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2.
Aging (Albany NY) ; 12(15): 15771-15783, 2020 08 15.
Article in English | MEDLINE | ID: covidwho-721665

ABSTRACT

During the COVID-19 outbreak, some patients with COVID-19 pneumonia also suffered from acute abdomen requiring surgical treatment; however, there is no consensus for the treatment of such patients. In this study, we retrospectively reviewed 34 patients with acute abdomen who underwent emergency surgery during the COVID-19 outbreak. Among the 34 patients with acute abdomen, a total of six cases were found with COVID-19 pneumonia (clinical classification for COVID-19 pneumonia: all were the common type). On the premise of similar demographics between both groups, patients with COVID-19 pneumonia had worse indicators of liver and coagulation function. Compared with acute abdomen patients without COVID-19, patients with COVID-19 pneumonia had a longer hospital stay, but there were no significant differences in postsurgical complications (P = 0.58) or clinical outcomes (P = 0.56). In addition, an obvious resolution of lung inflammation after surgery was observed in five COVID-19 patients (83.3%). No new COVID-19 cases occurred during the patients' hospital stays. Therefore, for the common type of COVID-19 pneumonia, emergency surgery could not only improve the outcomes of COVID-19 pneumonia patients with acute abdomen, but also benefit the resolution of pulmonary inflammation.


Subject(s)
Abdomen, Acute , Coronavirus Infections , Emergency Treatment , Gastrointestinal Diseases , Pandemics , Pneumonia, Viral , Surgical Procedures, Operative , Abdomen, Acute/diagnosis , Abdomen, Acute/epidemiology , Abdomen, Acute/etiology , Abdomen, Acute/surgery , Aged , Betacoronavirus/isolation & purification , Blood Coagulation Tests/methods , China/epidemiology , Comorbidity , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/physiopathology , Emergency Treatment/methods , Emergency Treatment/statistics & numerical data , Female , Gastrointestinal Diseases/epidemiology , Gastrointestinal Diseases/physiopathology , Humans , Length of Stay/statistics & numerical data , Liver Function Tests/methods , Male , Middle Aged , Outcome and Process Assessment, Health Care , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/etiology , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , Surgical Procedures, Operative/methods , Surgical Procedures, Operative/trends
4.
Dtsch Med Wochenschr ; 145(15): 1033-1038, 2020 Jul.
Article in German | MEDLINE | ID: covidwho-691080

ABSTRACT

COVID 19, caused by SARS-CoV2, a new variant of coronaviruses, typically presents with respiratory symptoms. However, in a significat number of patients different organs are involved in the disease, often including gastrointestinal symptoms. These could include loss of appetite, vomiting, abdominal pain and diarrhea, with diarrhea being associated with a more severe course of COVID-19. Because viral RNA can be detected in fecal samples, some implications for clinical routine in diagnostic and therapeutic procedures are grown. Until yet, no clear evidence is given regarding fecal-oral transmission of SARS-CoV2.


Subject(s)
Coronavirus Infections , Gastrointestinal Diseases , Pandemics , Pneumonia, Viral , Anorexia , Betacoronavirus , Coronavirus Infections/complications , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Diarrhea , Gastrointestinal Diseases/epidemiology , Gastrointestinal Diseases/therapy , Gastrointestinal Diseases/virology , Humans , Pneumonia, Viral/complications , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Vomiting
5.
Gastroenterology ; 159(1): 320-334.e27, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-683713

