Indian consensus statements on irritable bowel syndrome in adults: A guideline by the Indian Neurogastroenterology and Motility Association and jointly supported by the Indian Society of Gastroenterology.

The Indian Neurogastroenterology and Motility Association (INMA), earlier named the Indian Motility and Functional Diseases Association developed this evidence-based practice guidelines for the management of irritable bowel syndrome (IBS). A modified Delphi process was used to develop this consensus containing 28 statements, which were concerning diagnostic criteria, epidemiology, etiopathogenesis and comorbidities, investigations, lifestyle modifications and treatments. Owing to the Coronavirus disease-19 (COVID-19) pandemic, lockdowns and mobility restrictions, web-based meetings and electronic voting were the major tools used to develop this consensus. A statement was regarded as accepted when the sum of "completely accepted" and "accepted with minor reservation" voted responses were 80% or higher. Finally, the consensus was achieved on all 28 statements. The consensus team members are of the view that this work may find use in teaching, patient care, and research on IBS in India and other nations.

Molecular determinants associated with temporal succession of SARS-CoV-2 variants in Uttar Pradesh, India.

The emergence and rapid evolution of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) caused a global crisis that required a detailed characterization of the dynamics of mutational pattern of the viral genome for comprehending its epidemiology, pathogenesis and containment. We investigated the molecular evolution of the SASR-CoV-2 genome during the first, second and third waves of COVID-19 in Uttar Pradesh, India. Nanopore sequencing of the SARS-CoV-2 genome was undertaken in 544 confirmed cases of COVID-19, which included vaccinated and unvaccinated individuals. In the first wave (unvaccinated population), the 20A clade (56.32%) was superior that was replaced by 21A Delta in the second wave, which was more often seen in vaccinated individuals in comparison to unvaccinated (75.84% versus 16.17%, respectively). Subsequently, 21A delta got outcompeted by Omicron (71.8%), especially the 21L variant, in the third wave. We noticed that Q677H appeared in 20A Alpha and stayed up to Delta, D614G appeared in 20A Alpha and stayed in Delta and Omicron variants (got fixed), and several other mutations appeared in Delta and stayed in Omicron. A cross-sectional analysis of the vaccinated and unvaccinated individuals during the second wave revealed signature combinations of E156G, F157Del, L452R, T478K, D614G mutations in the Spike protein that might have facilitated vaccination breach in India. Interestingly, some of these mutation combinations were carried forward from Delta to Omicron. In silico protein docking showed that Omicron had a higher binding affinity with the host ACE2 receptor, resulting in enhanced infectivity of Omicron over the Delta variant. This work has identified the combinations of key mutations causing vaccination breach in India and provided insights into the change of [virus's] binding affinity with evolution, resulting in more virulence in Delta and more infectivity in Omicron variants of SARS-CoV-2. Our findings will help in understanding the COVID-19 disease biology and guide further surveillance of the SARS-CoV-2 genome to facilitate the development of vaccines with better efficacies.

Post COVID-19 irritable bowel syndrome.

OBJECTIVES: The long-term consequences of COVID-19 infection on the gastrointestinal tract remain unclear. Here, we aimed to evaluate the prevalence of gastrointestinal symptoms and post-COVID-19 disorders of gut-brain interaction after hospitalisation for SARS-CoV-2 infection. DESIGN: GI-COVID-19 is a prospective, multicentre, controlled study. Patients with and without COVID-19 diagnosis were evaluated on hospital admission and after 1, 6 and 12 months post hospitalisation. Gastrointestinal symptoms, anxiety and depression were assessed using validated questionnaires. RESULTS: The study included 2183 hospitalised patients. The primary analysis included a total of 883 patients (614 patients with COVID-19 and 269 controls) due to the exclusion of patients with pre-existing gastrointestinal symptoms and/or surgery. At enrolment, gastrointestinal symptoms were more frequent among patients with COVID-19 than in the control group (59.3% vs 39.7%, p<0.001). At the 12-month follow-up, constipation and hard stools were significantly more prevalent in controls than in patients with COVID-19 (16% vs 9.6%, p=0.019 and 17.7% vs 10.9%, p=0.011, respectively). Compared with controls, patients with COVID-19 reported higher rates of irritable bowel syndrome (IBS) according to Rome IV criteria: 0.5% versus 3.2%, p=0.045. Factors significantly associated with IBS diagnosis included history of allergies, chronic intake of proton pump inhibitors and presence of dyspnoea. At the 6-month follow-up, the rate of patients with COVID-19 fulfilling the criteria for depression was higher than among controls. CONCLUSION: Compared with controls, hospitalised patients with COVID-19 had fewer problems of constipation and hard stools at 12 months after acute infection. Patients with COVID-19 had significantly higher rates of IBS than controls. TRIAL REGISTRATION NUMBER: NCT04691895.

