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1.
BMJ Case Rep ; 13(12)2020 Dec 22.
Article in English | MEDLINE | ID: covidwho-1020892

ABSTRACT

An 87-year-old woman presented to us with a 5-day history of worsening epigastric pain and vomiting. Her medical history included known gallstones and a previous episode of acute cholecystitis complicated by a perforated gallbladder for which she had declined surgery 5 years prior. Radiological imaging confirmed a large gallstone impacted in the first part of the duodenum with gross gastric outlet obstruction and pneumobilia, confirming the diagnosis of Bouveret syndrome, an often overlooked and rare variant of gallstone ileus. Following an unsuccessful oesophagogastroduodenoscopy for stone retrieval, she underwent a laparotomy and gastrotomy with a successful outcome and discharged from hospital 4 weeks following the procedure.


Subject(s)
Duodenal Obstruction/diagnosis , Gallstones/complications , Gastric Outlet Obstruction/diagnosis , Ileus/diagnosis , Aged, 80 and over , Duodenal Obstruction/etiology , Duodenal Obstruction/surgery , Duodenum/diagnostic imaging , Duodenum/surgery , Endoscopy, Digestive System , Female , Gallbladder/diagnostic imaging , Gallstones/diagnosis , Gallstones/surgery , Gastric Outlet Obstruction/etiology , Gastric Outlet Obstruction/surgery , Humans , Ileus/etiology , Ileus/surgery , Stomach/diagnostic imaging , Stomach/surgery , Syndrome , Tomography, X-Ray Computed , Treatment Outcome , Ultrasonography
2.
Eur J Gastroenterol Hepatol ; 32(12): 1523-1526, 2020 12.
Article in English | MEDLINE | ID: covidwho-1020322

ABSTRACT

OBJECTIVES: Recent guidelines for celiac disease have allowed a biopsy-free approach in endomysial antibodies (EMAs) positive children with high antitransglutaminase (TGA-IgA) titer [>10 time upper limit of normal (ULN)]. Esophagogastroduodenoscopy is still necessary for diagnosis in children with lower title. Because elective pediatric endoscopy has been substantially shouted down during coronavirus disease (COVID-19) pandemic, many children remained undiagnosed - and therefore untreated - for a long time. We aimed to analyze the feasibility and accuracy of a biopsy-free approach in suspected celiac disease children with TGA-IgA values <10 ULN to facilitate the diagnostic process by avoiding endoscopy. METHODS: In this study cohort, we retrospectively analyzed all biopsy-confirmed diagnosis of celiac disease in our center (between 2014 and 2019). The positive predictive value (PPV) of TGA-IgA titers between 5 and 10 ULN and positive EMA in diagnosing celiac disease were determined. Mucosal atrophy and resolution of symptoms after gluten-free diet (GFD) were considered to confirm initial diagnosis. RESULTS: Of 430 celiac disease patients (F: 274; mean age 7.54 years) diagnosed by endoscopy, 84 (F: 46; mean age 8 years) with TGA-IgA between 5 and 10 ULN and positive EMA were identified. The PPV of TGA-IgA between 5 and 10 ULN and positive EMA was 0.93 (95% confidence interval 0.90-0.96). All these children had a symptom resolution and antibodies normalization after GFD. CONCLUSION: During the COVID-19 outbreak, a temporarily reduction of the TGA-IgA threshold for biopsy-sparing approach seems feasible in EMA positive children with TGA-IgA between 5 and 10 ULN.


Subject(s)
Autoantibodies/blood , Betacoronavirus , Celiac Disease/diagnosis , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Practice Guidelines as Topic , Transglutaminases/immunology , Autoantibodies/immunology , Biopsy , Celiac Disease/epidemiology , Celiac Disease/immunology , Child , Comorbidity , Coronavirus Infections/enzymology , Coronavirus Infections/immunology , Endoscopy, Digestive System , Female , Humans , Male , Pandemics , Pneumonia, Viral/enzymology , Pneumonia, Viral/immunology , Retrospective Studies , Transglutaminases/blood
4.
Gastroenterol Hepatol ; 43(8): 464-471, 2020 Oct.
Article in English, Spanish | MEDLINE | ID: covidwho-733849