ABSTRACT

BACKGROUND & AIMS: Multiple gastrointestinal (GI) symptoms, including diarrhea, nausea/vomiting, and abdominal pain, as well as liver enzyme abnormalities, have been variably reported in patients with coronavirus disease 2019 (COVID-19). This document provides best practice statements and recommendations for consultative management based on a systematic review and meta-analysis of international data on GI and liver manifestations of COVID-19. METHODS: We performed a systematic literature search to identify published and unpublished studies using OVID Medline and preprint servers (medRxiv, LitCovid, and SSRN) up until April 5, 2020; major journal sites were monitored for US publications until April 19, 2020. We pooled the prevalence of diarrhea, nausea, vomiting, and abdominal pain, as well as liver function tests abnormalities, using a fixed-effect model and assessed the certainty of evidence using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework. RESULTS: We identified 118 studies and used a hierarchal study selection process to identify unique cohorts. We performed a meta-analysis of 47 studies including 10,890 unique patients. Pooled prevalence estimates of GI symptoms were as follows: diarrhea 7.7% (95% confidence interval [CI], 7.2%-8.2%), nausea/vomiting 7.8% (95% CI, 7.1%-8.5%), and abdominal pain 2.7% (95% CI, 2.0%-3.4%). Most studies reported on hospitalized patients. The pooled prevalence estimates of elevated liver abnormalities were as follows: aspartate transaminase 15.0% (95% CI, 13.6%-16.5%) and alanine transaminase 15.0% (95% CI, 13.6%-16.4%). When we compared studies from China to studies from other countries in subgroup analyses, diarrhea, nausea/vomiting, and liver abnormalities were more prevalent outside of China, with diarrhea reported in 18.3% (95% CI, 16.6%-20.1%). Isolated GI symptoms were reported rarely. We also summarized the Gl and liver adverse effects of the most commonly utilized medications for COVID-19. CONCLUSIONS: GI symptoms are associated with COVID-19 in <10% of patients. In studies outside of China, estimates are higher. Further studies are needed with standardized GI symptoms questionnaires and liver function test checks on admission to better quantify and qualify the association of these symptoms with COVID-19. Based on findings from our meta-analysis, we provide several Best Practice Statements for the consultative management of COVID-19.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/complications , Gastrointestinal Diseases/diagnosis , Liver Diseases/diagnosis , Pneumonia, Viral/complications , Practice Guidelines as Topic , Referral and Consultation/standards , Antiviral Agents/adverse effects , Betacoronavirus/isolation & purification , Clinical Laboratory Techniques/standards , Coronavirus Infections/diagnosis , Coronavirus Infections/drug therapy , Coronavirus Infections/virology , Gastroenterology/standards , Gastrointestinal Diseases/epidemiology , Gastrointestinal Diseases/therapy , Gastrointestinal Diseases/virology , Gastrointestinal Tract/drug effects , Gastrointestinal Tract/virology , Humans , Liver/drug effects , Liver/virology , Liver Diseases/epidemiology , Liver Diseases/therapy , Liver Diseases/virology , Liver Function Tests , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/drug therapy , Pneumonia, Viral/virology , Prevalence , Societies, Medical/standards , United States
6.
Eur Rev Med Pharmacol Sci ; 24(13): 7506-7511, 2020 07.
Article in English | MEDLINE | ID: covidwho-676562

ABSTRACT

OBJECTIVE: The Coronavirus Disease 2019 (COVID-19) pandemic mainly involves respiratory symptoms, though gastrointestinal (GI) symptoms are increasingly being recognized. In this context, the presence of comorbidities appears to be associated with adverse outcomes. However, the role of digestive manifestations is not yet well defined. The primary aim of this study was to assess the prevalence of GI symptoms and digestive comorbidities in a cohort of patients with COVID-19 compared to controls. The secondary aim was to determine the association of GI-symptoms and digestive comorbidities with clinical outcomes. PATIENTS AND METHODS: Inpatients with COVID-19 and controls with similar symptoms and/or radiological findings were enrolled. Symptoms at admission and throughout hospitalization were collected as they were comorbidities. The measured clinical outcomes were mortality, intensive care unit admission and cumulative endpoint. RESULTS: A total of 105 patients were included: 34 with COVID-19 and 71 controls. At admission, the prevalence of GI symptoms among COVID-19 patients was 8.8%. During hospitalization, the frequency of GI symptoms was higher in patients with COVID-19 than in controls (p=0.004). Among patients with COVID-19, the mortality and a cumulative endpoint rates of those with GI symptoms were both lower than for those without GI symptoms (p=0.016 and p=0.000, respectively). Finally, we found digestive comorbidities to be associated with a milder course of COVID-19 (p=0.039 for cumulative endpoint). CONCLUSIONS: Our results highlighted the non-negligible frequency of GI symptoms in patients with COVID-19, partly attributable to the therapies implemented. In addition, the presence of GI symptoms and digestive comorbidities is associated with better outcomes. Most likely, digestive comorbidities do not hinder the host's immune response against SARS-COV-2, and the occurrence of GI symptoms might be linked to a faster reduction of the viral load via the faecal route.