Serological response to vaccination against coronavirus disease-19 in patients with inflammatory bowel disease.

Vaccination against coronavirus disease-19 (COVID-19) is effective in preventing the occurrence or reduction in the severity of the infection. Patients with inflammatory bowel disease (IBD) are on immunomodulators, which may alter serological response to vaccination against COVID-19. Accordingly, we studied (i) the serological response to vaccination against COVID-19 in IBD patients and (ii) a comparison of serological response in IBD patients with that in healthy controls. A prospective study was undertaken during a 6-month period (July 2021 to January 2022). Seroconversion was assessed among vaccinated, unvaccinated IBD patients and vaccinated healthy controls using anti-severe acute respiratory syndrome coronavirus 2 immunoglobulin G (anti-SARS-CoV-2 IgG) antibody detection enzyme-linked immunosorbent assay (ELISA) kit, and optical density (OD) was measured at 450 nm. OD is directly proportional to the antibody concentration. One hundred and thirty-two blood samples were collected from 97 IBD patients (85 [87.6%] ulcerative colitis and 12 [12.4%] Crohn's disease). Forty-one of the seventy-one (57.7%) unvaccinated and 60/61 (98.4%) vaccinated IBD patients tested positive (OD > 0.3) for SARS-CoV-2 IgG antibodies. Fourteen of the sixteen (87.5%) healthy controls tested positive for SARS-CoV-2 IgG antibodies. Vaccinated IBD patients had higher ODs than unvaccinated IBD patients (1.31 [1.09-1.70] vs. 0.53 [0.19-1.32], p < 0.001) and 16 vaccinated healthy controls (1.31 [1.09-1.70] vs. 0.64 [0.43-0.78], p < 0.001). Three of the seventy-one (4.2%) unvaccinated IBD patients reported having recovered from COVID-19. Most IBD patients seroconvert after vaccination against SARS-CoV-2, similar to a healthy population. A large proportion of IBD patients had anti-SARS-CoV-2 antibodies even before vaccination, suggesting the occurrence of herd immunity.

Factors associated with high compliance behaviour against COVID-19 in the early phase of pandemic: a cross-sectional study in 12 Asian countries

IntroductionRegardless of having effective vaccines against COVID-19, containment measures such as enhanced physical distancing and good practice of personal hygiene remain the mainstay of controlling the COVID-19 pandemic. Countries across Asia have imposed these containment measures to varying extents. However, residents in different countries would have a differing degree of compliance to these containment measures potentially due to differences in the level of awareness and motivation in the early phase of pandemic.ObjectivesIn our study, we aimed to describe and correlate the level of knowledge and attitude with the level of compliance with personal hygiene and physical distancing practices among Asian countries in the early phase of pandemic.MethodsA multinational cross-sectional study was carried out using electronic surveys between May and June 2020 across 14 geographical areas. Subjects aged 21 years and above were invited to participate through social media, word of mouth and electronic mail.ResultsAmong the 2574 responses obtained, 762 (29.6%) participants were from East Asia and 1812 (70.4%) were from Southeast Asia (SEA). A greater proportion of participants from SEA will practise physical distancing as long as it takes (72.8% vs 60.6%). Having safe distancing practices such as standing more than 1 or 2 m apart (AdjOR 5.09 95% CI (1.08 to 24.01)) or more than 3 or 4 m apart (AdjOR 7.05 95% CI (1.32 to 37.67)), wearing a mask when they had influenza-like symptoms before the COVID-19 pandemic, preferring online news channels such as online news websites/applications (AdjOR 1.73 95% CI (1.21 to 2.49)) and social media (AdjOR 1.68 95% CI (1.13 to 2.50) as sources of obtaining information about COVID-19 and high psychological well-being (AdjOR 1.39 95% CI (1.04 to 1.87)) were independent factors associated with high compliance.ConclusionsWe found factors associated with high compliance behaviour against COVID-19 in the early phase of pandemic and it will be useful to consider them in risk assessment, communication and pandemic preparedness.

