Changes in physical activity and its impact on MAFLD during the COVID-19 pandemic

Introduction and Objectives Multiple factors, such as diet and physical activity, are involved in the pathogenesis of fatty liver associated with metabolic dysfunction (MAFLD). After confinement by COVID-19, interest has arisen to study its effect on the population. This study aimed to describe the impact of changes in physical activity during the COVID-19 pandemic on the progression of MAFLD. Materials and Methods Observational, analytical, retrospective, longitudinal and comparative study in patients with MAFLD from the Instituto de Investigations Médico Biologicals of the Universidad Veracruzana. The information was obtained from a database from which values of steatosis, fibrosis and degree of physical activity measured by IPAQ were obtained. Student's t-test for related samples was used for numerical variables. Results Thirty-four patients were studied, of which 15 were excluded due to incomplete records. Nineteen patients were included;the mean age was 60.42±8.1 years, female sex was predominant (57.9%). Initial somatometric data are described in Table 1. A significant increase in physical activity in minutes per week was observed (p=0.037), as well as the reduction of intrahepatic fat after the pandemic (Fig.1). Conclusions The results demonstrate that during the COVID-19 pandemic, our population increased physical activity, which resulted in an improvement in hepatic steatosis significantly. Funding The resources used in this study were from the hospital without any additional financing Declaration of interest The authors declare no potential conflicts of interest.

TIVURON PROJECT: AN INTERNATIONAL MULTICENTER PROSPECTIVE COHORT STUDY EVALUATING THE GASTROINTESTINAL SYMPTOMS AND COMPLICATIONS OF COVID-19 IN HOSPITALIZED PATIENTS

Background/Aims: Digestive symptoms are common in patients with COVID-19. Neverthe-less, the evidence available so far is based on retrospective and observational studies. This prospective multicenter cohort study aimed to describe the frequency, intensity, evolution, and impact of digestive symptoms and complications, during hospitalization and after dis-charge, of patients with COVID-19. Methods: Patients hospitalized due to COVID-19 (posi-tive PCR for SARS-CoV-2) from May to August 2020, were prospectively recruited in 31 centers. Follow-up included the period between admission and 15 days after discharge. Results: 829 patients (mean age 56.7±17.9 years;42% of females) were enrolled in this study. Of these, 7.2% were active smokers and the mean BMI was 29.1±5.7. Proton pump inhibitors were used by 21.5% (n=178). The most prevalent symptoms on admission were diarrhea (39.4%), nausea (27.4%), and abdominal pain (20.7%). Anorexia, a non-specific symptom, was present in 49.8% of hospitalized patients. At discharge and 15 days after discharge, most symptoms resolved, returning to the baseline prevalence of patients (<5%). Digestive complications during admission were infrequent, except for liver injury defined as hypertransaminasemia which was present in 267 patients (32.3%). The mean length of hospital stay was 8 days (5-12) and 13.6% needed ICU admission. Death happened in 5.2%of patients. On multivariate analysis, diarrhea on admission was associated with a shorter hospital stay (<10 days) ORa 0.508 (0.350-0.739) p=0.000. During hospitalization, diarrhea, constipation, and abdominal bloating were associated with shorter hospital stay ORa 0.531 (0.298-0.946) p=0.032, ORa 0.384 (0.167-0.885) p=0.025, ORa 0.163 (0.057-0.466) p= 0.00, respectively.Odynophagia and dysphagia during hospitalization were associated with a higher need for ICU admission, ORa 6.518 (2.255-18.835) p=0.001 and ORa 4.035 (1.453-11.204) p=0.007, respectively. Liver injury during hospitalization was associated with a higher hospital stay (>10 days) ORa 1.442 (1.019-2.041) p=0.039. In the linear regression analysis, the set of GI symptoms and complications, along with age, comorbidity, and respiratory symptoms, were able to predict 43% (R2 0.43) of the observed variability in the speed of ICU admission;in this case, digestive symptoms slowed it down (more days until ICU admission). Conclusions: Gastrointestinal manifestations of COVID-19 are common in hospitalized patients, while complications are infrequent. Gastrointestinal symptoms seemed to predict a shorter hospital stay and slower speed of ICU admission. These tend to resolve to their baseline prevalence 15 days after discharge, while elevated transaminases were associated with a longer hospital stay. Odynophagia and dysphagia during hospitaliza-tion were associated with an increased need for ICU admission.