Subject(s)
Antiviral Agents/pharmacology , Betacoronavirus/drug effects , Coronavirus Infections/drug therapy , Gastrointestinal Diseases/drug therapy , Pneumonia, Viral/drug therapy , Aged , Aged, 80 and over , Case-Control Studies , Cohort Studies , Comorbidity , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Female , Gastrointestinal Diseases/diagnosis , Gastrointestinal Diseases/epidemiology , Humans , Italy , Male , Microbial Sensitivity Tests , Middle Aged , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Prospective Studies
7.
Scand J Gastroenterol ; 55(8): 1005-1011, 2020 08.
Article in English | MEDLINE | ID: covidwho-638746

ABSTRACT

While the COVID-19 pandemic evolves, we are beginning to understand the role the gastrointestinal tract plays in the disease and the impact of the infection on the care of patients with gastrointestinal (GI) and liver diseases. We review the data and understanding around the virus related to the digestive tract, impact of the pandemic on delivery of GI services and daily gastroenterology clinical practice, and the effects on patients with pre-existing GI diseases.


Subject(s)
Coronavirus Infections/epidemiology , Gastroenterology/organization & administration , Health Services Accessibility/statistics & numerical data , Infection Control/organization & administration , Pandemics/statistics & numerical data , Patient Care Team/organization & administration , Pneumonia, Viral/epidemiology , Communicable Disease Control/organization & administration , Coronavirus Infections/prevention & control , Female , Gastrointestinal Diseases/diagnosis , Gastrointestinal Diseases/epidemiology , Gastrointestinal Diseases/therapy , Health Personnel/organization & administration , Humans , Male , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Practice Guidelines as Topic , United States
8.
JMIR Public Health Surveill ; 6(3): e19354, 2020 07 17.
Article in English | MEDLINE | ID: covidwho-637869

ABSTRACT

BACKGROUND: Coronavirus disease (COVID-19) is a novel viral illness that has rapidly spread worldwide. While the disease primarily presents as a respiratory illness, gastrointestinal symptoms such as diarrhea have been reported in up to one-third of confirmed cases, and patients may have mild symptoms that do not prompt them to seek medical attention. Internet-based infodemiology offers an approach to studying symptoms at a population level, even in individuals who do not seek medical care. OBJECTIVE: This study aimed to determine if a correlation exists between internet searches for gastrointestinal symptoms and the confirmed case count of COVID-19 in the United States. METHODS: The search terms chosen for analysis in this study included common gastrointestinal symptoms such as diarrhea, nausea, vomiting, and abdominal pain. Furthermore, the search terms fever and cough were used as positive controls, and constipation was used as a negative control. Daily query shares for the selected symptoms were obtained from Google Trends between October 1, 2019 and June 15, 2020 for all US states. These shares were divided into two time periods: pre-COVID-19 (prior to March 1) and post-COVID-19 (March 1-June 15). Confirmed COVID-19 case numbers were obtained from the Johns Hopkins University Center for Systems Science and Engineering data repository. Moving averages of the daily query shares (normalized to baseline pre-COVID-19) were then analyzed against the confirmed disease case count and daily new cases to establish a temporal relationship. RESULTS: The relative search query shares of many symptoms, including nausea, vomiting, abdominal pain, and constipation, remained near or below baseline throughout the time period studied; however, there were notable increases in searches for the positive control symptoms of fever and cough as well as for diarrhea. These increases in daily search queries for fever, cough, and diarrhea preceded the rapid rise in number of cases by approximately 10 to 14 days. The search volumes for these terms began declining after mid-March despite the continued rises in cumulative cases and daily new case counts. CONCLUSIONS: Google searches for symptoms may precede the actual rises in cases and hospitalizations during pandemics. During the current COVID-19 pandemic, this study demonstrates that internet search queries for fever, cough, and diarrhea increased prior to the increased confirmed case count by available testing during the early weeks of the pandemic in the United States. While the search volumes eventually decreased significantly as the number of cases continued to rise, internet query search data may still be a useful tool at a population level to identify areas of active disease transmission at the cusp of new outbreaks.


