Impact of COVID-19 pandemic on gastrointestinal cancer diagnosis and resection: An observational study.

BACKGROUND: The COVID-19 pandemic disrupted routine screening for and treatment of gastrointestinal (GI) cancers. We analyzed changes in GI cancer pathology specimens resulting from diagnostic and therapeutic procedures at a single academic center in an epicenter of the COVID-19 pandemic. Our aim was to determine which cancer types, procedures, and patients were impacted by the pandemic. METHODS: This was a retrospective, cohort study of patients identified based on carcinoma containing pathologic specimens reviewed in our institution resulting from diagnostic or resection procedures. Pathology and medical records of patients with GI and liver carcinoma and high-grade dysplasia were reviewed from February 1 to April 30 in 2018, 2019 and 2020. We used March 16, 2020 to delineate the pre-COVID-19 and COVID-19 period in 2020. Chi-squared or t-tests, as appropriate, were used to compare these time periods in each year. Mann Kendall test was used to test for trend in volume. ANCOVA was used to compare differences across years. RESULTS: A total of 1028 pathology samples from 949 unique patients were identified during the study period. There was a 57% drop in samples within 2020 (p = 0.01) that was not present in either 2018 or 2019 (p<0.01). In 2020, there were significantly fewer resections compared to biopsies overall in the COVID-19 period (p = 0.01). There were fewer colorectal cancer specimens (p = 0.04) which were procured from older patients (p<0.01) in the 2020 COVID-19 period compared to pre-COVID-19. CONCLUSIONS: In our institution, there was a significant drop in diagnostic and resection specimens of GI cancers during the COVID-19 pandemic, disproportionately affecting older colorectal cancer patients.

Limited intestinal inflammation despite diarrhea, fecal viral RNA and SARS-CoV-2-specific IgA in patients with acute COVID-19.

Gastrointestinal symptoms are common in COVID-19 patients but the nature of the gut immune response to SARS-CoV-2 remains poorly characterized, partly due to the difficulty of obtaining biopsy specimens from infected individuals. In lieu of tissue samples, we measured cytokines, inflammatory markers, viral RNA, microbiome composition, and antibody responses in stool samples from a cohort of 44 hospitalized COVID-19 patients. SARS-CoV-2 RNA was detected in stool of 41% of patients and more frequently in patients with diarrhea. Patients who survived had lower fecal viral RNA than those who died. Strains isolated from stool and nasopharynx of an individual were the same. Compared to uninfected controls, COVID-19 patients had higher fecal levels of IL-8 and lower levels of fecal IL-10. Stool IL-23 was higher in patients with more severe COVID-19 disease, and we found evidence of intestinal virus-specific IgA responses associated with more severe disease. We provide evidence for an ongoing humeral immune response to SARS-CoV-2 in the gastrointestinal tract, but little evidence of overt inflammation.

Survey Finds Gender Disparities Impact Both Women Mentors and Mentees in Gastroenterology.

INTRODUCTION: Gastroenterologists at all levels of practice benefit from formal mentoring. Much of the current literature on mentoring in gastroenterology is based on expert opinion rather than data. In this study, we aimed to identify gender-related barriers to successful mentoring relationships from the mentor and mentee perspectives. METHODS: A voluntary, web-based survey was distributed to physicians at 20 academic institutions across the United States. Overall, 796 gastroenterology fellows and faculty received the survey link, with 334 physicians responding to the survey (42% response rate), of whom 299 (90%; 129 women and 170 men) completed mentorship questions and were included in analysis. RESULTS: Responses of women and men were compared. Compared with men, more women preferred a mentor of the same gender (38.6% women vs 4.2% men, P < 0.0001) but less often had one (45.5% vs 70.2%, P < 0.0001). Women also reported having more difficulty finding a mentor (44.4% vs 16.0%, P < 0.0001) and more often cited inability to identify a mentor of the same gender as a contributing factor (12.8% vs 0.9%, P = 0.0004). More women mentors felt comfortable advising women mentees about work-life balance (88.3% vs 63.8%, P = 0.0005). Nonetheless, fewer women considered themselves effective mentors (33.3% vs 52.6%, P = 0.03). More women reported feeling pressured to mentor because of their gender (39.5% vs 0.9% of men, P < 0.0001). Despite no gender differences, one-third of respondents reported negative impact of the COVID-19 pandemic on their ability to mentor and be mentored. DISCUSSION: Inequities exist in the experiences of women mentees and mentors in gastroenterology, which may affect career advancement and job satisfaction.