ABSTRACT

The SARS-CoV-2 pandemic is leading to high mortality and a global health crisis. The primary involvement is respiratory; however, the virus can also affect other organs, such as the gastrointestinal tract and liver. The most common symptoms are anorexia and diarrhea. In about half of the cases, viral RNA could be detected in the stool, which is another line of transmission and diagnosis. covid19 has a worse prognosis in patients with comorbidities, although there is not enough evidence in case of previous digestive diseases. Digestive endoscopies may give rise to aerosols, which make them techniques with a high risk of infection. Experts and scientific organizations worldwide have developed guidelines for preventive measures. The available evidence on gastrointestinal and hepatic involvement, the impact on patients with previous digestive diseases and operating guidelines for Endoscopy Units during the pandemic are reviewed.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/complications , Digestive System Diseases/etiology , Digestive System/virology , Pandemics , Pneumonia, Viral/complications , Aerosols , Anorexia/etiology , Antiviral Agents/adverse effects , Betacoronavirus/isolation & purification , Betacoronavirus/physiology , Cohort Studies , Coronavirus Infections/drug therapy , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Diarrhea/etiology , Digestive System Diseases/virology , Endoscopy, Digestive System/adverse effects , Feces/virology , Humans , Immunosuppressive Agents/adverse effects , Intestines/chemistry , Intestines/virology , Liver Diseases/etiology , Multicenter Studies as Topic , Pandemics/prevention & control , Peptidyl-Dipeptidase A/analysis , Peptidyl-Dipeptidase A/physiology , Personal Protective Equipment , Pneumonia, Viral/drug therapy , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Receptors, Virus/analysis , Receptors, Virus/physiology , Risk , Universal Precautions
5.
Gut ; 69(11): 1915-1924, 2020 11.
Article in English | MEDLINE | ID: covidwho-724057

ABSTRACT

The COVID-19 pandemic has had a profound impact on provision of endoscopy services globally as staff and real estate were repurposed. As we begin to recover from the pandemic, a cohesive international approach is needed, and guidance on how to resume endoscopy services safely to avoid unintended harm from diagnostic delays. The aim of these guidelines is to provide consensus recommendations that clinicians can use to facilitate the swift and safe resumption of endoscopy services. An evidence-based literature review was carried out on the various strategies used globally to manage endoscopy during the COVID-19 pandemic and control infection. A modified Delphi process involving international endoscopy experts was used to agree on the consensus statements. A threshold of 80% agreement was used to establish consensus for each statement. 27 of 30 statements achieved consensus after two rounds of voting by 34 experts. The statements were categorised as pre-endoscopy, during endoscopy and postendoscopy addressing relevant areas of practice, such as screening, personal protective equipment, appropriate environments for endoscopy and infection control precautions, particularly in areas of high disease prevalence. Recommendations for testing of patients and for healthcare workers, appropriate locations of donning and doffing areas and social distancing measures before endoscopy are unique and not dealt with by any other guidelines. This international consensus using a modified Delphi method to produce a series of best practice recommendations to aid the safe resumption of endoscopy services globally in the era of COVID-19.


Subject(s)
Coronavirus Infections/prevention & control , Cross Infection/prevention & control , Endoscopy, Digestive System/statistics & numerical data , Occupational Health , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Practice Guidelines as Topic , Consensus , Coronavirus Infections/epidemiology , Delphi Technique , Endoscopy, Digestive System/methods , Female , Follow-Up Studies , Humans , Incidence , Internationality , Male , Pandemics/statistics & numerical data , Patient Safety , Pneumonia, Viral/epidemiology , Risk Assessment , Time Factors , United States
7.
Br J Hosp Med (Lond) ; 81(7): 1-7, 2020 Jul 02.
Article in English | MEDLINE | ID: covidwho-690608