Subject(s)
Coronavirus Infections/diagnosis , Gastrointestinal Diseases/epidemiology , Pandemics , Pneumonia, Viral/diagnosis , Public Health Surveillance/methods , Search Engine/statistics & numerical data , Coronavirus Infections/epidemiology , Humans , Pneumonia, Viral/epidemiology , United States/epidemiology
9.
Am J Physiol Gastrointest Liver Physiol ; 319(2): G245-G252, 2020 08 01.
Article in English | MEDLINE | ID: covidwho-637284

ABSTRACT

In addition to the typical respiratory response, new coronavirus disease 2019 (COVID-19) is also associated with very common gastrointestinal symptoms. Cases with gastrointestinal symptoms are more likely to be complicated by liver injury and acute respiratory distress syndrome (ARDS). If not treated in time, coma and circulatory failure may ensue. As severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infects the human body through the combination of angiotensin-converting enzyme 2 (ACE2) in the gastrointestinal tract, the mechanism underlying the gastrointestinal symptoms may involve damage to the intestinal mucosal barrier and promotion of the production of inflammatory factors. Indeed, after cells in the lungs become infected by SARS-CoV-2, effector CD4+ T cells reach the small intestine through the gut-lung axis, causing intestinal immune damage and diarrhea; early extensive use of antibacterial and antiviral drugs can also lead to diarrhea in patients. Thus, treatment options for COVID-19 patients should be promptly adjusted when they have gastrointestinal symptoms. As SARS-CoV-2 has been detected in the feces of COVID-19 patients, future prevention and control efforts must consider the possibility of fecal-oral transmission of the virus.


Subject(s)
Betacoronavirus/physiology , Coronavirus Infections , Gastrointestinal Diseases , Gastrointestinal Tract , Pandemics , Pneumonia, Viral , Antiviral Agents/pharmacology , Coronavirus Infections/metabolism , Coronavirus Infections/physiopathology , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Gastrointestinal Diseases/epidemiology , Gastrointestinal Diseases/physiopathology , Gastrointestinal Diseases/therapy , Gastrointestinal Diseases/virology , Gastrointestinal Tract/metabolism , Gastrointestinal Tract/physiopathology , Gastrointestinal Tract/virology , Humans , Incidence , Infection Control/methods , Pandemics/prevention & control , Patient Selection , Peptidyl-Dipeptidase A/metabolism , Pneumonia, Viral/metabolism , Pneumonia, Viral/physiopathology , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission
10.
Pol Arch Intern Med ; 130(6): 501-505, 2020 06 25.
Article in English | MEDLINE | ID: covidwho-618056

ABSTRACT

INTRODUCTION: The coronavirus disease 2019 (COVID 19) is a communicable disease caused by a novel coronavirus. OBJECTIVES: This study aimed to assess self­reported frequency of gastrointestinal symptoms and olfactory or taste disorders in nonhospitalized patients with COVID­19 in Poland. PATIENTS AND METHODS: This cross­sectional survey was conducted between April 17 and 18, 2020, in 4516 nonhospitalized patients with COVID­19 in Poland. The questionnaire included 8 questions related to the health status, symptoms of COVID­19, comorbidities, and smoking status. RESULTS: Completed questionnaires were obtained from 1942 patients with COVID­19 with a response rate of 43%. The median age of the respondents was 50 years; 60.2% were women. Among nonhospitalized patients with COVID­19, 21.3% had hypertension, 4.5% had diabetes, and 3.1% had a chronic respiratory disease. Regular tobacco use was declared by 11.2% of patients with COVID­19. At least one gastrointestinal symptom was reported by 53.6% of patients. Almost half of patients (47%) with COVID­19 reported lack of appetite and 24.2% reported diarrhea. Among 1942 interviewed patients, 54.2% reported at least 1 olfactory or taste disorder and 42.5% reported both alterations. Self­reported olfactory and taste disorders were 49.2% and 47.5%, respectively. Self­reported frequency of gastrointestinal symptoms and olfactory or taste disorders during COVID­19 was significantly higher (P <0.001) in women than men. CONCLUSIONS: This study demonstrated that olfactory and taste disorders are frequent symptoms in patients with mild­to­moderate COVID­19. Moreover, our study indicated sex differences in the frequency of gastrointestinal symptoms and olfactory or taste disorders among nonhospitalized patients with COVID­19.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Gastrointestinal Diseases/epidemiology , Pneumonia, Viral/epidemiology , Taste Disorders/epidemiology , Adult , Comorbidity , Coronavirus Infections/diagnosis , Cross-Sectional Studies , Digestive System/virology , Female , Gastrointestinal Diseases/diagnosis , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/diagnosis , Poland , Surveys and Questionnaires , Taste Disorders/diagnosis
11.
Rev Invest Clin ; 72(3): 165-177, 2020.
Article in English | MEDLINE | ID: covidwho-617019

