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BSG Webinar: Reconfiguring our IBD services

This webinar, recorded on the 21st July 2020, was chaired by BSG Education Chair Ayesha Akbar, and focuses on perspectives on IBD Management in the COVID and peri-COVID era, with discussions on service success stories and training.

IBD management – The UK experience including impact on training

Chris Lamb, Clinical Intermediate Fellow and Honorary Consultant in Gastroenterology.

Chris Lamb is an academic gastroenterologist working as an Honorary Consultant in Gastroenterology at the Newcastle upon Tyne Hospitals NHS Foundation Trust and a Clinical Intermediate Fellow at Newcastle University where he leads a mucosal immunology research programme. A former NIHR Clinical Lecturer and Wellcome Trust Clinical Fellow in Translational Medicine and Therapeutics he has a clinical and research specialist interest in inflammatory bowel disease therapeutics.  Chris is a member of the BSG IBD Section Committee, is the lead author of the BSG guidelines for the management of inflammatory bowel disease in adults, and joint first author of the BSG guidance for the management of IBD during the COVID-19 pandemic.

Service recovery – How to keep our patients safe

Shahida Din, Consultant Gastroenterologist

Shahida Din is a Consultant Gastroenterologist at the Western General Hospital in Edinburgh and a National Research Scotland Clinician leading clinical trials and a programme of work to improve the detection of colonic epithelial dysplasia/colorectal cancer in patients with inflammatory bowel diseases. In 2019, Shahida was jointly awarded a Helmsley Charitable Trust Grant to develop the Crohn’s Disease Gut Cell Atlas with her collaborators in Edinburgh and Cambridge. A current Lady Estelle Wolfson/Emerging Women Leader Fellow, Shahida is a member of the BSG IBD Committee, Gastroenterology speciality advisor to the RCPE and lead author of the adaptations of the BSG ASUC guidelines – RAND panel- during the COVID-19 pandemic.

Panel Q&A: Ian Arnott, Christopher Lamb, Shahida Din

This webinar has been approved by the Federation of the Royal Colleges of Physicians of the United Kingdom for 1 category 1 (external) CPD credit. You can access this credit by filling out this short feedback form. In line with RCP guidance, this will be available for four weeks after the date of the original broadcast on 21st July 2020.

Questions from the webinar

We hope these are useful additions to the webinar replay. As a uniquely challenging time for the medical profession, the BSG is working hard to offer support and guidance for members. Please refer to the COVID-19 Advice section to view the latest guidance.

Why do you think prednisolone has such an adverse effect with respect to IBD and COVID whereas dexamethasone seems to be of benefit for sick COVID patients?

Ian Arnott: I think this is all about timing the dexamethasone when given in the acute phase of COVID works to suppress hyperimmune response that is so destructive. It is given for a relatively short period of time with no treatment before the infection.

Have transition clinics been reinstated in many adult IBD sites?

Ian Arnott: Transition services have been restarted in some sites. There are a number of different models of transition that exist across the UK and the adjustments that are related to COVID will differ depending on the setup. Most transition services depend on face to face consultation and services will have to consider going forward if should continue in a socially distanced manner if possible or if this can be done virtually.

What is the panel’s view on clearly defined COVID-free/COVID-light sites for IBD across all four nations?

Ian Arnott: Although there are some potential attractions to have COVID light sites this does present some challenges, including the asymptomatic infectious stage of infection and the pressures of staffing an additional site with people with an appropriate knowledge level. The approach that we have adopted is to try to keep those with IBD away from hospital as much as possible. This is facilitated by telephone and video clinics, remote therapeutic monitoring, remote calprotectin services, preferential use of subcutaneous drugs and the IBD helpline. We have also instituted a flare clinic. This enables people to be seen within 24 hours and the most appropriate therapy to be started straight away. The service includes counselling and screening for biologics and starts within a few days. The clinic is accessed through a side door so they do not need to go through busy parts of the hospital. We feel that this approach gives the best of both worlds and can prevent admission. Clean sites may work well for other services.

Should we extrapolate this data around detailed groupings for shielding and stringent social distancing to our hepatology cohorts, as there have been less guidance for patients with AIH etc than for IBD patients?

Ian Arnott: My feeling is that we need good quality data for the different groups of people with IBD and liver disease. This will inform us whether they need the same or different guidance.