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2.
Abdom Radiol (NY) ; 45(9): 2613-2623, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-695728

ABSTRACT

PURPOSE: Some patients with novel coronavirus disease 2019 (COVID-2019) present with abdominal symptoms. Abdominal manifestations of COVID on imaging are not yet established. The goal of this study was to quantify the frequency of positive findings on abdominopelvic CT in COVID-positive patients, and to identify clinical factors associated with positive findings to assist with imaging triage. MATERIALS AND METHODS: This retrospective study included adult COVID-positive patients with abdominopelvic CT performed within 14 days of their COVID PCR nasal swab assay from 3/1/2020 to 5/1/2020. Clinical CT reports were reviewed for the provided indication and any positive abdominopelvic findings. Demographic and laboratory data closest to the CT date were recorded. Multivariate logistic regression model with binary outcome of having no reported positive abdominopelvic findings was constructed. RESULTS: Of 141 COVID-positive patients having abdominopelvic CT (average age 64 years [± 16], 91 [64%] women), 80 (57%) had positive abdominopelvic findings. Abdominal pain was the most common indication, provided in 54% (43/80) and 74% (45/61) of patients with and without reported positive abdominopelvic findings, respectively (p = 0.015). 70% (98/141) of patients overall had reported findings in the lung bases. Findings either typical or intermediate for COVID were reported in 50% (40/80) and 64% (39/61) of patients with and without positive abdominopelvic findings, respectively (p = 0.099). Of 80 patients with positive abdominopelvic findings, 25 (31%) had an abnormality of gastrointestinal tract, and 14 (18%) had solid organ infarctions or vascular thromboses. In multivariate analysis, age (OR 0.85, p = 0.023), hemoglobin (OR 0.83, p = 0.029) and male gender (OR 2.58, p = 0.032) were independent predictors of positive abdominopelvic findings, adjusted for race and Charlson comorbidity index. CONCLUSION: Abdominopelvic CT performed on COVID-positive patients yielded a positive finding in 57% of patients. Younger age, male gender, and lower hemoglobin were associated with higher odds of having reportable positive abdominopelvic CT findings.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Coronavirus Infections/diagnostic imaging , Gastrointestinal Diseases/diagnostic imaging , Gastrointestinal Diseases/etiology , Pneumonia, Viral/complications , Pneumonia, Viral/diagnostic imaging , Radiography, Abdominal/methods , Age Factors , Aged , Female , Humans , Male , Middle Aged , Pandemics , Pelvis/diagnostic imaging , Retrospective Studies , Sex Factors , Tomography, X-Ray Computed/methods
4.
Rev Gastroenterol Mex ; 85(3): 282-287, 2020.
Article in English, Spanish | MEDLINE | ID: covidwho-680708

ABSTRACT

BACKGROUND: There is an increasing number of reports on the presentation of gastrointestinal symptoms in cases of COVID-19. AIM: To review the studies reporting gastrointestinal symptoms in COVID-19. RESULTS: Fifteen articles (2,800 patients) were identified. Gastrointestinal symptom frequency varied from 3.0% to 39.6% and included diarrhea (7.5%), náusea (4.5%), anorexia (4.4%), vomiting (1.3%), abdominal pain (0.5%), and belching/reflux (0.3%). Those symptoms can be the first manifestation of COVID-19, but whether they reflect a better or worse prognosis, is controversial. The potential relation of the angiotensin converting enzyme 2 receptor in the digestive tract as an entry route for the virus is discussed. CONCLUSION: Gastrointestinal symptoms may be common in COVID-19, in some cases appearing as the first manifestation, even before fever and respiratory symptoms. Therefore, clinicians and gastroenterologists must be aware of those atypical cases during the current pandemic, as well as of the fecal-oral route and corresponding preventive measures.