Survival analysis: A primer for the clinician scientists.

Survival analysis is a collection of statistical procedures employed on time-to-event data. The outcome variable of interest is time until an event occurs. Conventionally, it dealt with death as the event, but it can handle any event occurring in an individual like disease, relapse from remission, and recovery. Survival data describe the length of time from a time of origin to an endpoint of interest. By time, we mean years, months, weeks, or days from the beginning of being enrolled in the study. The major limitation of time-to-event data is the possibility of an event not occurring in all the subjects during a specific study period. In addition, some of the study subjects may leave the study prematurely. Such situations lead to what is called censored observations as complete information is not available for these subjects. Life table and Kaplan-Meier techniques are employed to obtain the descriptive measures of survival times. The main objectives of survival analysis include analysis of patterns of time-to-event data, evaluating reasons why data may be censored, comparing the survival curves, and assessing the relationship of explanatory variables to survival time. Survival analysis also offers different regression models that accommodate any number of covariates (categorical or continuous) and produces adjusted hazard ratios for individual factor.

Post-infection functional gastrointestinal disorders following coronavirus disease-19: A case-control study.

BACKGROUND AND AIM: Because acute infectious gastroenteritis may cause post-infection irritable bowel syndrome and functional dyspepsia and the severe acute respiratory syndrome coronavirus-2 affects gastrointestinal (GI) tract, coronavirus disease-19 (COVID-19) may cause post-infection-functional GI disorders (FGIDs). We prospectively studied the frequency and spectrum of post-infection-FGIDs among COVID-19 and historical healthy controls and the risk factors for its development. METHODS: Two hundred eighty patients with COVID-19 and 264 historical healthy controls were followed up at 1 and 3 months using translated validated Rome Questionnaires for the development of chronic bowel dysfunction (CBD), dyspeptic symptoms, and their overlap and at 6-month for IBS, uninvestigated dyspepsia (UD) and their overlap. Psychological comorbidity was studied using Rome III Psychosocial Alarm Questionnaire. RESULTS: At 1 and 3 months, 16 (5.7%), 16 (5.7%), 11 (3.9%), and 24 (8.6%), 6 (2.1%), 9 (3.2%) of COVID-19 patients developed CBD, dyspeptic symptoms, and their overlap, respectively; among healthy controls, none developed dyspeptic symptoms and one developed CBD at 3 months (P < 0.05). At 6 months, 15 (5.3%), 6 (2.1%), and 5 (1.8%) of the 280 COVID-19 patients developed IBS, UD, and IBS-UD overlap, respectively, and one healthy control developed IBS at 6 months (P < 0.05 for all except IBS-UD overlap). The risk factors for post-COVID-19 FGIDs at 6 months included symptoms (particularly GI), anosmia, ageusia, and presence of CBD, dyspeptic symptoms, or their overlap at 1 and 3 months and the psychological comorbidity. CONCLUSIONS: This is the first study showing COVID-19 led to post-COVID-19 FGIDs. Post-COVID-19 FGIDs may pose a significant economic, social, and healthcare burden to the world.

Prevalence of Gastrointestinal Symptoms in Severe Acute Respiratory Syndrome Coronavirus 2 Infection: Results of the Prospective Controlled Multinational GI-COVID-19 Study.

