Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 26, 2021; 9(36): 11220-11227
Published online Dec 26, 2021. doi: 10.12998/wjcc.v9.i36.11220
COVID-19 pandemic and exacerbation of ulcerative colitis
Toshikuni Suda, Morio Takahashi, Yasumi Katayama, Masaya Tamano
Toshikuni Suda, Yasumi Katayama, Masaya Tamano, Department of Gastroenterology, Dokkyo Medical University Saitama Medical Center, Koshigaya 343-8555, Japan
Morio Takahashi, Department of Gastroenterology, Morio Clinic, Koshigaya 343-0808, Japan
Author contributions: Suda T recruited patients and drafted the manuscript; Takahashi M designed the study and analyzed data; Katayama Y revised the manuscript; Tamano M supervised the study.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Dokkyo Medical University Saitama Medical Center (approval No. 20100).
Informed consent statement: All patients provided informed consent to participate in this study and agreed to publication of the research results.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Toshikuni Suda, MD, PhD, Doctor, Instructor, Department of Gastroenterology, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya-Shi, Saitama, Koshigaya 343-8555, Japan. toshikuni.suda@gmail.com
Received: June 7, 2021
Peer-review started: June 7, 2021
First decision: June 25, 2021
Revised: July 5, 2021
Accepted: November 15, 2021
Article in press: November 15, 2021
Published online: December 26, 2021
Abstract
BACKGROUND

In 2020, the world faced the unprecedented crisis of coronavirus disease 2019 (COVID-19). Besides the infection and its consequences, COVID-19 also resulted in anxiety and stress resulting from severe restrictions on economic and social activities, including for patients with ulcerative colitis (UC). Fresh acute stress exerts stronger influences than continuous stress on UC patients. We therefore hypothesized that the first wave of the COVID-19 pandemic would have serious effects on UC patients and performed this retrospective control study.

AIM

To determine whether the first wave of the COVID-19 pandemic would have serious effects on UC patients included in a retrospective controlled study.

METHODS

A total of 289 consecutive UC outpatients seen in March and April 2020 were included in this study. Modified UC disease activity index (UC-DAI) scores on the day of entry and at the previous visit were compared. An increase of ≥ 2 was considered to indicate exacerbation. The exacerbation rate was also compared with that in 256 consecutive control patients independently included in the study from the same period of the previous year in the same manner.

RESULTS

No significant differences in patient characteristics or pharmacotherapies before entry were seen between the groups. Mean UC-DAI score was significantly higher in subjects during the first wave of COVID-19 (0.67 + 0.07) compared to the previous visit (0.26 + 0.04; P = 0.0000). The exacerbation rate was significantly increased during the first wave of COVID-19, as compared with the previous year (15.9% [46/289] vs 8.9% [23/256]; P = 0.0151).

CONCLUSION

This study demonstrated that the COVID-19 pandemic caused exacerbations in UC patients, probably through psychological and physical stress.

Keywords: Ulcerative colitis, COVID-19, Psychological stress, Pharmacotherapy, World Health Organization

Core Tip: Previous reports have suggested that physical and mental stress can exacerbate ulcerative colitis (UC). The coronavirus disease 2019 (COVID-19) pandemic caused anxiety and stress due to severe restrictions on economic and social activities. We demonstrated, for the first time, that the first wave of the COVID-19 pandemic induced UC exacerbations. Preventive treatments such as increased 5-ASA or local administration may be preferable in situations predicted to be stressful such as pandemics.