Subject(s)
Coronavirus Infections/complications , Gastrointestinal Diseases/etiology , Pneumonia, Viral/complications , Coronavirus Infections/therapy , Gastroenterologists , Gastrointestinal Diseases/diagnosis , Gastrointestinal Diseases/therapy , Humans , Pandemics , Pneumonia, Viral/therapy
5.
Gastroenterol. latinoam ; 31(1): 35-38, mayo 2020.
Article in Spanish | LILACS (Americas) | ID: covidwho-678085

ABSTRACT

The pandemic of the novel coronavirus SARS-CoV-2 has caused more than 2.5 millions of confirmed cases worldwide, with a mortality rate around 7%. Most cases appear to be mild with the most common symptoms being fever, dry cough, myalgia, fatigue, and dyspnea but can result in more severe disease. Also, there are described gastrointestinal manifestations: anorexia 27%, diarrhea 12%, nausea/vomiting 10%, and abdominal pain 9%. In Chile, diarrhea has been described in 7.3%, and abdominal pain 3.7%. The primary mechanism proposed is the entry of SARS-CoV-2 into the enterocytes binding the Angiotensin-converting enzyme 2 (ACE2), which is widely distributed among the gastrointestinal tract. Also, SARS-CoV-2 can cause elevated liver enzymes in up to 40% of cases. This alteration could also be caused by the binding to the ACE2 receptor in hepatocytes and cholangiocytes. Gastrointestinal symptoms and elevated liver enzymes are more frequent in severe cases. Viral RNA has been detected in stools, which may suggest a possible fecal-oral transmission. It is essential to pay attention to gastrointestinal manifestations because they are frequent and more prevalent in severe cases. The presence of viral RNA in stool forces us to take preventive measures faced with a possible mechanism of fecal-oral transmission, mainly in the gastroenterology and endoscopy services.


La pandemia por el nuevo coronavirus SARS-CoV-2 ha causado más de 2,5 millones de casos confirmados en el mundo, con una mortalidad cercana al 7%. La mayoría de los casos parecen ser leves y los síntomas más comunes son fiebre, tos seca, mialgia, fatiga y disnea, pero pueden provocar una enfermedad más grave. También se han descrito síntomas gastrointestinales: anorexia 27%, diarrea 12%, náuseas/vómitos 10%, y dolor abdominal 9%. En Chile, se ha descrito diarrea en 7,3%, y dolor abdominal 3,7%. El principal mecanismo fisiopatológico propuesto es el ingreso al enterocito utilizando la Enzima Convertidora de Angiotensina 2 (ECA2) como receptor, el cual es ampliamente distribuido a lo largo del tracto gastrointestinal. También se ha descrito alteración de pruebas hepáticas hasta en 40% de los casos. Esta alteración también podría ser causada por el ingreso a los hepatocitos y colangiocitos mediante la ECA2. Los síntomas gastrointestinales, y las alteraciones de pruebas hepáticas son más frecuentes en los pacientes graves. Se ha detectado la presencia de ARN viral en deposiciones de pacientes, lo que podría sugerir una posible vía de transmisión fecal-oral. Es importante prestar atención a las manifestaciones gastrointestinales, ya que son comunes y más frecuentes en pacientes graves. La presencia viral en las heces nos obliga a tomar medidas de precaución y prevención de un posible mecanismo de transmisión fecal-oral, especialmente en los servicios de gastroenterología y endoscopia.


Subject(s)
Humans , Pneumonia, Viral/epidemiology , Coronavirus Infections/epidemiology , Betacoronavirus , Gastrointestinal Diseases/etiology , Pneumonia, Viral/transmission , Coronavirus Infections/transmission , Feces/virology , Pandemics
6.
BMJ Open Gastroenterol ; 7(1)2020 07.
Article in English | MEDLINE | ID: covidwho-646626

