Impact of the COVID-19 pandemic on inflammatory bowel disease care in Taiwan: A multicenter study

Yen-Ling Peng; Chung-Hsin Chang; Shu-Chen Wei; Tien-Yu Huang; Wei-Chen Tai; Wen-Hung Hsu; Deng-Chyang Wu; Hsu-Heng Yen; Chi-Ming Tai; Chen-Wang Chang; Wei-Chen Lin; Horng-Yuan Wang; Chun-Chi Lin; Chia-Jung Kuo; Cheng-Tang Chiu; Ching-Pin Lin; Hsi-Chang Lee; Jia-Feng Wu; Chen-Shuan Chung

doi:10.1016/j.jfma.2023.03.017

Impact of the COVID-19 pandemic on inflammatory bowel disease care in Taiwan: A multicenter study

J Formos Med Assoc. 2023 Oct;122(10):1042-1049. doi: 10.1016/j.jfma.2023.03.017. Epub 2023 Mar 27.

Authors

Yen-Ling Peng¹, Chung-Hsin Chang², Shu-Chen Wei³, Tien-Yu Huang⁴, Wei-Chen Tai⁵, Wen-Hung Hsu⁶, Deng-Chyang Wu⁶, Hsu-Heng Yen⁷, Chi-Ming Tai⁸, Chen-Wang Chang⁹, Wei-Chen Lin⁹, Horng-Yuan Wang⁹, Chun-Chi Lin¹⁰, Chia-Jung Kuo¹¹, Cheng-Tang Chiu¹¹, Ching-Pin Lin¹², Hsi-Chang Lee¹³, Jia-Feng Wu¹⁴, Chen-Shuan Chung¹⁵

Affiliations

¹ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
² Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taipei, Taiwan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, IBD Center, Taichung Veterans General Hospital, Taichung City, Taiwan.
³ Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
⁴ Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taipei, Taiwan; Taiwan Association for the Study of Small Intestinal Diseases (TASSID), New Taipei City, Taiwan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
⁵ Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taipei, Taiwan; Taiwan Association for the Study of Small Intestinal Diseases (TASSID), New Taipei City, Taiwan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
⁶ Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taipei, Taiwan; Taiwan Association for the Study of Small Intestinal Diseases (TASSID), New Taipei City, Taiwan; Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan; Department of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁷ Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taipei, Taiwan; Taiwan Association for the Study of Small Intestinal Diseases (TASSID), New Taipei City, Taiwan; Division of Gastroenterology, Changhua Christian Hospital, Changhua, Taiwan.
⁸ Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taipei, Taiwan; Taiwan Association for the Study of Small Intestinal Diseases (TASSID), New Taipei City, Taiwan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan.
⁹ Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taipei, Taiwan; Taiwan Association for the Study of Small Intestinal Diseases (TASSID), New Taipei City, Taiwan; Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan; MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan.
¹⁰ Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taipei, Taiwan; Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
¹¹ Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taipei, Taiwan; Taiwan Association for the Study of Small Intestinal Diseases (TASSID), New Taipei City, Taiwan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
¹² Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taipei, Taiwan; Taiwan Association for the Study of Small Intestinal Diseases (TASSID), New Taipei City, Taiwan; Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.
¹³ Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taipei, Taiwan; Taiwan Association for the Study of Small Intestinal Diseases (TASSID), New Taipei City, Taiwan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Renai Branch, Taipei City Hospital, Taipei, Taiwan.
¹⁴ Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taipei, Taiwan; Division of Pediatric Gastroenterology and Hepatology, Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
¹⁵ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taipei, Taiwan; Taiwan Association for the Study of Small Intestinal Diseases (TASSID), New Taipei City, Taiwan; College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan. Electronic address: selfdebate@gmail.com.

Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic had a great impact on healthcare system and patients. This study aimed to evaluate the effect of the COVID-19 pandemic on the perceptions of patients with inflammatory bowel disease (IBD).

Methods: This prospective multicenter study was conducted between July 2021 and December 2021. Patients with IBD answered a structured questionnaire, and their degree of anxiety was assessed using a visual analogue scale (VAS) before and after reading educational materials.

Results: A total of 225 (47.67%) patients with Crohn's disease, 244 (51.69%) with ulcerative colitis and 3 (0.64%) with indeterminate colitis were enrolled. Common concerns were adverse events from vaccination (20.34%), and higher risks of developing severe COVID-19 (19.28%) and COVID-19 infection (16.31%) than the general population. Medications deemed by the patients to increase the risk of COVID-19 were immunomodulators (16.10%), anti-tumor necrosis factor-α antagonists (9.96%), and corticosteroids (9.32%). Thirty-five (7.42%) patients self-discontinued IBD medication, of whom 12 (34.28%) had worse symptoms. Older age (>50 years) (OR 1.10, 95% CI 1.01-1.19, p = 0.03), IBD-related complications (OR 1.16, 95% CI 1.04-1.28, p = 0.01), education status below senior high school (OR 1.22, 95% CI 1.08-1.37, p = 0.001), and residing in north-central Taiwan (OR 1.21, 95% CI 1.10-1.34, p < 0.001) were associated with more anxiety. None of the enrolled patients contracted COVID-19. The anxiety VAS score (mean ± SD) improved after reading the educational materials (3.84 ± 2.33 vs. 2.81 ± 1.96, p < 0.001).

Conclusion: The medical behavior of IBD patients was influenced by the COVID-19 pandemic, and their anxiety could be mitigated after education.

Keywords: COVID-19; Inflammatory bowel disease; Patient education; SARS-CoV-2.

Publication types

Multicenter Study

MeSH terms

COVID-19* / epidemiology
Humans
Inflammatory Bowel Diseases* / complications
Inflammatory Bowel Diseases* / drug therapy
Inflammatory Bowel Diseases* / epidemiology
Pandemics
Prospective Studies
Taiwan / epidemiology