Neurogastroenterology & Motility Manifestations After COVID-19 Infection: A Case Series

Introduction: In a subset of Covid19-convalescent patients, a multitude of long-term sequelae are increasingly being reported. We report 4 cases with varying neuro-GI and motility manifestations after recent COVID-19 infection. Case Description/Methods: Case 1: A 23-year-old man contracted COVID-19 and had a protracted course of respiratory illness. Despite resolution of respiratory symptoms and dysgeusia, he continued to experience early satiety, postprandial nausea, vomiting and unintentional weight loss. Gastric Emptying Scan (GES) revealed gastroparesis (Figure A). Dietary modification and metoclopramide led to symptomatic improvement. Case 2: A 39-year-old woman with migraines, suffered from Covid-19 infection where anosmia and respiratory symptoms lasted for 2 weeks. Despite resolution of initial symptoms, she started experiencing nausea and vomiting, and reported stereotypical symptoms with complete absence of vomiting between episodes. Endoscopic examination, CT head and GES were normal. Urine tox screen was negative for cannabinoids. She responded favorably to amitriptyline and ondansetron. Case 3: A 47-year-old man started experiencing severe constipation associated with abdominal pain and bloating soon after being diagnosed with COVID-19. Three months after resolution of respiratory symptoms, in addition to constipation, he began reporting postprandial fullness, early satiation and epigastric pain. GES showed gastroparesis ( figure B) and a Sitzmarks Study revealed delayed colonic transit (Figure C). Prucalopride was started, leading to improvement in symptoms. Case 4: A 74-year-old woman with obesity and diabetes, was hospitalized and intubated for severe respiratory distress due to COVID-19. After discharge, she had persistent symptoms of brain fog, fatigue, dyspnea as well as diarrhea and abdominal cramping, persisting despite loperamide and dicyclomine. C. difficile toxin, random colonic biopsies and H2 breath test were unremarkable. Her symptoms eventually improved with rifaximin. Discussion(s): We report 4 cases with post-COVID gastroparesis, cyclical vomiting syndrome, pan-gut dysmotility, and post-infectious IBS phenotypes.The pathophysiology of post-infectious-gut-brain disorders is still obscure. The current conceptual framework implicates acquired neuropathy, altered motility, intestinal barrier disruption and persistent intestinal inflammation. Similar pathophysiology may be involved in COVID-19 infection leading to sustained neurogastroenterological dysfunction and gut dysmotility.

PREVALENCE OF PEDIATRIC FUNCTIONAL GASTROINTESTINAL DISORDERS UTILIZING THE ROME IV CRITERIA IN 3 LATIN AMERICAN COUNTRIES

INTRODUCTION: According to ROMA IV (R-IV), in schoolchildren and adolescents in Colombia and Ecuador, the prevalence to present some functional gastrointestinal disorder (FGID) is 21.2%-22.3% being the main FGID the functional constipation (FC). There’s no data about infants and toddlers in latinoamerican countries (Latam). OBJECTIVE: To describe the prevalence of FGIDs in children in 3 Latam countries according to R-IV. METHODS: 11493 children in Colombia, Ecuador and Panama were included: 1382 infants aged 0-12 months (Group A, 7.3+/-3.7 months), 2631 toddlers aged 1-4 years (Group B, 2.5+/-0.9 years old), 2791 schoolchildren aged 8-12 years (Group C, 10.6+/-1.2 years) and 4689 adolescents aged 13-18 years (Group D, 14.8+/-1.4 years). FGIDs were identified through the Questionnaire of Pediatric Gastrointestinal Symptoms Rome IV (QPGS-IV). RESULTS: The prevalence to present some FGID was 15.8% in infants;23.3% in toddlers;21.1% in schoolchildren and 22.1% in adolescents;being the most frequent FGDI in the Group A, colic (7.6%), regurgitation (6.4%) and FC (4.7%);in the Group B, FC (17.6%), cyclic vomiting syndrome (5.4%) and functional diarrhea (0.3%);in the Group C, FC (12.5%), functional dyspepsia (2.8%) and irritable bowel syndrome (1.8%), and the Group D, FC (11.1%), functional dyspepsia (3.9%) and functional abdominal pain (1.9%). There were more FGDIs in infants with caesarean section (OR=1.7 95%CI=1.22-2.41 p=0.0010), toddlers with previous diarrhea (OR=1.7 95% CI=1.39-2.23 p=0.0000), in schoolchildren with previous dengue infection (OR=2.0 95%CI=1.24-3.25 p=0.0019) and adolescents in covid-19 confinement (OR=1.4 95%CI =1.13-1.78 p=0.0013). CONCLUSIONS: The prevalence for FGIDs was lower in infants whose main FGDI was colic;the FC was one of the main FGIDs in all the age groups, being associated in children younger than 4 years old to caesarean section and history of diarrhea and children between 8-18 years old to history of dengue and confinement.