FACTORS RELATED TO NEW ONSET DYSPEPSIA AFTER COVID 19 INFECTION IN MEXICAN POPULATION

ntroduction: Since the COVID 19 infection has been declared a pandemic by the World Health Organization, the spectrum of symptoms have been described, however, the presence of digestive symptoms as part of the probable sequelae of the disease has not been well studied. Objective: To determine the variables present during the active stage period of the COVID 19 infection and their association with symptoms of dyspepsia during the recovery period. Material and methods: An online survey was conducted to patients recovered from COVID 19 infection during the months of May and June 2020, evaluating the demographic variables of age, sex and comorbidities, the presence of COVID 19 infection symptoms during the disease active stage and digestive symptoms during recovery. Using SPSS version 22, univar-iate and multivariate logistic regression analysis was performed to determine the variables associated with the presence of dyspeptic symptoms such as early satiety, epigastric pain and postprandial fullness during recovery from the disease (4 weeks after the infection resolved). Results: A total of 315 patients recovered from COVID 19 infection were evaluated, mainly 59.6% from Baja California, 12.2% from Sonora, 7.8% CDMX, 6% Sinaloa, 3% Veracruz with an average age of 35.7 ±11.5 years of age, 65.4% female, with obesity comorbidities in 19.6% of cases, high blood pressure in 10.9%, asthma in 7.1% and diabetes mellitus in 2.2%. The most frequent symptoms reported of the disease were headache 79.5 %, myalgias 64.1%, diarrhea 60.9%, anosmia 62.2%, fever 57.1%, ageusia 58.7%, odynophagia 56.1%, arthralgias 54.7%, anorexia 52.6%, cough 49.7%, chest pain 39.4%, dyspnea 28.5%. Dyspep-sia in the recovery period was reported with pain in 18.6%, postprandial fullness 34.3%and early satiety in 52.2%. It was found that the variables independently associated with the presence of postprandial fullness during recovery from the disease are male (OR 0.544,IC 0.309-0.958, P = 0.035), anorexia (OR 3.07, IC 1.73-5.45, P <.001) and diarrhea (OR 1.87. IC 1.04-3.34, P = 0.034). The variable associated with the presence of satiety during recovery from the disease is the presence of anorexia (OR 6.65, CI 3.75-11.79, P <0.001). The presence of epigastric pain after COVID 19 infection is associated with diarrhea (OR 3.32, IC 1.42-7.79, P = 0.006), arthralgia (OR 3.15, IC 3.15-1.16-8.55, P = 0.026), treatment with azithromycin ( OR 2.29, IC 1.13-4.64, P = 0.021), chlorine dioxide treatment (OR 11.35, IC 2.69-47.9, P = 0.001).Conclusions: The presence of dyspepsia after infection by COVID 19 is frequent, some of the associated variables are similar to those reported in other cases of post-infectious dyspep-sia, the use of medications has an important relationship with the presence of epigastric pain.