INTRODUCTION: Gastrointestinal (GI) symptoms in coronavirus-19 disease (COVID-19) have been reported with great variability and without standardization. In hospitalized patients, we aimed to evaluate the prevalence of GI symptoms, factors associated with their occurrence, and variation at 1 month. METHODS: The GI-COVID-19 is a prospective, multicenter, controlled study. Patients with and without COVID-19 diagnosis were recruited at hospital admission and asked for GI symptoms at admission and after 1 month, using the validated Gastrointestinal Symptom Rating Scale questionnaire. RESULTS: The study included 2036 hospitalized patients. A total of 871 patients (575 COVID+ and 296 COVID-) were included for the primary analysis. GI symptoms occurred more frequently in patients with COVID-19 (59.7%; 343/575 patients) than in the control group (43.2%; 128/296 patients) (P < 0.001). Patients with COVID-19 complained of higher presence or intensity of nausea, diarrhea, loose stools, and urgency as compared with controls. At a 1-month follow-up, a reduction in the presence or intensity of GI symptoms was found in COVID-19 patients with GI symptoms at hospital admission. Nausea remained increased over controls. Factors significantly associated with nausea persistence in COVID-19 were female sex, high body mass index, the presence of dyspnea, and increased C-reactive protein levels. DISCUSSION: The prevalence of GI symptoms in hospitalized patients with COVID-19 is higher than previously reported. Systemic and respiratory symptoms are often associated with GI complaints. Nausea may persist after the resolution of COVID-19 infection.

Association between well-being and compliance with COVID-19 preventive measures by healthcare professionals: A cross-sectional study.

IMPORTANCE: Knowledge and attitude influence compliance and individuals' practices. The risk and protective factors associated with high compliance to these preventive measures are critical to enhancing pandemic preparedness. OBJECTIVE: This survey aims to assess differences in mental health, knowledge, attitudes, and practices (KAP) of preventive measures for COVID-19 amongst healthcare professionals (HCP) and non-healthcare professionals. DESIGN: Multi-national cross-sectional study was carried out using electronic surveys between May-June 2020. SETTING: Multi-national survey was distributed across 36 countries through social media, word-of-mouth, and electronic mail. PARTICIPANTS: Participants ≥21 years working in healthcare and non-healthcare related professions. MAIN OUTCOME: Risk factors determining the difference in KAP towards personal hygiene and social distancing measures during COVID-19 amongst HCP and non-HCP. RESULTS: HCP were significantly more knowledgeable on personal hygiene (AdjOR 1.45, 95% CI -1.14 to 1.83) and social distancing (AdjOR 1.31, 95% CI -1.06 to 1.61) compared to non-HCP. They were more likely to have a positive attitude towards personal hygiene and 1.5 times more willing to participate in the contact tracing app. There was high compliance towards personal hygiene and social distancing measures amongst HCP. HCP with high compliance were 1.8 times more likely to flourish and more likely to have a high sense of emotional (AdjOR 1.94, 95% CI (1.44 to 2.61), social (AdjOR 2.07, 95% CI -1.55 to 2.78), and psychological (AdjOR 2.13, 95% CI (1.59-2.85) well-being. CONCLUSION AND RELEVANCE: While healthcare professionals were more knowledgeable, had more positive attitudes, their higher sense of total well-being was seen to be more critical to enhance compliance. Therefore, focusing on the well-being of the general population would help to enhance their compliance towards the preventive measures for COVID-19.

Impact of the coronavirus disease 2019 pandemic on irritable bowel syndrome.

BACKGROUND AND AIM: Gastrointestinal manifestations of the coronavirus disease 2019 (COVID-19) pandemic may mimic irritable bowel syndrome (IBS), and social distancing measures may affect IBS patients negatively. We aimed to study the impact of COVID-19 on respondents with self-reported IBS. METHODS: We conducted an anonymized survey from May to June 2020 in 33 countries. Knowledge, attitudes, and practices on personal hygiene and social distancing as well as psychological impact of COVID-19 were assessed. Statistical analysis was performed to determine differences in well-being and compliance to social distancing measures between respondents with and without self-reported IBS. Factors associated with improvement or worsening of IBS symptoms were evaluated. RESULTS: Out of 2704 respondents, 2024 (74.9%) did not have IBS, 305 (11.3%) had self-reported IBS, and 374 (13.8%) did not know what IBS was. Self-reported IBS respondents reported significantly worse emotional, social, and psychological well-being compared with non-IBS respondents and were less compliant to social distancing measures (28.2% vs 35.3%, P = 0.029); 61.6% reported no change, 26.6% reported improvement, and 11.8% reported worsening IBS symptoms. Higher proportion of respondents with no change in IBS symptoms were willing to practice social distancing indefinitely versus those who deteriorated (74.9% vs 51.4%, P = 0.016). In multivariate analysis, willingness to continue social distancing for another 2-3 weeks (vs longer period) was significantly associated with higher odds of worsening IBS. CONCLUSION: Our study showed that self-reported IBS respondents had worse well-being and compliance to social distancing measures than non-IBS respondents. Future research will focus on occupational stress and dietary changes during COVID-19 that may influence IBS.