ABSTRACT

Background: Regional information regarding the characteristics of patients with coronavirus disease (COVID)-19 is needed for a better understanding of the pandemic. Objective: The objective of the study to describe the clinical features of COVID-19 patients diagnosed in a tertiary-care center in Mexico City and to assess differences according to the treatment setting (ambulatory vs. hospital) and to the need of intensive care (IC). Methods: We conducted a prospective cohort, including consecutive patients with COVID-19 from February 26, 2020 to April 11, 2020. Results: We identified 309 patients (140 inpatients and 169 outpatients). The median age was 43 years (interquartile range, 33-54), 59.2% men, and 18.6% healthcare workers (12.3% from our center). The median body mass index (BMI) was 29.00 kg/m2 and 39.6% had obesity. Compared to outpatients, inpatients were older, had comorbidities, cough, and dyspnea more frequently. Twenty-nine (20.7%) inpatients required treatment in the IC unit (ICU). History of diabetes (type 1 or 2) and abdominal pain were more common in ICU patients compared to non-ICU patients. ICU patients had higher BMIs, higher respiratory rates, and lower room-air capillary oxygen saturations. ICU patients showed a more severe inflammatory response as assessed by white blood cell count, neutrophil and platelet count, C-reactive protein, ferritin, procalcitonin, and albumin levels. By the end of the study period, 65 inpatients had been discharged because of improvement, 70 continued hospitalized, and five had died. Conclusions: Patients with comorbidities, either middle-age obese or elderly complaining of fever, cough, or dyspnea, were more likely to be admitted. At admission, patients with diabetes, high BMI, and clinical or laboratory findings consistent with a severe inflammatory state were more likely to require IC.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Pandemics , Pneumonia, Viral/epidemiology , Abdominal Pain/epidemiology , Adult , Aged , Ambulatory Care , Biomarkers/blood , Body Mass Index , Comorbidity , Coronavirus Infections/complications , Coronavirus Infections/therapy , Critical Care , Dyspnea/etiology , Female , Gastrointestinal Diseases/epidemiology , Humans , Inpatients/statistics & numerical data , Male , Mexico , Middle Aged , Obesity/epidemiology , Outpatients/statistics & numerical data , Pneumonia, Viral/complications , Pneumonia, Viral/therapy , Severity of Illness Index , Tertiary Care Centers/statistics & numerical data , Treatment Outcome
13.
JAMA Netw Open ; 3(6): e2011335, 2020 06 01.
Article in English | MEDLINE | ID: covidwho-595662