COVID AND COVID VACCINATION AMONG OUTPATIENTS WITH FUNCTIONAL GI AND GI MOTILITY DISORDERS;EFFECTS ON GI SYMPTOMS

Introduction: The ongoing COVID pandemic from SARS-CoV-2 infection has posed healthcare challenges. COVID and even COVID vaccines have been reported to have effects on underlying GI conditions. Several efficacious vaccines with infrequent side effects are available. However, many eligible recipients are not getting vaccinated. Aims: The aims of this study were threefold: 1) Determine the prevalence of prior COVID infection and COVID vaccination in patients within a GI practice seeing primarily functional GI and GI motility disorders;2) Inquire as to why patients do not get vaccinated;and 3) Assess if COVID-19 illness or COVID vaccination provoked patient typical GI symptoms. Methods: Patients seen in clinical practice either in person or telemedicine were asked about COVID vaccination and prior COVID infection. If patients had not been vaccinated, they were asked the reasons for that decision. If patients had COVID and/or COVID vaccination, they were asked if either caused worsening of their typical GI symptoms. Results: 538 patients (414 females and 124 males;average age 49.1±17.7 years) were questioned about COVID vaccination and prior COVID-19 acquisition. Of these 538 patients, 105 had esophageal disorders, 358 had gastric disorders, and 88 had colonic disorders. 456 of the 538 (83.8%) had received a COVID-19 vaccination (Table 1). Of the 82 people not getting COVID vaccination, 13 people did not receive vaccine due to medical reasons (allergies, immune system disorders), 46 people were afraid or skeptical of the vaccine/the side effects, and 22 people considered it unnecessary. 72 of the 538 (13.4%) had contracted COVID at some time (7 after their COVID vaccine [breakthrough COVID]) (Table 2). 23/72 (32%) said their GI symptoms were exacerbated during their COVID infection, whereas 49/72 said there was no effect on their GI symptoms. Of the 23 patients who had their GI symptoms exacerbated by COVID, 3 had esophageal disorders,17 had gastric disorders (11 had idiopathic gastroparesis, 5 diabetic gastroparesis, and 1 with chronic abdominal pain), and 0 had colonic disorders. 8 of 456 (1.8%) vaccinated patients said their GI symptoms were exacerbated with the COVID vaccine (0 had esophageal disorders, 7 had gastric disorders [5 with idiopathic gastroparesis, 1 with cyclic vomiting syndrome, and 1 with diabetic gastroparesis], and 2 had colonic disorders). Conclusions: In this outpatient practice setting of functional and GI motility patients, 84% had been vaccinated and 13% had previously contracted COVID. Among patients with functional and GI motility disorders, naturally acquired COVID infection caused an aggravation of symptoms in an important proportion of patients (32%), especially in those with gastric disorders, particularly gastroparesis. Aggravation of symptoms rarely (<2%) occurred following administration of COVID vaccine. (Table Presented) (Table Presented)

Cyclic Vomiting: a late complication of COVID-19

The novel coronavirus disease (COVID-19) has caused a great pandemic since the end of 2019. A variety of symptoms have been identified for this disease. In this case series we report 5 patients in different age groups who presented with cyclic vomiting as a late complication of COVID-19. All patients have gone through complete diagnostic process for cyclic vomiting syndrome (CVS) including endoscopy. However, they all showed normal findings. The diagnosis of cyclic vomiting syndrome was made based on the symptoms and normal endoscopic and laboratory findings. We treated all of the patients applying the guideline we previously published regarding treatment of CVS patients. According to the results of the present study, CVS might be a late complication of COVID-19 infection. So, it is necessary for physicians to consider it as a differential diagnosis in patients with recent COVID-19 infection and to be aware of its management in each phase. © 2021, University Hospital of Infectious Diseases. All rights reserved.