Care of inflammatory bowel disease patients during coronavirus disease-19 pandemic using digital health-care technology.

Background and Aim: Although telemedicine is an option for the care of inflammatory bowel disease (IBD) patients during the Coronavirus Disease (COVID)-19 pandemic, its feasibility and acceptability data are scant. Data on the frequency of COVID-19 among patients with IBD, quality of life (QOL), access to health care, psychological stress, and anxiety during the COVID-19 pandemic are scant. Methods: Video/audio consultation for IBD patients was undertaken after a web-based appointment, and data on acceptability, IBD control, Hospital Anxiety Depression Scale (HADS), and World Health Organization Quality of Life questionnaire (WHOQOL-Bref) were obtained electronically. IBD patients were assessed for COVID-19 symptoms or contact history and tested using reverse transcriptase polymerase chain reaction (RT-PCR) on naso- oro-pharyngeal swabs, and data were compared with 16,317 non-IBD controls. Results: Teleconsultation was feasible and acceptable. IBD patients had COVID-19 as frequently as non-IBD controls despite immunosuppressive therapy, possibly due to their awareness and preventive practices. Although the physical, psychological, and social QOL scores during the COVID-19 pandemic were comparable to the prepandemic period, the environmental scores were worse. Psychological tension and interference with work due to pain were lower during the pandemic, which might be influenced by the control of the disease. Conclusions: Teleconsultation is a feasible and acceptable alternative for IBD patients. They had COVID-19 as frequently as non-IBD controls despite a high frequency of immunosuppressive treatment, possibly due to their awareness of the disease and preventive practices. The QOL scores (except the environmental domains) and psychological issues were quite comparable or even better during the COVID-19 pandemic than earlier.

The Spectrum of Gastrointestinal Symptoms in Patients With Coronavirus Disease-19: Predictors, Relationship With Disease Severity, and Outcome.

INTRODUCTION: We prospectively studied the frequency, spectrum, and predictors of gastrointestinal (GI) symptoms among patients with coronavirus disease-19 (COVID-19) and the relationship between GI symptoms and the severity and outcome. METHODS: Consecutive patients with COVID-19, diagnosed in a university hospital referral laboratory in northern India, were evaluated for clinical manifestations including GI symptoms, their predictors, and the relationship between the presence of these symptoms, disease severity, and outcome on univariate and multivariate analyses. RESULTS: Of 16,317 subjects tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in their oropharyngeal and nasopharyngeal swabs during April-May 2020, 252 (1.5%) were positive. Of them, 208 (82.5%) were asymptomatic; of the 44 symptomatic patients, 18 (40.9%) had non-GI symptoms, 15 (34.1%) had a combination of GI and non-GI symptoms, and 11 (25.0%) had GI symptoms only. Thirty-three had mild-to-moderate disease, 8 severe, and 5 critical. Five patients (1.98%) died. On multivariate analysis, the factors associated with the presence of GI symptoms included the absence of contact history and presence of non-GI symptoms and comorbid illnesses. Patients with GI synptoms more often had severe, critical illness and fatal outcome than those without GI symptoms. DISCUSSION: Eighty-two percent of patients with COVID-19 were asymptomatic, and 10.3% had GI symptoms; severe and fatal disease occurred only in 5% and 2%, respectively. The presence of GI symptoms was associated with a severe illness and fatal outcome on multivariate analysis. Independent predictors of GI symptoms included the absence of contact history, presence of non-GI symptoms, and comorbid illnesses.(Equation is included in full-text article.).