ABSTRACT

Importance: Coronavirus disease 2019 (COVID-19) is a global pandemic and can involve the gastrointestinal (GI) tract, including symptoms like diarrhea and shedding of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in feces. Objective: To provide a pooled estimate of GI symptoms, liver enzyme levels outside reference ranges, and fecal tests positive for SARS-CoV-2 among patients with COVID-19. Data Sources: An electronic literature search was performed for published (using MEDLINE/PubMed and Embase) and preprint (using bioRxiv and medRxiv) studies of interest conducted from November 1, 2019, to March 30, 2020. Search terms included "COVID-19," "SARS-Cov-2," and/or "novel coronavirus." Study Selection: Eligible studies were those including patients with SARS-CoV-2 infection who reported GI symptoms. Data Extraction and Synthesis: Data on patients with GI symptoms (ie, diarrhea, nausea, or vomiting), liver enzyme level changes, and fecal shedding of virus were extracted. Quality of studies was examined using methodological index for nonrandomized studies. Pooled estimates (%) were reported with 95% CIs with level of heterogeneity (I2). Main Outcomes and Measures: Study and patient characteristics with pooled detection rates for diarrhea, nausea or vomiting, liver enzyme levels outside reference ranges, and SARS-CoV-2 positivity in feces tests were analyzed. Results: Of 1484 records reviewed, 23 published and 6 preprint studies were included in the analysis, with a total of 4805 patients (mean [SD] age, 52.2 [14.8] years; 1598 [33.2%] women) with COVID-19. The pooled rates were 7.4% (95% CI, 4.3%-12.2%) of patients reporting diarrhea and 4.6% (95% CI, 2.6%-8.0%) of patients reporting nausea or vomiting. The pooled rate for aspartate aminotransferase levels outside reference ranges was 20% (95% CI, 15.3%-25.6%) of patients, and the pooled rate for alanine aminotransferase levels outside reference ranges was 14.6% (95% CI, 12.8%-16.6%) of patients. Fecal tests that were positive for SARS-CoV-2 were reported in 8 studies, and viral RNA shedding was detected in feces in 40.5% (95% CI, 27.4%-55.1%) of patients. There was high level of heterogeneity (I2 = 94%), but no statistically significant publication bias noted. Conclusions and Relevance: These findings suggest that that 12% of patients with COVID-19 will manifest GI symptoms; however, SAR-CoV-2 shedding was observed in 40.5% of patients with confirmed SARS-CoV-2 infection. This highlights the need to better understand what measures are needed to prevent further spread of this highly contagious pathogen.


Subject(s)
Betacoronavirus , Coronavirus Infections/physiopathology , Feces/virology , Gastrointestinal Diseases/epidemiology , Pneumonia, Viral/physiopathology , Virus Shedding , Adult , Coronavirus Infections/complications , Coronavirus Infections/virology , Female , Gastrointestinal Diseases/virology , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/virology , Prevalence , Young Adult
14.
Mayo Clin Proc ; 95(8): 1632-1648, 2020 08.
Article in English | MEDLINE | ID: covidwho-592129

ABSTRACT

OBJECTIVE: To perform a systematic review and meta-analysis evaluating the prevalence of gastrointestinal (GI) symptoms and mortality in patients with coronavirus disease 2019 (COVID-19) diagnosed. METHODS: A systematic search of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus was performed from December 1, 2019 to May 7, 2020. Observational studies including adults with COVID-19 infection and reporting GI symptoms were included. The primary outcome was assessing the weighted pooled prevalence (WPP) of GI symptoms in patients with COVID-19 infection. Secondary outcomes were WPP of overall mortality, and mortality in patients with COVID-19 infection with GI symptoms. RESULTS: A total of 78 studies with 12,797 patients were included. Among GI symptoms (at onset of illness in 6, at admission in 17, data given separately for both in 3, and data unavailable in 52 studies), the WPP of diarrhea was 12.4% (95% CI, 8.2% to 17.1%), I2=94%; nausea and/or vomiting, 9.0% (95% CI, 5.5% to 12.9%), I2=93%; loss of appetite, 22.3% (95% CI, 11.2% to 34.6%, I2=94%; and abdominal pain, 6.2% (95% CI, 2.6% to 10.3%), I2=92%. Mortality among patients with GI symptoms (0.4%; 95% CI, 0% to 1.1%; I2=74%) was similar to overall mortality (2.1%; 95% CI, 0.2% to 4.7%; I2=94%), P=.15. Most studies had high risk of bias and overall quality of evidence was low to very low for all outcomes. CONCLUSION: Gastrointestinal symptoms are seen in up to 1 in 5 patients with COVID-19 infection. More high-quality evidence is needed to confirm these findings and explore factors causing mortality in these patients.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Gastrointestinal Diseases/virology , Pneumonia, Viral/complications , Adult , Coronavirus Infections/diagnosis , Coronavirus Infections/mortality , Gastrointestinal Diseases/epidemiology , Global Health , Humans , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/mortality
16.
World J Gastroenterol ; 26(19): 2323-2332, 2020 May 21.
Article in English | MEDLINE | ID: covidwho-482512