INCIDENCE OF “NEW-ONSET” CONSTIPATION AND ASSOCIATED FACTORS DURING LOCKDOWN DUE TO THE CORONAVIRUS-19 PANDEMIC

Background: A minimum of physical activity and low liquid intake are factors that havebeen associated with constipation. The health emergency brought on by the COVID-19pandemic has resulted in adopting behavior, such as sheltering-in-place (less mobility) anddietary changes, creating a scenario we believe to be an adequate model for examining theappearance of symptoms of constipation and its associated factors. At present, there are no reports in the literature that establish a relation between a change in bowel movement habitand being under the current lockdown. Thus, the aim of our study was to evaluate theincidence of symptoms of constipation and associated factors during the lockdown implementedto contain the spread of COVID-19 in Mexico.Methods: A cross-sectional and descriptive study was conducted on an open population,applying an electronic survey (4 weeks after lockdown due to COVID-19 in Mexico) toevaluate: demographic characteristics, physical activity, water and fiber intake, appearanceof constipation symptoms (including stool consistency), and quality of life. Incidence (newcases) of constipation after the lockdown (“new-onset” constipation) was calculated and the95% CI was reported. A comparative analysis of the categorical variables and continuousvariables was carried out between the participants with “new-onset” constipation and thosewith no constipation during the lockdown, utilizing the Student’s t test, the Mann-WhitneyU test, the chi-square test, or the Wilcoxon test, as appropriate. Statistical significance wasset a p < 0.05.Results: Out of 678 subjects evaluated, 170 (25%, 95% CI 21.7-28.4) developed symptomsof “new-onset” constipation, with a significant decrease in the number of daily bowelmovements (p<0.05) and stool consistency (p<0.05) during lockdown (Figure 1). Furthermore,in the “new-onset” constipation population, there was a higher proportion of subjects(48%) who stopped exercising during the pandemic compared to the subjects who did notdevelop constipation symptoms (29%, p=0.0005, OR 2.23, CI 95% 1.4-3.48, Figure 2).The multivariate analysis (logistic regression) showed that female sex (p=0.001), water intake(p=0.039), and physical activity (p=0.012) were associated with “new-onset” constipation.Conclusions: In conclusion, in our study we found that one-fourth of the population thatreduced their physical activity and drank less water due to mobility restrictions imposedfor epidemiologic reasons, in the face of the COVID-19 pandemic, developed “new-onset”constipation symptoms. Given those results, appropriate physical activity and adequateliquid intake during prolonged periods of lockdown should be recommended to preventsaid symptoms.(Image Presented)Number of bowel movements, days of physical activity and stool consistency before and after the lockdown(Image Presented)Percentage of subjects who stop physical activity during the pandemic among groups.

Prospective multicenter evaluation of the gastrointestinal manifestations of covid-19 in outpatients

Introduction: The global spread of the SARS-CoV-2 virus has resulted in a worldwide pandemic with important socio-health repercussions. Current clinical experience and several published retrospective studies suggest that digestive symptoms are common in infected patients. [1][2] The aim of this study was to evaluate the frequency of gastrointestinal (GI) symptoms and complications in patients with COVID-19 disease managed on an outpatient basis. Aims & Methods: International, multicenter, prospective cohort study was conducted in 18 centers from Latin America, Asia, Africa and Europe. Subjects ≥18 years old, with COVID-19 disease, managed on an outpatient basis were included. Followed up period was 6 months. Baseline characteristics, comorbidities, GI symptoms or complications, hospital admission, ICU admission and mortality data were collected. A descriptive analysis of the study results was performed. A multivariate analysis was carried out, evaluating the association of GI symptoms and complications with age, baseline characteristics, comorbidity and COVID-19 treatments received. The adjusted Odd Ratio (ORa) was calculated assuming a significance level of p <0.05. Results: The preliminary analysis included a total of 436 patients. The median age was 35 years, interquartile range (IQR) 27-48 years. Two hundred and ten patients (48.2%) were male. The median of age-adjusted Charlson Comorbidity Index was 0 (IQR 0-1). The most frequent GI symptoms were anorexia 216 (49.5%), diarrhea 207 (47.5%), nausea 134 (30.7%), abdominal pain 122 (28%) and abdominal distension 121 (27.8%). At 4-week follow- up, symptoms resolved in most cases. Multivariate analysis showed that nausea was associated with Ivermectin treatment ORa 3.24 (95% CI 1.11-9.43) p= 0.030;abdominal pain was associated with Hydroxychloroquine treatment ORa 5.27 (95% CI 1.52-18.19) p= 0.009;diarrhea was associated with age ORa 0.966 (95% CI 0.93-0.99), p= 0.020 and Hydroxychloroquine treatment ORa 6.9 (95% CI 1.55-30.79), p= 0. 011;abdominal distension was associated with body mass index ORa 1.147 (95% CI 1.05-1.24), p< 0.001 and Hydroxychloroquine treatment ORa 7.6 (95% CI 2.00-29.51), p= 0.003. Digestive complications were infrequent (1 gastritis, 2 duodenitis, 1 jejunal ulcer, 3 hypertransaminasemia, 1 enteritis, 1 colitis). Twenty-three patients (5.3%) required hospital admission, of whom 4 (0.9%) required ICU admission and 2 (0.5%) died. Conclusion: Anorexia, diarrhea, nausea, abdominal pain and abdominal bloating were common symptoms in patients with COVID-19 disease managed on an outpatient basis. GI complications were infrequent in patients with COVID-19 who do not require hospitalization. Treatment with Hydroxychloroquine and Ivermectin was associated with more GI symptoms in COVID-19 outpatients.