IDDF2020-ABS-0205 The impact of the COVID-19 pandemic on irritable bowel syndrome

IDDF2020-ABS-0205 Table 1Comparison of demographic variables between respondents with and without IBS Non-IBS (n = 2024) IBS (n = 305) p Age 39.7 ± 12.9 40.1 ± 13.0 1.0 Gender 0.6 Male 727 (35.9) 119 (39.0) Female 1297 (64.1) 186 (61.0) Race 0.2 Bengali 31 (1.5) 2 (0.7) Caucasian 24 (1.2) 6 (2.0) Chinese 1148 (56.7) 188 (61.6) Filipino 45 (2.2) 2 (0.7) Indian 154 (7.6) 20 (6.6) Japanese 5 (0.2) 0 (0.0) Korean 131 (6.5) 28 (9.2) Malay 328 (16.2) 39 (12.8) Others 158 (7.8) 20 (6.6) Economic region 0.3 High 1156 (57.1) 183 (60.0) Upper-middle 457 (22.6) 74 (24.3) Middle/Low 411 (20.3) 48 (15.7) What is your highest education level? 0.8 No formal education/Primary school 9 (0.4) 0 (0.0) Secondary school 164 (8.1) 29 (9.5) Pre-university 258 (12.7) 44 (14.4) Tertiary – undergraduate/postgraduate degree 1593 (78.7) 232 (76.1) Employment 0.4 Full-time 1497 (74.0) 213 (69.8) Part-time 125 (6.2) 18 (5.9) Not working 402 (19.9) 74 (24.3) Housing 1.0 Dormitory 61 (3.0) 13 (4.3) Government housing with 2 or 3 rooms 306 (15.1) 37 (12.1) Government housing with more than 3 rooms 376 (18.6) 62 (20.3) Private apartment or condominium 601 (29.7) 89 (29.2) Private landed property 680 (33.6) 104 (34.1) Annual household Income per capita in USD (total household income/number of people in the household) 1.0 Less than $1000 259 (12.8) 37 (12.1) $1000 - $2000 274 (13.5) 46 (15.1) $2000 - $4000 375 (18.5) 49 (16.1) $4000 - $6000 211 (10.4) 29 (9.5) $6000 - $8000 138 (6.8) 24 (7.9) $8000 - $10000 173 (8.5) 23 (7.5) More than $10000 594 (29.3) 97 (31.8) Have you been diagnosed with COVID-19? 1.0 Yes 32 (1.6) 4 (1.3) No 1992 (98.4) 301 (98.7) Compliance 0.029 Yes 715 (35.3) 86 (28.2) No 1309 (64.7) 219 (71.8) Not flourishing 1025 (50.6) 207 (67.9) <0.01 Flourishing 999 (49.4) 98 (32.1) Well-being total scores 45.8 ± 14.6 40.5 ± 14.8 <0.01 Emotional well-being 10.3 ± 3.5 9.4 ± 3.6 <0.01 Social well-being 15.0 ± 6.1 12.8 ± 6.1 <0.01 Psychological well-being 20.4 ± 6.6 18.3 ± 6.7 <0.01 Abstract IDDF2020-ABS-0205 Table 2Comparison of demographic variables between respondents who reported no change and worsening in severity of IBSQuestion No change (n = 183) Worsen (n = 35) p Age 38.8 ± 12.2 40.1 ± 14.3 1.0 Gender 1.0 Male 71 (38.8) 14 (40.0) Female 112 (61.2) 21 (60.0) Economic region 0.1 High 110 (60.1) 28 (80.0) Upper-middle 44 (24.0) 6 (17.1) Middle/Low 29 (15.8) 1 (2.9) What is your highest education level? 1.0 Secondary school 18 (9.8) 4 (11.4) Pre-university 22 (12.0) 5 (14.3) Tertiary – undergraduate/postgraduate degree 143 (78.1) 26 (74.3) Employment 0.2 Full-time 132 (72.1) 26 (74.3) Part-time 7 (3.8) 4 (11.4) Not working 44 (24.0) 5 (14.3) Work from home 1.0 Yes 45 (32.1) 8 (26.7) No 95 (67.9) 22 (73.3) Compliance 1.0 Yes 54 (29.5) 10 (28.6) No 129 (70.5) 25 (71.4) Which of the following would you consider as main reason for compliance with social distancing measures? 