ABSTRACT

The severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) that causes coronavirus disease-2019 (COVID-19) is a global pandemic, manifested by an infectious pneumonia. Although patients primarily present with fever, cough and dyspnea, some patients also develop gastrointestinal (GI) and hepatic manifestations. The most common GI symptoms reported are diarrhea, nausea, vomiting, and abdominal discomfort. Liver chemistry abnormalities are common and include elevation of aspartate transferase, alanine transferase, and total bilirubin. Studies have shown that SARS-CoV-2 infects the GI tract via its viral receptor angiotensin converting enzyme II, which is expressed on enterocytes of the ileum and colon. Viral RNA has also been isolated from stool specimens of COVID-19 patients, which raised the concern for fecal-oral transmission in addition to droplet transmission. Although indirect evidence has suggested possible fecal-oral transmission of SARS-CoV-2, more effort is needed to establish the role of the fecal-oral transmission route. Further research will help elucidate the association between patients with underlying GI diseases, such as chronic liver disease and inflammatory bowel disease, and severity of COVID-19. In this review, we summarize the data on GI involvement to date, as well as the impact of COVID-19 on underlying GI diseases.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Gastrointestinal Diseases/virology , Liver Diseases/virology , Pneumonia, Viral/complications , Comorbidity , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Coronavirus Infections/virology , Disease Transmission, Infectious , Gastrointestinal Diseases/epidemiology , Gastrointestinal Diseases/etiology , Gastrointestinal Tract/virology , Humans , Inflammatory Bowel Diseases/epidemiology , Liver/virology , Liver Diseases/epidemiology , Liver Diseases/etiology , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Pneumonia, Viral/virology
17.
Clin Gastroenterol Hepatol ; 18(10): 2378-2379.e1, 2020 09.
Article in English | MEDLINE | ID: covidwho-457454

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an RNA virus responsible for coronavirus disease 2019 (COVID-19).1,2 The virus enters cells via the angiotensin-converting enzyme 2 receptor, which is present in enterocytes in the ileum and colon.3 Gastrointestinal (GI) manifestations include diarrhea, nausea, vomiting, and abdominal pain, and the prevalence of GI symptoms varies greatly, with a range between 2% and 57%.4 In addition, abnormal liver chemistries are reported commonly.4 As a medical center at the forefront of the early epidemic in the United States, we seek to contribute to the growing body of literature that outlines the gastrointestinal and hepatic manifestations of COVID-19.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Gastrointestinal Diseases/diagnosis , Liver Diseases/diagnosis , Pneumonia, Viral/complications , Aged , Coronavirus Infections/epidemiology , Female , Gastrointestinal Diseases/epidemiology , Gastrointestinal Diseases/etiology , Humans , Liver Diseases/epidemiology , Liver Diseases/etiology , Male , Middle Aged , New York/epidemiology , Pandemics , Pneumonia, Viral/epidemiology , Prevalence , Retrospective Studies
18.
Clin Gastroenterol Hepatol ; 18(10): 2366-2368.e3, 2020 09.
Article in English | MEDLINE | ID: covidwho-359348

ABSTRACT

Since February 2020, the COVID-19 pandemic has spread to Italy affecting more than 100,000 people. Several studies have reported a high prevalence of gastrointestinal (GI) symptoms, and investigated their potential association with clinical outcomes.1 The timing, clinical significance, and possible impact on viral spread of GI symptoms presentation have not been fully elucidated. Elevation of liver function tests and other laboratory values has also been reported; however, their prognostic significance has not been clearly established.2.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Gastrointestinal Diseases/diagnosis , Hospitals/statistics & numerical data , Pandemics , Pneumonia, Viral/complications , Aged , Coronavirus Infections/epidemiology , Female , Gastrointestinal Diseases/complications , Gastrointestinal Diseases/epidemiology , Humans , Italy/epidemiology , Male , Pneumonia, Viral/epidemiology , Prevalence
19.
Inflamm Bowel Dis ; 26(8): e89-e91, 2020 07 17.
Article in English | MEDLINE | ID: covidwho-343390

