ABSTRACT
Background and aim: 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 (DGBI) after hospitalization for SARS-CoV-2 infection. Material(s) and Method(s): GI-COVID19 is a prospective, multicenter, controlled study. Patients with and without COVID-19 diagnosis were evaluated upon hospital admission and after 1, 6, and 12 months post-hospitalization. Gastrointestinal symptoms, anxiety, and depression were assessed using validated questionnaires, namely the Gastrointestinal Symptoms Rating Scale (GSRS), the Hanxiety and Depression Scale (HADS) and the Rome IV Diagnostic Questionnaire for Functional Gastrointestinal Disorders in Adults. Result(s): The study included 2183 hospitalized patients. The primary analysis included a total of 883 patients (614 COVID-19 patients and 269 controls) due to the exclusion of patients with pre-existing gastrointestinal symptoms and/or surgery. At enrollment, gastrointestinal symptoms were more frequent among COVID-19 patients 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 COVID-19 patients (16% vs. 9.6%, P=0.019 and 17.7% vs. 10.9%, P=0.011, respectively). Compared to controls, COVID- 19 patients reported higher rates of irritable bowel syndrome (IBS) according to Rome IV criteria: 0.5% vs. 3.2%, P=0.045. Factors significantly associated with IBS diagnosis included history of allergies, chronic intake of proton pump inhibitors, and presence of dyspnea. [Table presented] At the 6-month follow-up, the rate of COVID-19 patients fulfilling the criteria for depression was higher than among controls. Conclusion(s): Compared to controls, hospitalized COVID-19 patients had fewer complaints of constipation and hard stools at 12 months after acute infection. COVID-19 patients had significantly higher rates of IBS than controls. ClinicalTrials.gov number, NCT04691895.Copyright © 2023. Editrice Gastroenterologica Italiana S.r.l.
ABSTRACT
Introduction: SARS-CoV-2 infection, known as COVID-19, may lead to persistent gastrointestinal dysfunction resembling aspects of post-infection disorders of gut-brain interaction (DGBI). However, the long-term consequences of COVID-19 on the gastrointestinal tract remain unclear. Aims & Methods: We aimed to evaluate the prevalence of gastrointestinal symptoms and post-infection disorders of gut-brain interaction (DGBI) up to 12 months after hospitalization and the factors associated with their presence. The GI-COVID19 is a prospective, multicenter, controlled study. Patients with and without COVID-19 diagnosis were assessed at hospital admission and followed up after 1, 6, and 12 months to assess gastrointestinal symptoms using the Gastrointestinal Symptoms Rating Scale, the Rome IV Diagnostic Questionnaire for Functional Gastrointestinal Disorders in Adults, and the hospital anxiety and depression scale. ClinicalTrials. gov number, NCT04691895. Result(s): The study included2183 hospitalized patients. After excluding patients with pre-existing gastrointestinal symptoms and/or surgery, a total of 883 patients (614 COVID-19 and 269 controls) were included in the primary analysis, of whom 435 COVID-19 and 188 controls completed 12 months of follow-up. At enrollment, gastrointestinal symptoms occurred more frequently in COVID-19 patients than in the control group (59.3% vs. 39.7%, P<0.001). Symptoms more frequently complained by COVID-19 patients at enrollment were nausea, diarrhea, loose stool, and urgency. At 1-month follow-up evaluation, nausea and acid regurgitation were significantly more prevalent in COVID-19 patients than in the control group (8.7% vs. 1.7%, P=0.015 and 8.4% vs. 2.1%, P=0.006, respectively). At 6 months, COVID-19 patients reported lower rates of flatus (17.6% vs. 19.1%, P=0.024), constipation (8.9% vs. 17.1%, P<0.001) and hard stools (9.6 vs. 17.2%, P=0.030) as compared with the control group. At 12 months, constipation and hard stools were significantly less prevalent in COVID-19 patients than in the control group (9.6% vs. 16%, P=0.019 and 10.9% vs. 17.7%, P=0.011, respectively). COVID-19 patients reported higher rates of DGBI during follow-up compared to controls (Table), although statistically significant differences were found only for irritable bowel syndrome (IBS) according to Rome III criteria (4.4% vs 1.1%, P=0.036) and Rome IV criteria (3.2% vs 0.5%, P=0.045). The rate of COVID-19 patients depressed at 6 months and with anxiety at 12 months was higher compared to controls (4.1% vs 2.7%, P=0.014 and 4.5% vs 1.1%, P=0.088, respectively). Factors significantly associated with IBS diagnosis were anamnestic allergies (OR 10.024, 95% CI 1.766-56.891, P=0.009), chronic intake of proton pump inhibitors (OR 4.816, 95% CI 1.447-16.025, P=0.010) and dyspnea (OR 4.157, 95% CI 1.336-12.934, P=0.014). Conclusion(s): Hospitalized COVID-19 patients complain less constipation and hard stools than control at 12 months after acute infection. COVID-19 patients are also more likely to develop IBS.