0.034 Fear of getting COVID 19 90 (49.2) 11 (31.4) Fear of family members getting COVID 19 86 (47.0) 19 (54.3) Fear of fines/punitive measures 7 (3.8) 5 (14.3) Would you willingly participate in the contact tracing app? 1.0 Yes 143 (78.1) 27 (77.1) No 40 (21.9) 8 (22.9) For how long are you willing to practice social distancing behaviour to keep yourself and others safe? 0.016 As long as it takes 137 (74.9) 18 (51.4) For another 2–3 weeks 4 (2.2) 4 (11.4) For another 1 month 12 (6.6) 6 (17.1) For another 3 months 14 (7.7) 5 (14.3) For another 6 months 13 (7.1) 1 (2.9) I want social distancing to stop now 3 (1.6) 1 (2.9) Flourishing <0.01 Yes 64 (35.0) 3 (8.6) No 119 (65.0) 32 (91.4) Well-being total scores 40.5 ± 15.0 35.4 ± 13.3 0.1 Emotional well-being 9.5 ± 3.5 7.7 ± 3.6 0.014 Social well-being 12.7 ± 6.3 11.7 ± 4.7 0.8 Psychological well-being 18.3 ± 6.9 15.9 ± 6.5 0.1 Abstract IDDF2020-ABS-0205 Table 3Univariable and multivariable regression of factors associated with worsening in severity of IBS (with no change in severity of IBS group as reference)Question OR (95% CI) p AdjOR(95%CI) p Do you wash your hands before and after handing food?* Never (ref) 1.00 - - Seldom 0.0 (0.0) 1.0 - - 50% of the time 0.0 (0.0) 1.0 - - Most of the time 0.0 (0.0) 1.0 - - Always 0.0 (0.0) 1.0 - - Do you cover your mouth when you sneeze or cough?* Never (ref) 1.00 - - Seldom 0.0 (0.0) 1.0 - - 50% of the time 0.0 (0.0) 1.0 - - Most of the time 0.0 (0.0) 1.0 - - Always 0.0 (0.0) 1.0 - - Which of the following would you consider as main reason for compliance with social distancing measures? Fear of getting COVID 19 (ref) 1.00 1.00 Fear of family members getting COVID 19 1.8 (0.8 – 4.0) 0.1 2.0 (0.9 – 4.7) 0.1 Fear of fines/punitive measures 5.8 (1.6 – 21.6) <0.01 5.9 (1.4 – 25.6) 0.017 For how long are you willing to practice social distancing behaviour to keep yourself and others safe? As long as it takes (ref) 1.00 1.00 For another 2–3 weeks 7.6 (1.7 – 33.1) <0.01 6.0 (1.2 – 28.8) 0.026 For another 1 month 3.8 (1.3 – 11.4) 0.017 2.9 (0.9 – 9.0) 0.1 For another 3 months 2.7 (0.9 – 8.4) 0.1 3.1 (0.9 – 10.2) 0.1 For another 6 months 0.6 (0.1 – 4.7) 0.6 0.6 (0.1 – 4.7) 0.6 I want social distancing to stop now 2.5 (0.3 – 25.7) 0.4 1.3 (0.1 – 22.3) 0.9 Emotional well-being 0.9 (0.8 – 1.0) <0.01 0.9 (0.8 – 1.0) 0.042 Flourishing was excluded from analysis due to overlap with emotional well-being.*Excluded from multivariable analysis due to 0 respondents in reference categories for respondents with no change in control IBSConclusionsOur study showed differences in well-being and compliance to social distancing between IBS and non-IBS respondents, and these factors influence the worsening in severity of IBS. Further research will focus on how occupational stress and dietary changes may influence IBS symptoms