ABSTRACT

Severe Acute Respiratory Syndrome Coronavirus-2 (SAR-CoV-2) has been shown to invade brain tissue. Based on the evolutionary similarity with SARS-CoV, researchers propose that SARS-CoV-2 can invade the olfactory bulb and gastrointestinal (GI) system through angiotensin-converting enzyme 2. However, how SARS-CoV-2 causes neurological or GI symptoms is not clear. Many suggested intestinal and neural inflammations, caused by viral invasion, as the most likely reason for the GI and neurological symptoms; however, the patients with coronavirus disease 2019 (COVID-19) without neurological or GI symptoms indicate that this is not the case. The gut-brain axis could explain the reason for why some with COVID-19 do not have these symptoms. COVID-19 patients mostly show respiratory distress first, then diarrhea, anorexia, stroke, or loss of consciousness comes into view. Obviously, GI invasion is a mechanical process that begins with oral invasion and, therefore, most probably exists before the brain invasion, as indicated in case reports. However, when the GI tract is invaded, the virus may enter the central nervous system through vascular and lymphatic systems or the vagal nerve. SARS-CoV-2 can infect leukocytes and migrate with them into the brain, or the viral particles can be directly transported across the blood-brain barrier to the brain. Also, more recent research has revealed that SARS-CoV-2 can invade the peripheral lymphatic vessels connecting with the glymphatic system of the brain. The temporal correlation between neurological and gastrointestinal symptoms suggests the lymph vessels around the GI tract, the vascular system, or the gut-brain axis (enteric nervous system) as the most likely entry route for SARS-CoV-2 to the brain.


Subject(s)
Coronavirus Infections/epidemiology , Enteric Nervous System/physiopathology , Gastrointestinal Diseases/epidemiology , Nervous System Diseases/epidemiology , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Severe Acute Respiratory Syndrome/epidemiology , Comorbidity , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Female , Gastrointestinal Diseases/diagnosis , Gastrointestinal Diseases/microbiology , Global Health , Humans , Male , Nervous System Diseases/diagnosis , Nervous System Diseases/therapy , Neuropeptides , Oligopeptides , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Prevalence , Risk Assessment , Severe Acute Respiratory Syndrome/diagnosis , Severe Acute Respiratory Syndrome/therapy , Severity of Illness Index
20.
Eur J Clin Invest ; 50(9): e13276, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-260421

ABSTRACT

The coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 was declared in the last weeks as global pandemic. Currently affecting more than 5 000 000 individuals worldwide, COVID-19 is most commonly associated with symptoms caused by the acute respiratory distress syndrome (ARDS). As the number of infected individuals increases, we are learning that not only lungs, but also other organs can be affected by the virus. The gastrointestinal symptoms, for example diarrhoea, vomiting, nausea or abdominal pain, are frequent in patients with COVID-19. Moreover, alimentary tract symptoms may precede the respiratory presentation of SARS-CoV-2 infection. This can lead to delayed diagnosis and inappropriate management of infected patients. In addition, SARS-CoV-2 nucleic acid can be detected in faeces of infected patients and rectal swabs are even reported to remain positive for a longer period of time than nasopharyngeal swabs. Here, we aim to provide an update on the gastrointestinal involvement of COVID-19 presenting the symptoms that can be encountered in infected patients. We address the role of angiotensin-converting enzyme 2 (ACE2), as a functional receptor for SARS-CoV-2, which also was found in the gastrointestinal tract. Finally, we briefly discuss faecal shedding of SARS-CoV-2 and its potential role in the pathogenesis of the disease.


Subject(s)
Coronavirus Infections/epidemiology , Disease Transmission, Infectious/statistics & numerical data , Gastrointestinal Diseases/epidemiology , Pandemics/statistics & numerical data , Peptidyl-Dipeptidase A/blood , Pneumonia, Viral/epidemiology , Respiratory Distress Syndrome, Adult/epidemiology , Biomarkers/blood , Comorbidity , Coronavirus Infections/physiopathology , Disease Transmission, Infectious/prevention & control , Female , Gastrointestinal Diseases/physiopathology , Humans , Male , Pneumonia, Viral/physiopathology , Prognosis , Respiratory Distress Syndrome, Adult/diagnostic imaging , Risk Assessment
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