Medical care of atrophic gastritis patients during COVID-19 pandemic: Results of telemedicine in a referral center

Introduction: Atrophic gastritis (AG) is a chronic condition, often affecting the elderly with one or more comorbidities, characterized by the absence or the presence of few specific symptoms, and the clinical interview is the mainstay of the face-to-face outpatient visits At the end of February 2020 in Italy were reported the first cases of SARS-CoV-2 infection and since the beginning of March not-urgent outpatient visits were cancelled, so the vast majority of AG patients' visits were postponed Telemedicine has been used in some chronic diseases as a supportive care tool instead of face-to-face visits in order to properly establish the management of patients with chronic diseases during pandemic Aims & Methods: The aim of the study was to investigate the impact of SARS-CoV-2 pandemic on AG patients and to assess the presence of GI symptoms using telemedicine as tool of supportive care, in an academic hospital of a low risk region of central Italy A cross-sectional study on AG patients who had a last face-to-face outpatient visit within the last two years was conducted During telephone interviews, the personal risk perception for SARS-CoV-2 infection, the presence of symptoms related to infection (fever, cough, asthenia, anosmia/ageusia and diarrhea) and risk of infection exposure, were addressed Furthermore, GI symptoms were investigated using a standardised questionnaire currently used in our department to investigate the presence, severity and frequency of new (onset during the SARS-CoV-2 pandemic) or already present (last face-toface visit) GI symptoms and to establish the need of an urgent face-to-face outpatient visit or other medical intervention Results: Overall 218 pts were included and 151 (69 2%) responded to the telephone calls and adhered to the telemedicine interview Female (F) were the 72 2% and median age was 67 years (range 30-89, 60 9% > 60yrs) Seventeen (11 3%, F 64 7%, median age 66yrs) referred at least one symptom suspect for SARS-CoV-2 infection (one of them, a man of 75 yrs, had radiological diagnosis of pneumonia with a favorable outcome), but only 1 patient was tested by nasopharyngeal swabs to rule out diagnosis of SARS-CoV-2 infection and resulted negative Considering the risk of exposure, 19 (12 6%) pts had a job at risk for infection and 22 (14 6%) had a contact with hospitals or people working in a hospital Risk perception for SARS-CoV-2 infection was none, low or high for 82 (54 3%), 38 (25 3%) and 31 (20 4%) respectively Concerning GI symptoms, 17 (11 3%) presented new-onset symptoms, already treated by themselves or by the general practitioner, while 65 (43 0%) presented symptoms already present at the last visit Dyspepsia (29 8%) was the most frequent upper GI tract symptom, whilst constipation (21 2%) for the lower GI tract None of the pts presented red-flag symptoms requiring urgent outpatient face-to-face visit or medical intervention Conclusion: Despite the presence of symptoms suspicious for SARS-CoV-2 infection in about 10% of elder AG patients and one case of pneumonia, none of the interviewed patients had a negative outcome due to COVID-19 New GI symptoms occurred in a low proportion (11%) of patients, whose potential relationship to pandemic is unlikely as 80% of interviewed patients perceived a low or did not perceive any pandemic-related risk Telemedicine was well accepted and may be viewed as a powerful tool to offer remote medical care to AG patients during health emergencies making infeasible face-to-face outpatients visits due to social distancing and lockdown to control the spread of pandemic infection