Impact of COVID-19 on gastrointestinal endoscopy practice in India: a cross-sectional study.

Background and study aims Gastrointestinal endoscopy, being an aerosol-generating procedure, has the potential to transmit Severe Acute Respiratory Distress Syndrome Corona Virus-2 (SARS-CoV-2) during the current pandemic. Adequate knowledge is the key to prevention. A survey, perhaps the first, was conducted among Indian endoscopists to assess the impact of Coronavirus Disease (COVID)-19 on gastroinestinal endoscopy practice in the country. Methods From April 24 to 28, 2020, an electronic survey (using Google Form) was conducted with 23 questions (single or multiple answers) on: (1) endoscopy practice before the pandemic; (2) knowledge about COVID-19; and (3) its impact on endoscopy practice. Results Responses were received from 375 of 1205 (31.1 %) endoscopists. Most (35.7 %) were young (31-40 years), practicing in corporate multi-speciality hospitals (44.6 %) or independent practice set-up (17.7 %) in metropolitan cities (55.6 %) and urban areas (42.3 %). In most units (75.4 %), fewer than 10 % of procedures performed are endoscopies, as compared to before the pandemic. A reduction in volume of endoscopy related to restriction of the routine procedures by the latest guideline was reported by 86.9 % of respondents. Most are using N95 masks (74.7 %) and/or complete personal protective equipment (PPE, 49.2 %) during endoscopic procedures . Only 18.3 % of respondents had access to negative pressure rooms either within (5.4 %) or outside (12.9 %) the usual endoscopy suite. Conclusion Endoscopy units in India are performing fewer than 10 % of their usual volumes due to current restrictions. Resources to follow current international guidelines, including use of negative pressure rooms and PPE, are limited. Alternate measures are needed to keep up the services.

The Practice of Gastrointestinal Motility Laboratory During COVID-19 Pandemic: Position Statements of the Asian Neurogastroenterology and Motility Association (ANMA-GML-COVID-19 Position Statements).

During the Coronavirus Disease 2019 (COVID-19) pandemic, practices of gastrointestinal procedures within the digestive tract require special precautions due to the risk of contraction of severe acute respiratoy syndrome coronavirus-2 (SARS-CoV-2) infection. Many procedures in the gastrointestinal motility laboratory may be considered moderate to high-risk for viral transmission. Healthcare staff working in gastrointestinal motility laboratories are frequently exposed to splashes, air droplets, mucus, or saliva during the procedures. Moreover, some are aerosol-generating and thus have a high risk of viral transmission. There are multiple guidelines on the practices of gastrointestinal endoscopy during this pandemic. However, such guidelines are still lacking and urgently needed for the practice of gastrointestinal motility laboratories. Hence, the Asian Neurogastroenterology and Motility Association had organized a group of gastrointestinal motility experts and infectious disease specialists to produce a position statement paper based-on current available evidence and consensus opinion with aims to provide a clear guidance on the practices of gastrointestinal motility laboratories during the COVID-19 pandemic. This guideline covers a wide range of topics on gastrointestinal motility activities from scheduling a motility test, the precautions at different steps of the procedure to disinfection for the safety and well-being of the patients and the healthcare workers. These practices may vary in different countries depending on the stages of the pandemic, local or institutional policy, and the availability of healthcare resources. This guideline is useful when the transmission rate of SARS-CoV-2 is high. It may change rapidly depending on the situation of the epidemic and when new evidence becomes available.

Gastrointestinal and Hepatic Involvement in Severe Acute Respiratory Syndrome Coronavirus 2 Infection: A Review.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has caused a pandemic coronavirus disease-19 (COVID-19) that began in Wuhan city, China, in December 2019. Till 14th April, 19,39,801 people have been affected by this virus, of whom 1,20,897 died. Though respiratory symptoms are the typical manifestation of this disease, gastrointestinal (GI) symptoms such as anorexia, nausea, vomiting, loss of taste sensation, diarrhea, abdominal pain, and discomfort have been reported. The pooled prevalence of GI symptom is 17.6% (95% confidence interval, 12.3%-24.5%), as indicated in a meta-analysis. A few studies suggested that the presence of GI symptoms is associated with poorer prognosis. The virus is excreted in feces during the acute disease, and even after, the nasopharyngeal swab has become negative for viral ribonucleic acid. Fecal viral excretion may have clinical significance because of possible feco-oral transmission of the infection. Nearly, 10.5%-53% of patients with COVID-19, particularly those with severe disease, have been shown to have an elevation of hepatic enzymes though biochemical and clinical jaundice are uncommon. Knowledge about this disease in general and GI involvement, in particular, is currently evolving.