ABSTRACT

BACKGROUND: COVID-19 has caused an unprecedented pandemic and medical emergency that has changed routine care pathways. This article discusses the extent of aerosolisation of severe acute respiratory syndrome coronavirus 2, the virus that causes COVID-19, as a result of oesophagogastroduodenoscopy and colonoscopy. METHODS: PubMed and Google Scholar were searched for relevant publications, using the terms COVID-19 aerosolisation, COVID-19 infection, COVID-19 transmission, COVID-19 pandemic, COVID-19 and endoscopy, Endoscopy for COVID-19 patients. RESULTS: A total of 3745 articles were identified, 26 of which were selected to answer the question of the extent of SARS-CoV-2 aerosolisation during upper and lower gastrointestinal endoscopy. All studies suggested high infectivity from contact and droplet spread. No clinical study has yet reported the viral load in the aerosol and therefore the infective dose has not been accurately determined. However, aerosol-generating procedures are potentially risky and full personal protective equipment should be used. CONCLUSIONS: As it is a highly infectious disease, clinicians treating patients with COVID-19 require effective personal protective equipment. The main routes of infection are direct contact and droplets in the air and on surfaces. Aerosolisation carries a substantial risk of infection, so any aerosol-producing procedure, such as endoscopy, should be performed wearing personal protective equipment and with extra caution to protect the endoscopist, staff and patients from cross-infection via the respiratory system.


Subject(s)
Colonoscopy/adverse effects , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Endoscopy, Digestive System/adverse effects , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Volatilization , Aerosols/adverse effects , Air Pollutants, Occupational/adverse effects , Betacoronavirus , Humans , Infection Control , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Personal Protective Equipment
8.
Korean J Gastroenterol ; 76(1): 4-8, 2020 07 25.
Article in English, Korean | MEDLINE | ID: covidwho-675920

ABSTRACT

The World Health Organization (WHO) declared the worldwide pandemic of Coronavirus disease-2019 (COVID-19) On March 11, 2020, just three months after the first outbreak of COVID-19 caused by Severe Acute Respiratory Syndrome Coronavirus 2 in China in December 2019. COVID-19 is a contagious disease that can affect anyone, anytime, anywhere, and has had a huge impact on our lives, including social, economic, educational, and cultural life. In this paper, I would like to explore the issues related to COVID-19 in the gastroenterology and share the experiences of domestic and overseas gastroenterologists, and ultimately to seek ways to effectively prepare for and cope with the pandemic era of COVID-19.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/pathology , Gastroenterologists/psychology , Pneumonia, Viral/pathology , Betacoronavirus/isolation & purification , Betacoronavirus/metabolism , Coronavirus Infections/transmission , Coronavirus Infections/virology , Endoscopy, Digestive System , Gastrointestinal Tract/metabolism , Humans , Pandemics , Peptidyl-Dipeptidase A/metabolism , Pneumonia, Viral/transmission , Pneumonia, Viral/virology
11.
Gastroenterol Hepatol ; 43(8): 464-471, 2020 Oct.
Article in English, Spanish | MEDLINE | ID: covidwho-611816

ABSTRACT

The SARS-CoV-2 pandemic is leading to high mortality and a global health crisis. The primary involvement is respiratory; however, the virus can also affect other organs, such as the gastrointestinal tract and liver. The most common symptoms are anorexia and diarrhea. In about half of the cases, viral RNA could be detected in the stool, which is another line of transmission and diagnosis. covid19 has a worse prognosis in patients with comorbidities, although there is not enough evidence in case of previous digestive diseases. Digestive endoscopies may give rise to aerosols, which make them techniques with a high risk of infection. Experts and scientific organizations worldwide have developed guidelines for preventive measures. The available evidence on gastrointestinal and hepatic involvement, the impact on patients with previous digestive diseases and operating guidelines for Endoscopy Units during the pandemic are reviewed.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/complications , Digestive System Diseases/etiology , Digestive System/virology , Pandemics , Pneumonia, Viral/complications , Aerosols , Anorexia/etiology , Antiviral Agents/adverse effects , Betacoronavirus/isolation & purification , Betacoronavirus/physiology , Cohort Studies , Coronavirus Infections/drug therapy , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Diarrhea/etiology , Digestive System Diseases/virology , Endoscopy, Digestive System/adverse effects , Feces/virology , Humans , Immunosuppressive Agents/adverse effects , Intestines/chemistry , Intestines/virology , Liver Diseases/etiology , Multicenter Studies as Topic , Pandemics/prevention & control , Peptidyl-Dipeptidase A/analysis , Peptidyl-Dipeptidase A/physiology , Personal Protective Equipment , Pneumonia, Viral/drug therapy , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Receptors, Virus/analysis , Receptors, Virus/physiology , Risk , Universal Precautions
16.
Am J Gastroenterol ; 115(8): 1153-1155, 2020 08.
Article in English | MEDLINE | ID: covidwho-525850
17.
Rev. colomb. gastroenterol ; 35(supl.1)2020.
Article in Spanish | LILACS (Americas) | ID: covidwho-526059

