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Dig Dis Sci ; 66(11): 3635-3658, 2021 11.
Article in English | MEDLINE | ID: covidwho-1406167


AIM: To report revolutionary reorganization of academic gastroenterology division from COVID-19 pandemic surge at metropolitan Detroit epicenter from 0 infected patients on March 9, 2020, to > 300 infected patients in hospital census in April 2020 and > 200 infected patients in April 2021. SETTING: GI Division, William Beaumont Hospital, Royal Oak, has 36 GI clinical faculty; performs > 23,000 endoscopies annually; fully accredited GI fellowship since 1973; employs > 400 house staff annually since 1995; tertiary academic hospital; predominantly voluntary attendings; and primary teaching hospital, Oakland-University-Medical-School. METHODS: This was a prospective study. Expert opinion. Personal experience includes Hospital GI chief > 14 years until 2020; GI fellowship program director, several hospitals > 20 years; author of > 300 publications in peer-reviewed GI journals; committee-member, Food-and-Drug-Administration-GI-Advisory Committee > 5 years; and key hospital/medical school committee memberships. Computerized PubMed literature review was performed on hospital changes and pandemic. Study was exempted/approved by Hospital IRB, April 14, 2020. RESULTS: Division reorganized patient care to add clinical capacity and minimize risks to staff of contracting COVID-19 infection. Affiliated medical school changes included: changing "live" to virtual lectures; canceling medical student GI electives; exempting medical students from treating COVID-19-infected patients; and graduating medical students on time despite partly missing clinical electives. Division was reorganized by changing "live" GI lectures to virtual lectures; four GI fellows temporarily reassigned as medical attendings supervising COVID-19-infected patients; temporarily mandated intubation of COVID-19-infected patients for esophagogastroduodenoscopy; postponing elective GI endoscopies; and reducing average number of endoscopies from 100 to 4 per weekday during pandemic peak! GI clinic visits reduced by half (postponing non-urgent visits), and physical visits replaced by virtual visits. Economic pandemic impact included temporary, hospital deficit subsequently relieved by federal grants; hospital employee terminations/furloughs; and severe temporary decline in GI practitioner's income during surge. Hospital temporarily enhanced security and gradually ameliorated facemask shortage. GI program director contacted GI fellows twice weekly to ameliorate pandemic-induced stress. Divisional parties held virtually. GI fellowship applicants interviewed virtually. Graduate medical education changes included weekly committee meetings to monitor pandemic-induced changes; program managers working from home; canceling ACGME annual fellowship survey, changing ACGME physical to virtual site visits; and changing national conventions from physical to virtual. CONCLUSION: Reports profound and pervasive GI divisional changes to maximize clinical resources devoted to COVID-19-infected patients and minimize risks of transmitting infection.

COVID-19/economics , COVID-19/epidemiology , Economics, Hospital/organization & administration , Gastroenterology/education , Hospital Administration/methods , SARS-CoV-2 , Cities/economics , Cities/epidemiology , Education, Medical, Graduate/organization & administration , Gastroenterology/economics , Hospital Administration/economics , Humans , Internship and Residency , Michigan/epidemiology , Organizational Affiliation/economics , Organizational Affiliation/organization & administration , Prospective Studies , Schools, Medical/organization & administration
Dig Dis Sci ; 66(12): 4557-4564, 2021 12.
Article in English | MEDLINE | ID: covidwho-1064547


Collagenous colitis (CC) is associated with non-bloody, watery diarrhea, which is pathophysiologically reasonable because normal colonic absorption (or excretion) of water and electrolytes can be blocked by the abnormally thick collagen layer in CC. However, CC has also been associated with six previous cases of protein-losing enteropathy (PLE), with no pathophysiologic explanation. The colon does not normally absorb (or excrete) amino acids/proteins, which is primarily the function of the small bowel. Collagenous duodenitis (CD) has not been associated with PLE. This work reports a novel case of CD (and CC) associated with PLE; a pathophysiologically reasonable mechanism for CD causing PLE (by the thick collagen layer of CD blocking normal intestinal amino acid absorption); and a novel association of PLE with severe COVID-19 infection (attributed to relative immunosuppression from hypoproteinemia, hypoalbuminemia, hypogammaglobulinemia, and malnutrition from PLE).

Amino Acids/metabolism , COVID-19/etiology , Colitis, Collagenous/complications , Duodenitis/complications , Duodenum/physiopathology , Intestinal Absorption , Intestinal Mucosa/physiopathology , Protein-Losing Enteropathies/etiology , Aged , COVID-19/diagnosis , COVID-19/drug therapy , COVID-19/physiopathology , Colitis, Collagenous/diagnosis , Colitis, Collagenous/physiopathology , Colitis, Collagenous/therapy , Duodenitis/diagnosis , Duodenitis/physiopathology , Duodenitis/therapy , Duodenum/metabolism , Female , Fluid Therapy , Glucocorticoids/therapeutic use , Humans , Intestinal Mucosa/metabolism , Nutritional Status , Parenteral Nutrition, Total , Protein-Losing Enteropathies/diagnosis , Protein-Losing Enteropathies/physiopathology , Protein-Losing Enteropathies/therapy , Risk Factors , Treatment Outcome