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1.
Eur J Gastroenterol Hepatol ; 34(2): 168-176, 2022 02 01.
Article in English | MEDLINE | ID: covidwho-1831515

ABSTRACT

OBJECTIVE: Studies have suggested that coronavirus disease 2019 (COVID-19) appears to be more serious in patients with gastrointestinal symptoms. This meta-analysis was conducted to explore the relationship between gastrointestinal symptoms and the severity of COVID-19. METHODS: We searched PubMed, Web of Science, Science Direct, Embase, and Google Scholar on 16 October 2020, to identify observational studies that provided data on gastrointestinal symptoms and severity of COVID-19. Gastrointestinal symptoms include diarrhea, abdominal pain, nausea, and vomiting. The severe rate and the odds ratio (OR) were pooled. Heterogeneity was assessed using the I2 statistic. RESULTS: A total of 21 studies with 5285 patients were included in this meta-analysis. The severe rate of COVID-19 patients with diarrhea was 41.1% [95% confidence interval (CI): 31.0-51.5%], and the OR of association between diarrhea and severe COVID-19 was 1.41 (95% CI: 1.05-1.89); sensitivity analysis showed that the results for the OR and 95% CI were unstable. For abdominal pain, the severe rate and OR of association with severe COVID-19 were 59.3% (95% CI: 41.3-76.4%) and 2.76 (95% CI: 1.59-4.81), respectively; for nausea, 41.4% (95% CI: 23.2-60.7%) and 0.92 (95% CI: 0.59-1.43), respectively; for vomiting, 51.3% (95% CI: 36.8-65.8%) and 1.68 (95% CI: 0.97-2.92), respectively. CONCLUSION: The severe rate was more than 40% in COVID-19 patients with gastrointestinal symptoms. Abdominal pain was associated with a near 2.8-fold increased risk of severe COVID-19; the relationship between diarrhea and the severity of COVID-19 was regionally different; nausea and vomiting were limited in association with an increased risk of severe COVID-19.


Subject(s)
COVID-19 , Gastrointestinal Diseases , Gastrointestinal Diseases/diagnosis , Gastrointestinal Diseases/epidemiology , Gastrointestinal Diseases/etiology , Humans , Prevalence , SARS-CoV-2 , Vomiting/epidemiology , Vomiting/etiology
3.
J Nerv Ment Dis ; 210(2): 98-103, 2022 02 01.
Article in English | MEDLINE | ID: covidwho-1504110

ABSTRACT

ABSTRACT: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly contagious new ß-coronavirus that primarily affects the lungs. Because of its unprecedented spread, in a relatively short interval, it is declared a global pandemic. Binding to the angiotensin-converting enzyme 2 receptors, SARS-CoV-2 is easily disseminated through air. Apart from the established clinical panel, individuals exposed to prolonged chronic stress also manifest gastrointestinal (GI) symptoms similar to those exhibited by SARS-CoV-2-infected patients.The present study aims to assess the incidence of GI deficiencies and prevalence of anxiety among healthy medical staff by applying the Visual Analog Scale for Irritable Bowel Syndrome (VAS-IBS) and Hamilton Anxiety Rating Scale (HAM-A) during this global crisis.We found significant differences on several items of the VAS-IBS: regarding the incidence of diarrhea (p = 0.04), bloating/gases (p = 0.02), and nausea/vomiting (p = 0.01) from the physical spectrum. After stratification based on age of the participants and after we applied Kruskal-Wallis test because of heterogeneity between groups, we noted two situations in which the null hypothesis is rejected: nausea/vomiting in women between 20 and 30 years, and between 30 and 40, and between 40 and 50 years, respectively (p = 0.026/0.029). Anxiety was prevalent among young and middle-class people after the centralization of HAM-A data, where 40.4% of the participants had various forms of anxiety: mild (n = 13; 13.82%), severe (n = 13; 13.82%), and moderate (n = 12; 12.76%).This study demonstrates that VAS-IBS is a reliable tool for assessing the incidence of GI deficiencies, as well as HAM-A for anxiety.


Subject(s)
Abdominal Pain/epidemiology , Anxiety Disorders/epidemiology , COVID-19 , Constipation/epidemiology , Diarrhea/epidemiology , Irritable Bowel Syndrome/epidemiology , Nausea/epidemiology , Occupational Diseases/epidemiology , Personnel, Hospital/statistics & numerical data , Vomiting/epidemiology , Adult , Female , Humans , Middle Aged , Prevalence , Psychiatric Status Rating Scales , Psychometrics , Severity of Illness Index , Young Adult
4.
Eur Rev Med Pharmacol Sci ; 25(18): 5836-5842, 2021 09.
Article in English | MEDLINE | ID: covidwho-1451041

