key: cord-1012129-0zsvhoog
authors: Ghisa, Matteo; Barberio, Brigida; Lorenzon, Greta; Zingone, Fabiana; Savarino, Edoardo
title: Reorganization of the Functional Gastrointestinal Disorders Unit during the SARS-CoV-2 Outbreak - Practical Recommendations
date: 2020-07-10
journal: Dig Liver Dis
DOI: 10.1016/j.dld.2020.07.011
sha: 68717b9778698333a893de0664809c5615ad5932
doc_id: 1012129
cord_uid: 0zsvhoog

nan

Dear Editor, on March 11, 2020 the World Health Organization (WHO) declared Coronavirus disease 2019 (COVID-19) a pandemic 1 . Worldwide, clinicians of all specialties started to deal with severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) and most of the efforts have been focused on the fight against this enemy. However, other diseases have not stopped to affect our patients and we confronted with the difficulties to provide the best care to patients with gastrointestinal diseases during this pandemic. Among the different areas of gastroenterology, the field of functional gastrointestinal disorders has witnessed a great reduction in human resources, infrastructures and available time slots, in order to make these resouces available for the fight COVID-19 2 . Therefore, a reorganization of the motility laboratories and activities is needed.

Functional Gastrointestinal Disorders Units with their motility laboratories tackle a wide range of disorders 3 . These are usually benign conditions, such as gastro-esophageal reflux disease and irritable bowel syndrome, which, however, affect more than 25% of the population 4 . Moreover, some motility disorders (i.e. achalasia) are associated to high morbidity and severe worsening of quality of life, preventing the postponement of their diagnosis and treatment 4 . While endoscopy with biopsies and radiology remain our most effective weapons to identify or manage these disorders, procedures such as high-resolution manometry (HRM) and reflux monitoring are the most specialized techniques able to clarify unclear clinical scenarios and improve patients' management.

Considering ambulatory evaluations, avoiding those not strictly necessary is recommended.

Indeed, available data suggests that a high percentage of patients gets infected in hospitals 5 .

Nowadays, the majority of first evaluations should be carried out via telemedicine, whereas phone or email consultations should be reserved to follow-up assessments. For most of these patients, such as those with GERD, functional dyspepsia and functional bowel disorders, online consultation with reassurance of their healthy status can solve most problems. Indeed, we must remember that discontinuation of elective evaluations may cause disorientation and anxiety among patients and worsen their disease perception. For patients requiring resupply of long-term medications, telematic renewal of prescriptions and home drugs delivery, these should be provided.

The outpatient clinic should remain accessible to provide services only to patients with severe dysphagia, bolus impaction and abdominal pain refractory to medical therapy. In this context, alarm signs need to be carefully considered. If an appointment is necessary, the day before the visit, health care professionals (HCPs) should call the patients to confirm it and to ask questions A rapid and functional reorganization of all the activities of a motility laboratory is mandatory to maintain as good as possible the standards of care, to reduce risks for both patients and healthcare personnel and to leave resources available to tackle this pandemic. All non-priority face to face evaluations and invasive procedures should be discontinued. Alternative consultation modalities such as telemedicine, phone consultations and e-mail service should be provided and preferred. Also, when not available this type of services should be implemented and organised by local organizations and insurance systems. Functional testing should be performed when absolutely necessary. However, considering that the efficacy of herd immunity is uncertain, a vaccine is not yet available and another wave of infections may arrive, COVID-19 could become a long-term problem and therefore it is necessary to permanently integrate these services in our way of providing medical care. 

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Worldwide Prevalence and Burden of Functional Gastrointestinal Disorders, Results of Rome Foundation Global Study

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Novel Coronavirus-Infected Pneumonia in Wuhan, China

ESGE and ESGENA Position Statement on gastrointestinal endoscopy and the COVID-19 pandemic. Endoscopy