Ocak 2018 ile Aralık 2020 tarihleri arasında COVID19 öncesi ve COVID-19 dönemi olmak üzere her iki dönemde başvuran İBH tanılı hastalar demografik özellikler, klinik ve laboratuvar bulguları açısından retrospektif olarak incelendi. COVID-19 döneminde yeni tanı alan hastalar ayrı olarak değerlendirildi. Bulgular: Çalışmaya 179’u takipli, 17’si yeni tanı olamk üzere 196 vaka alındı. Hem COVID-19 öncesi COVID-19 döneminde hastaneye başvuranların %73,2’i (n=131) Ülseratif Kolit hastası iken %26,8’i (n=48) Crohn hastası idi. Her iki dönemde başvuran tüm hastaların %57,0’ı (n=102) erkek, %43,0’ı (n=77) kadın idi. Bu hastaların yaş ortalaması 43,88±13,88 olarak tespit edildi. Yeni tanı alan 17 hastanın 7’si ÜK, 10’u Chron hastasıydı ve hastaların yaş ortalaması 36,71± 14,70 idi.

Introduction and aim: COVID-19, which emerged in December 2019, has become a public health problem affecting the whole world. It is known that immunosuppressive and immunomodulatory drugs used in the treatment of IBD increase the risk of opportunistic infections, and this situation raises concerns about the safety of the use of these drugs during the pandemic period. However, it is unknown whether IBD patients have a higher risk for COVID-19 infection than the general population. In our study, we aimed to evaluate the impact of the COVID-19 pandemic on the health care and disease management of patients with IBD and to determine the risk factors for COVID-19 Materials and methods: In this study; Patients with a diagnosis of IBD who applied to the Necmettin Erbakan University Meram Medical Faculty Gastroenterology Clinic between January 2018 and December 2020 and in both pre-COVID-19 and COVID19 periods were retrospectively analyzed in terms of demographic characteristics, clinical and laboratory findings. Newly diagnosed patients during the COVID-19 period were evaluated separately. Results: 196 cases were included in the study, of which 179 were followed up and 17 were newly diagnosed. 73.2% of the patients who applied to the hospital during the preCOVID-19 period had Ulcerative Colitis, while 26.8% had Crohn's disease. Of all patients admitted in both periods, 57.0% (n=102) were male and 43.0% (n=77) were female. The mean age of these patients was 43.88±13.88 years. Of the 17 newly diagnosed patients, 7 had UC and 10 had Chron, and the mean age of the patients was 36.71± 14.70 years. viii It was determined that the number of hospital admissions decreased significantly during the Covid-19 period. (p=0.001). It was determined that the number of endoscopic interventions decreased by 40% and the number of surgical interventions decreased by approximately one third compared to the pre-pandemic period. Patients followed up with IBD; During the Covid-19 period, the rate of admission with mild disease severity decreased compared to the pre-Covid-19 period (44.1% and 41.3%, respectively), while the level of moderate and severe disease and the application rates increased during the COVID-19 period (41.6% and 64.1% respectively). In addition, a significant increase in ESR (17,13±15,43 ve 25,86±20,77, respectively, p=0,001) and CRP values (14,74±26,31 ve 21,32±41,88, respectively, p=0,031) was found in laboratory tests performed in IBD patients (p=0.001, p=0.031). It was determined that the use of 5-ASA and Anti-TNF increased, and the use of thiopurine and combined therapy decreased for both disease groups during the Covid-19 period. It was determined that the use of infliximab and vedolizumab among biologic agents increased. When the medical treatment doses received by the patients were compared in mg/kg, it was found that the thiopurine dose in both UC (1,30±0,57 and 1,09±0,68, 1,45±0,48 and 1,16±0,72 respectively) and Chron patients (1,30±0,57 and 1,09±0,68, 1,45±0,48 and 1,16±0,72 respectively) in the Covid-19 period was statistically significantly lower than in the pre-Covid-19 period. (p=0.017 and p=0.046, respectively). No significant difference was detected in other drug doses. 17% of IBD patients were diagnosed with COVID-19 infection. Age, gender, active disease status, comorbidity and medical treatment characteristics were not found to have a significant effect on the status of being infected with COVID-19 in IBD patients. Conclusion: During the COVID-19 pandemic, it was determined that the medical treatment approach changed as the use of immunosuppressive therapy (thiopurine and steroid) decreased and the use of biological agents increased. At the same time, the COVID-19 pandemic has caused a major shift in access to healthcare among IBD patients, including a reduction in the rate of hospital admissions, endoscopic intervention, and surgical treatment. Comprehensive follow-up studies are important and necessary to understand the long-term consequences of these changes on patients.