ABSTRACT

OBJECTIVE: Functional gastrointestinal disorders are common gastrointestinal diseases. The pathophysiology is multifactorial and psychosocial distress worsens symptoms severity. Since the end of 2019 the world has been facing COVID-19 pandemic. The associated control measures have affected the psychological health of people. The aim of the present study is to evaluate the impact of the COVID-19 pandemic on the prevalence of functional gastrointestinal disorders among Italian children and adolescents. PATIENTS AND METHODS: The study sample is composed of 407 patients (187 males, 220 females), aged from 10 to 17 years. The mean age is 14.27 ± 2.24 years. The study was conducted through the Italian version of the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III Version.  The prevalence of each disorder has been calculated as the ratio of affected subjects for each disease and the total number of effective cases for that specific disease. RESULTS: The study demonstrates that the prevalence of Functional Gastrointestinal Disorder in Italian children, during the COVD-19 pandemic, is higher, compared with the one reported in the previous studies. The most frequent disorders are Abdominal Migraine and Irritable Bowel Syndrome. CONCLUSIONS: Our study is the first one which provides data of the prevalence of Functional gastrointestinal disorders in sample of Italian adolescents, during the COVID-19 pandemic. The study underlines the need to focus on stress management, in order to reduce the effects of the lockdown on the psychological wellness of the youngest.


Subject(s)
COVID-19/psychology , Gastrointestinal Diseases/etiology , Gastrointestinal Diseases/psychology , Quarantine/psychology , Social Isolation/psychology , Stress, Psychological/complications , Abdominal Pain/epidemiology , Abdominal Pain/etiology , Abdominal Pain/psychology , Adolescent , Aerophagy/epidemiology , Aerophagy/etiology , Aerophagy/psychology , COVID-19/epidemiology , COVID-19/prevention & control , Child , Constipation/epidemiology , Constipation/etiology , Constipation/psychology , Dyspepsia/epidemiology , Dyspepsia/etiology , Dyspepsia/psychology , Fecal Incontinence/epidemiology , Fecal Incontinence/etiology , Fecal Incontinence/psychology , Female , Gastrointestinal Diseases/diagnosis , Gastrointestinal Diseases/epidemiology , Humans , Irritable Bowel Syndrome/epidemiology , Irritable Bowel Syndrome/etiology , Irritable Bowel Syndrome/psychology , Italy , Male , Migraine Disorders/epidemiology , Migraine Disorders/etiology , Migraine Disorders/psychology , Prevalence , Rumination Syndrome/epidemiology , Rumination Syndrome/etiology , Rumination Syndrome/psychology , Stress, Psychological/diagnosis , Surveys and Questionnaires , Vomiting/epidemiology , Vomiting/etiology , Vomiting/psychology
7.
Int Arch Allergy Immunol ; 182(10): 989-996, 2021.
Article in English | MEDLINE | ID: covidwho-1282178

ABSTRACT

INTRODUCTION: There are a limited number of studies about the clinical findings of coronavirus infection in pediatric patients with asthma. We aimed to evaluate the clinical and laboratory characteristics of pediatric patients with asthma and healthy children without chronic disease who infected with SARS-CoV-2. METHODS: This is a retrospective, case-control study comparing the asthma diagnosed and healthy children who were diagnosed as COVID-19 in our hospital between March 11 and November 10, 2020. RESULTS: During the study period, 6,205 children were diagnosed with CO-VID-19 in our hospital. Only 54 (0.87%) patients had a diagnosis of asthma. The mean of the age was 10.5 years and 53.7% (n:29) of the patients with asthma were male. Cough, shortness of breath, emesis, and diarrhea were found to be significantly higher in asthma group than in the control group (respectively p = 0.002, 0.000, 0.002, 0.019, 0.015). Patients who were given SABA was significantly higher in asthma diagnosed patients (p = 0.000). Hospitalization was significantly higher in asthma group (p = 0.025), and the duration of hospitalization was significantly higher in control group (p = 0.034). There was no significant difference between the 2 groups in terms of requiring oxygen treatment and in laboratory findings between groups. CONCLUSION: This study revealed that pediatric patients diagnosed with asthma were in a mild clinic. According to these findings, asthma may not affect the course of the COVID-19 in children.


Subject(s)
Asthma/epidemiology , COVID-19/epidemiology , SARS-CoV-2 , Adolescent , Adrenergic beta-Agonists/therapeutic use , Anti-Asthmatic Agents/therapeutic use , Asthma/diagnosis , Asthma/therapy , COVID-19/diagnosis , COVID-19/therapy , Child , Cough/diagnosis , Cough/epidemiology , Cough/therapy , Diarrhea/diagnosis , Diarrhea/epidemiology , Diarrhea/therapy , Dyspnea/diagnosis , Dyspnea/epidemiology , Dyspnea/therapy , Female , Hospitalization/statistics & numerical data , Humans , Male , Oxygen Inhalation Therapy , Retrospective Studies , Vomiting/diagnosis , Vomiting/epidemiology , Vomiting/therapy
8.
J Trop Pediatr ; 67(2)2021 05 17.
Article in English | MEDLINE | ID: covidwho-1246757