ABSTRACT

Los procedimientos endoscópicos, al estar asociados a la exposición de la vía aérea superior, tienen un mayor riesgo de transmisión del virus SARS-CoV-2; por esta razón, es necesario el planteamiento de in-tervenciones para atenuar o eliminar la exposición a éste. En este artículo nos permitimos presentar una estrategia de mitigación de bajo costo, ya que con el progreso de la pandemia se podría estar en un estado de austeridad de recursos económicos, lo cual haría estos dispositivos totalmente válidos.(AU)


Endoscopic procedures, as they are associated with exposure of the upper airway, have a higher risk of transmission of the SARS-CoV-2 virus; so, it is necessary to consider interventions to mitigate or eliminate ex-posure to it. In this article, we allow ourselves to present a low-cost mitigation strategy, since with the progress of the pandemic it could be in a state of austerity of economic resources, making these devices totally valid.(AU)


Subject(s)
Humans , Respiratory Protective Devices/standards , Endoscopy, Digestive System/instrumentation , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Cost-Benefit Analysis/economics
19.
Dig Dis Sci ; 65(7): 1932-1939, 2020 07.
Article in English | MEDLINE | ID: covidwho-343558

ABSTRACT

The month of December 2019 became a critical part of the time of humanity when the first case of coronavirus disease 2019 (COVID-19) was reported in the Wuhan, Hubei Province in China. As of April 13th, 2020, there have been approximately 1.9 million cases and 199,000 deaths across the world, which were associated with COVID-19. The COVID-19 is the seventh coronavirus to be identified to infect humans. In the past, Severe Acute Respiratory Syndrome and Middle East Respiratory Syndrome were the two coronaviruses that infected humans with a high fatality, particularly among the elderly. Fatalities due to COVID-19 are higher in patients older than 50 years of age or those with multimorbid conditions. The COVID-19 is mainly transmitted through respiratory droplets, with the most common symptoms being high fever, cough, myalgia, atypical symptoms included sputum production, headache, hemoptysis and diarrhea. However, the incubation period can range from 2 to 14 days without any symptoms. It is particularly true with gastrointestinal (GI) symptoms in which patients can still shed the virus even after pulmonary symptoms have resolved. Given the high percentage of COVID-19 patients that present with GI symptoms (e.g., nausea and diarrhea), screening patients for GI symptoms remain essential. Recently, cases of fecal-oral transmission of COVID-19 have been confirmed in the USA and China, indicating that the virus can replicate in both the respiratory and digestive tract. Moreover, the epidemiology, clinical characteristics, diagnostic procedures, treatments and prevention of the gastrointestinal manifestations of COVID-19 remain to be elucidated.


Subject(s)
Coronavirus Infections/physiopathology , Diarrhea/physiopathology , Nausea/physiopathology , Pneumonia, Viral/physiopathology , Vomiting/physiopathology , Betacoronavirus/physiology , Coronavirus Infections/immunology , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Cytokine Release Syndrome/immunology , Cytokines/immunology , Diarrhea/immunology , Endoscopy, Digestive System , Feces/virology , Humans , Nausea/immunology , Pandemics/prevention & control , Pneumonia, Viral/immunology , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Viral Tropism , Virus Shedding , Vomiting/immunology
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