ABSTRACT

OBJECTIVE: To study the correlation between gastrointestinal (GI) symptoms and disease severity in patients with COVID-19. DESIGN: We searched six databases including three Chinese and three English databases for all the published articles on COVID-19. Studies were screened according to inclusion and exclusion criteria. The relevant data were extracted and all the statistical analyses were performed using Revman5.3. RESULT: In a meta-analysis of 9 studies, comprising 3022 patients, 479 patients (13.7%, 95% CI 0.125 to 0.149) had severe disease and 624 patients (14.7%, 95% CI 0.136 to 0.159) had GI symptoms. Of 624 patients with GI symptoms, 118 patients had severe disease (20.5%, 95% CI 0.133 to 0.276) and of 2397 cases without GI symptoms, 361 patients had severe disease (18.2%, 95% CI 0.129 to 0.235). Comparing disease severity of patients with and without GI symptoms, the results indicated: I²=62%, OR=1.21, 95% CI 0.94 to 1.56, p=0.13; there was no statistically significant difference between the two groups. The funnel plot was symmetrical with no publication bias. CONCLUSION: Current results are not sufficient to demonstrate a significant correlation between GI symptoms and disease severity in patients with COVID-19.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Gastrointestinal Diseases/etiology , Pneumonia, Viral/complications , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Gastrointestinal Diseases/diagnosis , Humans , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Severity of Illness Index
7.
Exp Biol Med (Maywood) ; 245(15): 1299-1307, 2020 09.
Article in English | MEDLINE | ID: covidwho-637473

ABSTRACT

IMPACT STATEMENT: The current survey of studies outlines the direct and indirect effects of SARS-CoV-2 on the specific body systems and summarizes the SARS-CoV-2 main pathogenicity mechanisms that require attention during patient hospitalization and for further research.


Subject(s)
Betacoronavirus/pathogenicity , Cardiovascular Diseases/etiology , Coronavirus Infections/pathology , Gastrointestinal Diseases/etiology , Nervous System Diseases/etiology , Pneumonia, Viral/pathology , Betacoronavirus/physiology , Coronavirus Infections/complications , Coronavirus Infections/virology , Humans , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/virology , Virus Internalization , Virus Replication
8.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 32(4): 412-416, 2020 Apr.
Article in Chinese | MEDLINE | ID: covidwho-596847

ABSTRACT

OBJECTIVE: To investigate the clinical characteristics of gastrointestinal symptoms in patients with coronavirus disease 2019 (COVID-19) during the whole disease process, and provide reference for etiological diagnosis and treatment. METHODS: The clinical data of patients with COVID-19 admitted in the Infectious Diseases Branch of the First Affiliated Hospital of University of Science and Technology of China from January 22nd, 2020 to March 8th, 2020 were analyzed retrospectively. According to whether there were gastrointestinal symptoms (poor appetite, nausea/vomiting and diarrhea), all patients were divided into gastrointestinal symptom group and asymptomatic group. The characteristics of gastrointestinal symptoms, such as poor appetite, nausea, vomiting and diarrhea were counted and analyzed, and the correlation between gastrointestinal symptoms and gender, age, basic diseases, disease severity, laboratory examination and drug treatment were analyzed. RESULTS: A total of 80 COVID-19 patients were involved, 43 cases (53.8%) presented with poor appetite, 17 cases (21.3%) had nausea and vomiting, and 33 cases (41.3%) had diarrhea. Among them, 5 cases, 1 case and 4 cases respectively preformed poor appetite, nausea/vomiting and diarrhea before admission, while the others experienced gastrointestinal symptoms within 48 hours after admission. Duration of poor appetite, nausea/vomiting and diarrhea (days) of all patients were 5.3±2.1, 2.2±1.0 and 1.4±0.9, respectively. The patients with poor appetite were older than those without symptoms (years old: 48.2±17.6 vs. 39.3±15.1), albumin (Alb) level and the lymphocytes ratio were lower than those in asymptomatic group [Alb (g/L): 39.8 (35.7, 45.1) vs. 46.1 (42.6, 49.4), lymphocytes ratio: 0.19 (0.09, 0.28) vs. 0.28 (0.17, 0.35)], while the neutrophil ratio, the levels of C-reactive protein (CRP), D-dimer, and lactate dehydrogenase (LDH) were higher than those in asymptomatic group [the neutrophil ratio: 0.74 (0.61, 0.85) vs. 0.64 (0.52, 0.76), CRP (mg/L): 21.4 (3.9, 52.9) vs. 5.6 (2.4, 14.0), D-dimer (mg/L): 0.2 (0.2, 0.5) vs. 0.2 (0.1, 0.3), LDH (µmol×s-1×L-1): 4.49 (3.59, 5.19) vs. 3.12 (2.77, 4.90)]; at the same time, more traditional Chinese medicine was used in the patients with gastrointestinal symptoms [65.1% (28/43) vs. 40.5% (15/37), all P < 0.05]. In addition, 14 cases of 18 patients with cardiovascular diseases presented with poor appetite, 7 patients had nausea and vomiting symptoms. All of the 3 patients with chronic kidney disease presented with poor appetite, nausea and vomiting, and 2 of them had diarrhea. CONCLUSIONS: The gastrointestinal symptoms in patients with COVID-19 are common. Whether it is caused by the virus or related drugs, diet and mental conditions, clinicians should analyze the causes of these symptoms timely, and then provide a better treatment for patients with COVID-19.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Gastrointestinal Diseases/etiology , Pneumonia, Viral/complications , China , Humans , Pandemics , Retrospective Studies
9.
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
10.
Am J Gastroenterol ; 115(7): 1129-1132, 2020 07.
Article in English | MEDLINE | ID: covidwho-618936

