Gastrointestinal symptoms in COVID-19.

SARS-CoV-2 infection manifests mainly by involving the respiratory system. Due to the presence of abdominal symptoms, the digestive system is clearly involved in the expression, transmission, and possible pathogenesis of COVID-19. There are many theories regarding the development of abdominal symptoms, including angiotensin 2 receptor, cytokine storm, and disturbances of the intestinal microbiome. This paper provides an overview of the most important meta-analyses and publications on gastrointestinal symptoms and the gut microbiome in COVID-19.

Gastrointestinal symptoms in patients with coronavirus disease 2019 (COVID-19) - friend or foe?

Introduction: Gastrointestinal (GI) symptoms can be considered as a manifestation of coronavirus disease 2019 (COVID-19). Aim: Our study analysed GI symptoms depending on their occurrence, and their possible causes and impact on the course of COVID-19. Material and methods: A retrospective, single-centre assessment of the frequency, risk factors, and impact of GI symptoms in 441 patients with COVID-19. Results: A statistically significant reduction in the length of stay (LOS) (15 days vs. 17 days; p = 0.04), intensive care unit admission (ICU) (16.9% vs. 26.8%; p = 0.02), and need for mechanical ventilation (14.1% vs. 23.4%; p = 0.02) in the group who had experienced GI symptoms before hospitalization was noticed. For comparison, patients who developed GI symptoms during hospitalization had statistically significantly longer LOS (21 days vs. 15 days; p = 0.0001), were more frequently admitted to the ICU (38.1% vs. 18.6%; p = 0.0003), and had a higher need for mechanical ventilation (32.7% vs. 16.2%; p < 0.001). Risk factors for GI symptoms during hospitalization in COVID-19 patients included age, Clostridioides difficile infection, and receiving certain treatment (antibiotics and lopinavir + ritonavir). Conclusions: The GI symptoms that developed before admission to hospital correlated with reduced severity of the course of COVID-19. However, in the group of patients who developed GI symptoms during hospitalization, attention should be paid to concomitant treatment. The use of antibiotics should be limited because they are associated with the deterioration of the course of COVID-19; one of the reasons might be changes in the intestinal microbiome.

Irritable bowel syndrome following COVID-19: an underestimated consequence of SARS-CoV-2 infection.

INTRODUCTION: Gastrointestinal (GI) symptoms are a common manifestation of COVID­19. OBJECTIVES: We aimed to investigate whether GI symptoms persist in patients previously infected with SARS­CoV­2 in the form of post­infection irritable bowel syndrome (PI­IBS). PATIENTS AND METHODS: A prospective, single­center evaluation of questions regarding IBS was conducted using the Rome IV Adult Diagnostic Questionnaire among 257 patients previously hospitalized for COVID­19. RESULTS: GI symptoms (abdominal pain with diarrhea or constipation) were reported at the following time points: at discharge from the hospital, and after 3 and 6 months of follow­up. GI symptoms not meeting the full Rome IV diagnostic criteria for IBS due to too short symptom duration were reported by 28 individuals (10.6%) at hospital discharge, 58 (22.3%) after 3 months, and 70 (26.9%) after 6 months. The full Rome IV criteria for IBS were not met at discharge by any of the participants, but they were met after 3 and 6 months of follow­up in 14 (5.4%) and 15 individuals (5.8%), respectively. CONCLUSION: Persistent GI symptoms following COVID­19 are frequent and deserve significant and growing attention of gastroenterologists and other health care practitioners. The Rome IV criteria may be too strict to address the full spectrum of GI symptoms following COVID­19.

Clostridioides difficile infection in coronavirus disease 2019 (COVID-19): an underestimated problem?

INTRODUCTION: The use of antibiotics and possibility of microbiota disruption during the coronavirus disease 2019 (COVID­19) pandemic have raised questions about the incidence of Clostridioides difficile infection (CDI). OBJECTIVES: This study aimed to assess the frequency of and risk factors for CDI in patients with COVID­19. PATIENTS AND METHODS: We conducted a retrospective, single­center evaluation study on the frequency of and risk factors for CDI in patients with COVID­19 and in the prepandemic era. The analysis included 441 patients with severe acute respiratory syndrome coronavirus 2 (SARS­CoV­2) infection and 2961 pa­ tients hospitalized before the pandemic. RESULTS: A significant increase in the incidence of CDI was noted during the COVID­19 pandemic compared with the prepandemic period: 10.9% versus 2.6%, P <0.001. Risk factors for CDI in patients with COVID­19 included: age, length of hospital stay, occurrence of diarrhea during hospitalization, use of antibiotics other than azithromycin, and coexistence of nervous system disease or chronic kidney disease-all of these factos had a weak association with CDI development. The multivariable logistic regression model indicated other unassessed variables that had an impact on the CDI incidence rate. CONCLUSIONS: We observed a higher incidence of CDI in patients with COVID­19. Antibiotic therapy was a relevant risk factor for CDI, although its effect was weak. Other drugs used during the pandemic were not found to have an impact on disease development. Possible causes of CDI may include fecal microbiota disruption by SARS­CoV­2 infection, but further research is needed to validate this hypothesis.

Skin and gastrointestinal symptoms in COVID-19.

INTRODUCTION: The first cases of coronavirus disease 2019 (COVID-19) were noted in December 2019 in Wuhan province, China. The World Health Organisation (WHO) announced the pandemic status on March 11, 2020. The manifestations of the disease are as follows: fever, cough, fatigue, anosmia and ageusia, dyspnoea, chest pain, muscle soreness, chills, sore throat, rhinitis, headache, gastrointestinal (GI) symptoms, and dermal lesions. AIM: To evaluate the relationship between dermal lesions and GI symptoms in a group of COVID-19 patients. MATERIAL AND METHODS: A group of 441 COVID-19 patients admitted to the Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw between March 15th and June 15th, 2020. RESULTS: Of 441 patients with confirmed SARS-CoV-2 infection, 255 (58.5%) experienced gastrointestinal (GI) symptoms: lack of appetite was reported in 124 (48.6%) cases, diarrhoea was noted in 109 (42.7%), abdominal pain in 95 (37.3%), vomiting in 37 (14.5%), and nausea in 32 (12.5%) cases. Eight (1.81%) patients had dermal lesions: erythematous macular lesions (2 patients - 25%), erythematous infiltrated lesions (2; 25%), erythematous infiltrated and exfoliative lesions (3; 37.5%), erythematous papular lesions (3; 37.5%), and erythematous oedematous lesions (2; 25%). All of those patients reported gastrointestinal symptoms during the hospitalisation. CONCLUSIONS: The following study analyses possible causes of dermal lesions and their coexistence with GI symptoms. Several possible theories were taken into account, including the microbiota alterations and issue of drug-related complications.