ABSTRACT
Introduction: Gastrointestinal symptomatology in SARS-CoV-2 infection is a common clinical presentation, reported in up to 61% in those affected, being the presence of acute diarrhea one of the most common symptoms, reported in up to 33.7%. There are multiple theories about physiopathological mechanisms of diarrhea associated with SARS-CoV2 infection, but there is not enough evidence to attribute this symptom only to the infection without the influence of host and environment factors. Objective: Determine the associated factors with acute diarrhea in Mexican population with SARS-CoV-2 infection. Methods: A case-control cross-sectional study was performed to analyze the factors associated with acute diarrhea in patients with SARS-CoV-2. This research was carried out during the 2020-2021 in five states of Mexico. An online survey was applied to 784 patients, selected by randomized sampling of whom sociodemographic data, medical history, and symptoms related to SARSCoV- 2 infection were collected. A univariate and multivariate logistic regression analysis was performed applying a χ2 test with 95% confidence intervals to determinate the association of acute diarrhea in SARS-CoV-2 infection with other symptomatology and possible nonhost contributing factors for its presentation. Results: A total of 784 patients were analyzed with a mean age of 29 ± 8 years, predominantly female with 75.4% (591). The most frequently described symptom was fatigue in 75% (588) followed by anosmia and myalgias with 67% (525) and 65.5% (514) respectively. Acute diarrhea was present in 28.6% (321) of our population during the acute phase of SARS-CoV-2 infection. The most used drugs were acetaminophen (79.2%) and azithromycin (29.7%). The multivariate logistic regression analysis showed a statistically significant association between acute diarrhea and the use of macrolides, mainly with clarithromycin with an OR of 2.96 (95% CI of 1.26-6.95, p = 0.001) followed by azithromycin with an OR of 1.47 (95% CI 1.035-2.091, p = 0.031). In this same analysis, there was no significant association of acute diarrhea with the rest of SARS-CoV-2 infection symptoms. Discussion: This study demonstrates the association of acute diarrhea in SARS-CoV-2 infection with the concomitant use of macrolides, without finding any association with described SARS-CoV-2 viral symptoms. According to the previously mentioned, we propose that a proportion of acute diarrhea associated with SARSCoV- 2 infection may be secondary to inappropriate macrolide prescription and not due to the viral disease itself.
ABSTRACT
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.
ABSTRACT
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.
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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.