ABSTRACT

INTRODUCTION: High rates of concurrent gastrointestinal manifestations have been noted in patients with corona virus disease 2019 (COVID-19); however, the association between these digestive manifestations and need for hospitalization has not been established. METHODS: This is a retrospective review of consecutive patients diagnosed with COVID-19. A total of 207 patients were identified; 34.5% of patients noted concurrent gastrointestinal symptoms, with 90% of gastrointestinal symptoms being mild. RESULTS: In a multivariate regression model controlled for demographics and disease severity, an increased risk of hospitalization was noted in patients with any digestive symptom (adjusted odds ratio 4.84, 95% confidence interval: 1.68-13.94). DISCUSSION: The presence of digestive symptoms in COVID-19 is associated with a need for hospitalization.


Subject(s)
Coronavirus Infections/complications , Gastrointestinal Diseases/etiology , Pneumonia, Viral/complications , Adult , Aged , Betacoronavirus , Digestive System Diseases/etiology , Digestive System Diseases/virology , Female , Gastrointestinal Diseases/virology , Hospitalization , Humans , Male , Middle Aged , Pandemics , Retrospective Studies
11.
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
16.
World J Gastroenterol ; 26(14): 1546-1553, 2020 Apr 14.
Article in English | MEDLINE | ID: covidwho-122463

ABSTRACT

The current pandemic due to the severe acute respiratory syndrome coronavirus 2 has caused an extreme burden for health care systems globally, and the number of cases is expected to continue to increase, at least in the immediate future. The virus is estimated to have infected more than 1.5 million individuals. The available reports suggest that gastrointestinal (GI) involvement in coronavirus disease 2019 (COVID-19) is common and in some cases the GI symptoms may precede the respiratory symptoms. In addition to direct effects of severe acute respiratory syndrome coronavirus 2, the infected patients remain at risk for the complications commonly managed by gastroenterology and hepatology consultants. The most commonly reported GI manifestation of COVID-19 is diarrhea, which is reported in a third to up to more than half of the patients. Mild to moderate elevation of the liver enzymes are also common, although no case of acute liver failure has been reported so far. Many of the medications used for treatment of COVID-19 can also be associated with GI symptoms or liver injury and can be included in the differential diagnosis in these patients. Although the diagnosis of the infection is currently based on RNA analysis in respiratory samples, the available literature on fecal shedding of this virus suggests that fecal RNA testing might prove to be a useful diagnostic test. It is reasonable to delay all non-urgent endoscopic procedures during the peak of the pandemic and use additional protective equipment such as N95 respirators during endoscopy while most patients can be considered high risk for having been exposed to the virus.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Gastrointestinal Diseases/etiology , Pneumonia, Viral/complications , Animals , Consultants , Diarrhea/etiology , Humans , Pandemics
18.
Int J Infect Dis ; 96: 19-24, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-72509

