TABLE 3.
Questions 7–9
| Country | How should one investigate and manage someone presenting with potentially new onset IBD? How is this affected by resource availability? | Considering that at least 5% of persons with COVID-19 present with isolated GI symptoms when a patient with IBD presents with worsening GI symptoms are you routinely testing for COVID-19? | What is the role of noninvasive markers in assessing disease if endoscopy is not available? For example, ESR, CRP, fecal calprotectin, WBC / platelet count, radiology? How does resource availability affect this testing?* |
|---|---|---|---|
| Bangladesh (n = 2) | No change from pre-COVID Some limitation on access to endoscopy and imaging | Yes (n = 2) | Some limitation on access to imaging (n = 1) All testing done (n = 1) |
| Brazil (n = 4) | Avoid endoscopy | No (n = 3), Yes (n = 1) | All testing done (n = 3) Limited imaging access (n = 1) |
| Canada (n = 3) | Doing colonoscopy. Avoid IV biologicals if possible | No (n = 3) | All testing done (n = 1) Limited imaging access (n = 2) |
| China (n = 4) | Avoid endoscopy and in person testing (n = 2) Doing endoscopy (n = 1) Doing endoscopy and test for COVID 19 first (n = 1) | Yes (n = 4) | All testing done |
| France (n = 1) | Limited endoscopy | Yes | All testing done |
| Hong Kong (n = 1) | Limited endoscopy COVID-19 test first | Yes | All testing done |
| India (n = 2) | Avoid endoscopy (n = 1) Doing endoscopy (n = 1) | No (n = 1) Yes (n = 1) | All testing done |
| Indonesia (n = 1) | No change from pre-COVID | Yes | All testing done |
| Israel (n = 2) | No change from pre-COVID (n = 1) Patients reluctant for testing. Empiric treatment (n = 1) | No (n = 2) | All testing done Fecal calprotectin at home (n = 1) |
| Kenya (n = 2) | No change from pre-COVID-19 (n = 2) | No (n = 2) | All testing done (n = 2) |
| Korea (n = 1) | No change except for avoiding steroids and doing COVID-19 testing | No | All testing done |
| Kuwait (n = 1) | No change from pre-COVID-19 except endoscopy is limited | No | All testing done |
| Malaysia (n = 2) | Avoid endoscopy (n = 1) No change from pre-COVID-19 (n = 1) | Yes (n = 1) No (n = 1) | All testing done (n = 2) |
| Mexico (n = 1) | Endoscopy in suspected UC; diagnosis delayed in CD | No | All testing done |
| Myanmar (n = 2) | Endoscopy is limited | No | All testing done |
| Nepal (n = 1) | Limited access to endoscopy. Using mostly CT scan. | No | Using mostly CT scan and bloodwork. Fecal calprotectin not available. |
| New Zealand (n = 1) | If subacute use labs not endoscopy | No | All testing done |
| Pakistan (n = 2) | Endoscopy being done | No (n = 1) Yes (n = 1) | All testing done |
| Philippines (n = 1) | Endoscopy used to aid in diagnosis and management of IBD in moderate to severe cases | Yes | Imaging tested preferred to serum and stool |
| Portugal (n = 2) | No change (n = 1) Less endoscopy and more imaging, noninvasive testing (n = 1) | No but yes if IBD work up is negative (n = 1) Yes (n = 1) | All testing done (n = 1) More abdominal ultrasound and fecal calprotectin (n = 1) |
| Puerto Rico (n = 1) | Outpatient endoscopy and imaging not available | No | All testing done except limited imaging |
| Qatar (n = 1) | If steroids required patient would be in isolation. Delay biological therapy | Yes for anyone with severe symptoms presenting to the ED. Rest of milder cases managed by telemedicine only and no COVID-19 testing | All testing done but patients avoiding attending clinics for testing |
| Romania (n = 1) | No change | No | All testing done |
| Saudi Arabia (n = 1) | No change except for COVID test first | Yes | All testing done |
| Singapore (n = 1) | No change | No, but yes before biological started | All testing done |
| South Africa (n = 1) | Avoid endoscopy, steroids and thiopurines | No | All testing done |
| Sri Lanka (n = 1) | Flexible sigmoidoscopy and biopsy | No | All testing done |
| Taiwan (n = 1) | No change except for COVID test first | No | All testing done |
| Thailand (n = 3) | Avoid endoscopy | No | Fecal calprotectin and imaging less available |
| Uruguay (n = 1) | No change | No | All testing done. Increased use of fecal calprotectin |
| United Kingdom (n = 1) | Avoid endoscopy; treat empirically | No | All testing done. Fecal calprotectin at home |
| United States (n = 2) | Endoscopy being done (n = 2). COVID-19 testing first (n = 1) empiric 5ASA(n = 1) | No (n = 1) Yes (n = 1) | All testing done except limited imaging |
| Vietnam (n = 1) | No change except for COVID test first | No | All testing done |
Abbreviations: n refers to number of respondents from that country. “?” refers to unclear response on that question.