ABSTRACT
Introduction: The novel coronavirus disease 2019 (COVID-19) has been reported to affect the gastrointestinal system with a variety of symptoms, including gastrointestinal bleeding. The prevalence of bleeding in these patients remains unclear. Aims & Methods: The aim of this meta-analysis is to estimate the rate of gastrointestinal bleeding in COVID-19 patients. MEDLINE and Embase were searched through December 20th, 2020. Studies reporting COVID-19 patients with and without gastrointestinal bleeding were included. Estimated prevalence with 95% confidence intervals (CI) was pooled;heterogeneity was expressed as I2. Meta-regression analysis was performed to assess the impact of confounding covariates. Results: Ten studies met the inclusion criteria and were included in the analysis. A total of 91887 COVID-19 patients were considered, of whom 534 reported gastrointestinal bleeding (0.6%) [409 (76.6%) upper and 121 (22.7%) lower gastrointestinal bleeding (UGIB and LGIB, respectively)]. The overall pooled bleeding rate was 5% [95%CI 2-8], with high heterogeneity (I2 99.2%);small study effect was observed using the Egger test (p=0.049). After removing two outlier studies, the pooled bleeding rate was 2% [95%CI 0-4], with high heterogeneity (I2 99.2%), and no small study effect (p=0.257). The pooled UGIB rate was 1% (95%CI 0-3, I2 98.6%, p=0.214), whereas the pooled LGIB rate was 1% (95%CI 0-2, I2 64.7%, p=0.919). Meta regression analysis showed that overall estimates on GI bleeding were affected by studies reporting different source of bleeding. Conclusion: In this meta-analysis of published studies, individuals with COVID-19 were found to be at risk for gastrointestinal bleeding, especially upper gastrointestinal bleeding.
ABSTRACT
Aims The novel SARS-CoV-2 disease (COVID-19) has been reported to affect the gastrointestinal (GI) system with a widevariety of symptoms, including GI bleeding. The aim of this meta-analysis is to estimate the rate of GI bleeding of patientsinfected with SARS-CoV-2. Methods MEDLINE via PubMed, Ovid Embase, Scopus and Cochrane Library were systematically searched through October,10th 2020. Studies simultaneously reporting cohorts of COVID-19 patients with and without GI bleeding were included. Arandom-effect model was applied for pooling results;heterogeneity was expressed as I . Impact of confounding covariateson the meta-analytic results was evaluated using meta-regression analysis. Results Seven studies (including a total of 1047 COVID-19 patients) met the inclusion criteria and were included in theanalysis. Among COVID-19 patients with gastrointestinal bleeding, 93 experienced upper and 21 lower GI bleeding. The mean age ofparticipants ranged from 45.3 to 73.7 years. Four studies have been carried out in Western countries (2 in the US, 1 in Italyand 1 in Israel), and 3 in Eastern countries (China). Three studies reported the rate of patients taking anticoagulants orantiplatelets, ranging from 37.4 % to 100 %. The overall pooled bleeding rate was 9 % [95 % CI: 2 % to 20 %], with highheterogeneity (I 96.4 %), and no “small study effect” observed using the Egger test (p = 0.979). The pooled uppergastrointestinal bleeding rate was 7 % (95 % CI: 1 % to 17 %, I 95.3 %, Egger test p = 0.835), whereas the pooled lowergastrointestinal bleeding rate was 1 % (95 % CI: 0 % to 4 %, I 82.4 %, Egger test p = 0.437). Meta-regression analysisshowed that overall risk bleeding was significantly affected by the geographic area of the study (β 0.899±0.027) and theupper source of bleeding (β 1.010±0.003). Conclusions In this meta-analysis of published studies, individuals with SARS-CoV-2 infections were found to be at risk forGI bleeding, especially upper GI bleeding.
ABSTRACT
Aims SARS-CoV-2 disease (COVID-19) is a major challenge for the healthcare system and physicians, imposing changes indaily clinical activity. We aimed to describe what European trainees and young gastroenterologists know about COVID-19and identify training gaps to implement educational programs. Methods A prospective web-based electronic survey was developed and distributed via e-mail to all members of the ItalianYoung Gastroenterologist and Endoscopist Association and to European representatives. Results One hundred and ninety-seven subjects participated in the survey, of whom 14 (7.1 %) were excluded. Themajority were gastroenterologists in training (123, 67.7 %) working in institutions with COVID-19 inpatients (159, 86.9 %),aged ≤30 years (113, 61.8 %). The activity of Gastroenterology Units was restricted to emergency visits and endoscopy,with reductions of activities of up to 90 %. 84.5 % of participants felt that the COVID-19 outbreak impacted on theirtraining, due to unavailability of mentors (52.6 %) and interruption of trainee's involvement (66.4 %). Most participantsreferred absence of training on the use of personal protective equipment, oxygen ventilation systems and COVID-19therapies. Conclusions COVID-19 outbreak significantly impacted on gastroenterologists' clinical activity. The resources currentlydeployed are inadequate, and therefore educational interventions to address this gap are warranted in the next future.