ABSTRACT

The coronavirus disease 2019 (COVID-19) was first reported in Wuhan, China and rapidly spread in other countries in December 2019. The infected patients presented with fever, respiratory symptoms, sometimes with digestive and other systemic manifestations, and some progressed with a severe acute respiratory syndrome or even death. Associated digestive symptoms were frequently observed in the patients, with an unknown significance and mechanism. ACE2, as the major known functional receptor of the 2019 novel coronavirus (2019-nCoV) attracted our attention. We collected the clinical data of the 2019-nCoV-infected patients from published studies and extracted the data about the incidence of gastrointestinal symptoms. Furthermore, we used online datasets to analyze ACE2 expression in different human organs, especially in the small intestine, to explore the relationship between ACE2 expression patterns and clinical symptoms. We found that diarrhea accounted for a notable proportion of COVID-19 patients, ranging from 8.0% to 12.9%. The results reveal that ACE2 mRNA and protein are highly expressed in the small intestinal enterocytes but not in the goblet cells or intestinal immune cells. High expression of ACE2 on the surface cells in the digestive tract may lead to gastrointestinal symptoms and inflammation susceptibility. Overall, digestive symptoms were common in the COVID-19 patients. ACE2 expression on surface cells of the small intestine may mediate the invasion and amplification of the virus and activation of gastrointestinal inflammation. It is a possible mechanism of digestive symptoms in the COVID-19 patients and explains the presence of the virus in patients' stool samples. The study also highlights the necessity of taking stool samples for suspected patients to help in early diagnosis and assessment of disease status.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Diarrhea/etiology , Enterocytes/enzymology , Gastrointestinal Diseases/etiology , Intestine, Small/enzymology , Peptidyl-Dipeptidase A/physiology , Pneumonia, Viral/complications , Adult , Aged , Aged, 80 and over , Feces/virology , Female , Humans , Male , Middle Aged , Pandemics , Peptidyl-Dipeptidase A/genetics
19.
Acta Med Indones ; 52(1): 63-67, 2020 Jan.
Article in English | MEDLINE | ID: covidwho-71125

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is currently causing a widespread infection in the world. During the pandemic, physicians may need to raise the index of suspicion earlier in at-risk patients presenting with gastrointestinal symptoms, which are uncommon findings in coronavirus disease 2019 (COVID-19) patients. We report a patient in Indonesia with chest pain and gastrointestinal symptoms who was later confirmed to have SARS-CoV-2 infection after spending days of hospitalisation in the standard ward.


Subject(s)
Betacoronavirus , Coronavirus Infections/diagnosis , Gastrointestinal Diseases/etiology , Pneumonia, Viral/diagnosis , Chest Pain/etiology , Clinical Laboratory Techniques , Coronavirus Infections/complications , Humans , Indonesia , Pandemics , Pneumonia, Viral/complications
20.
J Chin Med Assoc ; 83(6): 521-523, 2020 06.
Article in English | MEDLINE | ID: covidwho-33813

ABSTRACT

As the outbreak of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly spread over the world, the World Health Organization has declared the outbreak of COVID-19 an international public health emergency. Besides typical respiratory symptoms and signs of COVID-19, digestive symptoms and liver injury have been frequently reported during the course of the disease. In this review, we summarized the recent studies reporting of gastrointestinal and liver manifestations during the course of COVID-19. Digestive symptoms, including anorexia, nausea, vomiting, and diarrhea, are not uncommon in patients with COVID-19, and in some cases digestive symptoms may occur in the absence of any respiratory symptoms. Furthermore, SARS-CoV-2 could be detected in the stool of infected patients, implicating the possibility of fecal-oral transmission. Attention should also be paid to monitor liver function during the course of COVID-19, especially in patients with higher disease severity.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Gastrointestinal Diseases/etiology , Liver Diseases/etiology , Pneumonia, Viral/complications , Betacoronavirus/isolation & purification , Coronavirus Infections/transmission , Feces/virology , Humans , Pandemics , Pneumonia, Viral/transmission
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