The War in Gaza and Barriers to Inflammatory Bowel Disease Care

Abstract

Objectives

Stress is associated with inflammatory bowel disease (IBD) development and exacerbation. We evaluated the impact of the war in Gaza on Israeli IBD patients and related barriers to IBD care.

Methods

Adult IBD patients were blindly enrolled to complete a patient-reported-outcome electronic questionnaire assessing symptoms, hospitalizations, medications, psychosocial factors, economic issues, and adherence to therapy during wartime.

Results

Overall, 526 participants completed the questionnaire, 67% with CD and 33% with UC. Fifty one percent had moderate–severe IBD patients. Compared to central residents, residents of peripheral regions described a higher need for financial support as their main missing aspect in IBD coping (26% vs. 17%), had increased financial difficulties attributed to wartime that led them to skip therapy (21% vs. 9%), and reported increased rates of requiring financial support to purchase biological medications (13% vs. 3%). Compared to mild patients, moderate–severe patients reported significantly more disease aggravations (47% vs. 23%), hospitalizations (16% vs. 2%), greater need for financial support as their main missing aspect in IBD coping (31% vs. 11%), increased financial difficulties attributed to wartime that led them to skip medical therapy (32% vs. 3%), increased rates of missing IBD medical therapy owing to wartime-related stress (34% vs. 11%), and increased daily cannabis use (21% vs. 9%).

Conclusions

Periphery-residents with IBD experience more financial difficulties, hospitalizations, and disease exacerbation during wartime. Efforts should be taken to minimize disparities in medical care availability and accessibility, with special emphasis on moderate–severe patients who are more prone to disease aggravations.