Recommendations for the reopening and activity resumption of the neurogastroenterology units in the face of the COVID-19 pandemic. Position of the Sociedad Latinoamericana de Neurogastroenterología. / Recomendaciones para la reapertura y reinicio de actividades de las Unidades de Neurogastroenterología ante la pandemia por COVID-19. Posicionamiento de la Sociedad Latinoamericana de Neurogastroenterología.

The COVID-19 pandemic has forced the establishment of preventive measures against contagion during the performance of diagnostic and therapeutic tests in gastroenterology. Digestive tract motility tests involve an intermediate and elevated risk for the transmission of COVID-19 infection. Given their elective or non-urgent indication in the majority of cases, we recommend postponing those tests until significant control of the infection rate in each Latin American country has been achieved during the pandemic. When the health authorities allow the return to normality, and in the absence of an effective treatment for or preventive vaccine against COVID-19 infection, we recommend a strict protocol for classifying patients according to their infectious-contagious status through the appropriate use of tests for the detection of the virus and the immune response to it, and the following of protective measures by the healthcare personnel to prevent contagion during the performance of a gastrointestinal motility test.

Recommendations for the reopening and activity resumption of the neurogastroenterology units in the face of the COVID-19 pandemic. Position of the Sociedad Latinoamericana de Neurogastroenterología

The COVID 19 pandemic has forced the establishment of measures to avoid contagion during diagnostic and therapeutic tests in gastroenterology. Gastrointestinal motility studies involve a high and intermediate risk of transmission of infection by this virus. Given its elective or non-urgent indication in most cases, we recommend deferring the performance of these tests until there is a significant control of the infection rate in each country, during the pandemic. When health authorities allow a return to normalcy and in the absence of effective treatment or a preventive vaccine for COVID 19 infection, we recommend a strict protocol to classify patients according to their infectious-contagious status through the appropriate use of tests to detect the virus and its immune response, as well as the use of protective measures to be followed by health personnel to avoid contagion during the performance of a gastrointestinal motility test. Resumen La pandemia por COVID 19 ha obligado a establecer medidas para evitar los contagios durante la realización de pruebas diagnósticas y terapéuticas en gastroenterología. Los estudios motores del tubo digestivo implican un riesgo elevado e intermedio de trasmisión de la infección por este virus. Dada su indicación electiva o no urgente en la mayoría de los casos, recomendamos diferir la realización de estas pruebas hasta que haya un control significativo de la tasa de infección en cada país, durante la pandemia. Cuando las autoridades sanitarias permitan el regreso a la normalidad y en ausencia de un tratamiento efectivo o una vacuna preventiva de la infección por COVID 19, recomendamos un protocolo estricto para clasificar a los pacientes de acuerdo a su estatus infecto-contagioso mediante el uso apropiado de pruebas para la detección del virus y su respuesta inmune, así como el uso de medidas de protección que deberá seguir el personal de la salud para evitar el contagio durante la realización de una prueba de motilidad gastrointestinal.

Hepatic manifestations and impact of COVID-19 on the cirrhotic patient. / Manifestaciones hepáticas y repercusión en el paciente cirrótico de COVID-19.

The novel SARS-CoV-2 coronavirus is responsible for the infectious disease caused by coronavirus 19 (COVID-19). The current pandemic is growing worldwide and could affect 50-60% of the world population in the months to come. The most severe disease manifestations are atypical pneumonia and sepsis, but the gastrointestinal tract, particularly the liver, has recently been reported to be affected by SARS-CoV-2. Therefore, the aim of the present work was to review the literature available on the topic and provide information about COVID-19, in both healthy and diseased livers, and issue recommendations. The incidence of liver injury specifically associated with COVID-19 varies from 14.8-53%. The majority of case series have reported altered ALT and AST, elevated total bilirubin, and low serum albumin and liver compromise has been associated with the most severe cases of COVID-19. Cirrhosis of the liver has a recognized immune dysfunction status that includes immunodeficiency and systemic inflammation, making it reasonable for those patients to be more susceptible to SARS-CoV-2 infection. The recommendations for those patients, in addition to the general measures of physical distancing and handwashing for all persons, include social, medical, and psychologic support during the period of home quarantine to prevent lapses in treatment. Patients should be made aware that they need to keep abreast of changes in recommendations and social policies.