ABSTRACT

BACKGROUND: Data on the gastrointestinal (GI) manifestations of Pediatric Corona Virus Disease (COVID-19) are conflicting and the relationship between GI involvement and the severity of COVID-19 disease has not been evaluated. The objectives of this systematic review were to determine the GI manifestations of pediatric COVID-19 and to evaluate their role as risk factors for a severe clinical course. METHODS: : A systematic literature search was carried out in PubMed and Scopus for studies published before 31 December 2020 with information about the GI manifestations of pediatric COVID-19. Patients with a severe and nonsevere clinical course were compared using the inverse variance heterogeneity model and odds ratio (OR) as the effect size. A sensitivity analysis was performed if the heterogeneity was high among studies. RESULTS: A total of 811 studies were identified through a systematic search of which 55 studies (4369 patients) were included in this systematic review. The commonest GI symptoms were diarrhea-19.08% [95% confidence interval (CI) 10.6-28.2], nausea/vomiting 19.7% (95% CI 7.8-33.2) and abdominal pain 20.3% (95% CI 3.7-40.4). The presence of diarrhea was significantly associated with a severe clinical course with a pooled OR of 3.97 (95% CI 1.80-8.73; p < 0.01). Abdominal pain and nausea/vomiting were not associated with disease severity. CONCLUSIONS: Diarrhea, nausea/vomiting or abdominal pain are present in nearly one-fifth of all children with COVID-19. The presence of diarrhea portends a severe clinical course.


Subject(s)
COVID-19 , Gastrointestinal Diseases , Child , Diarrhea/epidemiology , Diarrhea/etiology , Gastrointestinal Diseases/epidemiology , Gastrointestinal Diseases/etiology , Humans , SARS-CoV-2 , Vomiting/epidemiology , Vomiting/etiology
9.
Turk J Gastroenterol ; 32(2): 148-154, 2021 02.
Article in English | MEDLINE | ID: covidwho-1220242

ABSTRACT

BACKGROUND: Patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), have fever, dry cough, dyspnea, and fatigue. The disease has now become a global pandemic. The purpose of this study was to explore the relationship between COVID-19 and gastrointestinal (GI) symptoms. METHODS: We collected and analyzed data on patients with laboratory-confirmed COVID-19 by high-throughput sequencing or reverse transcription-polymerase chain reaction. We reviewed electronic medical records of 405 hospitalized COVID-19 patients in the Third Hospital of Wuhan. RESULTS: Among the 405 confirmed patients, 210 had no GI symptoms, 195 had GI symptoms, and the first symptom of 155 patients was GI. The prevalence of vascular and digestive diseases in the group with GI symptoms was significantly higher than in the group without GI symptoms. In patients with GI symptoms, the proportion with fever, cough, dysphoria, chest tightness, poor appetite, chest pain, and pharyngeal pain was significantly higher than in those without GI symptoms. There was no significant difference in imaging between the 2 groups. In patients with GI symptoms, the proportion with increased procalcitonin (PCT) level and decreased lymphocyte count was significantly higher than in those without GI symptoms. CONCLUSION: COVID-19 patients with GI symptoms had significantly more vascular and digestive system diseases and were more likely to have clinical manifestations of fever, cough, poor appetite, chest tightness, chest pain, insomnia, and pharyngeal pain. There were more patients with diarrhea, nausea, and vomiting. Patients with GI symptoms were more likely to have increased PCT and decreased lymphocyte count.


Subject(s)
COVID-19/complications , Gastrointestinal Diseases/epidemiology , Gastrointestinal Diseases/virology , SARS-CoV-2 , Adult , Aged , COVID-19/blood , COVID-19/virology , China/epidemiology , Diarrhea/blood , Diarrhea/epidemiology , Diarrhea/virology , Female , Humans , Lymphocyte Count , Male , Middle Aged , Nausea/blood , Nausea/epidemiology , Nausea/virology , Procalcitonin/blood , Vomiting/blood , Vomiting/epidemiology , Vomiting/virology
10.
Eur J Gastroenterol Hepatol ; 33(5): 691-694, 2021 05 01.
Article in English | MEDLINE | ID: covidwho-1159992

ABSTRACT

BACKGROUND: Infection due to severe acute respiratory syndrome coronavirus 2 is typically associated with a respiratory syndrome, but gastrointestinal symptoms have been described in early reports from China. However, data from European centres are scarce. OBJECTIVES: We aimed to characterise the gastrointestinal manifestations of patients with coronavirus disease 2019 (COVID-19) and their disease course. METHODS: Patients admitted at our centre between March and April 2020 with diagnosis of COVID-19 were included. Asymptomatic patients or those without symptom information were excluded. Clinical features, laboratory data and disease severity (mechanical ventilation, intensive care admission or death) were analysed. RESULTS: Two-hundred one patients were included (median age 71 years; 56.2% male). Digestive symptoms were reported by 60 (29.9%) patients during the disease course, being part of the disease presentation in 34 (16.9%). The most frequent were diarrhoea in 36 patients (17.9%). Patients with gastrointestinal symptoms were younger (P = 0.032), had higher haemoglobin levels (P = 0.002) and lower C-reactive protein (P = 0.045) and potassium levels (P = 0.004). Patients with digestive symptoms had less severe disease (28.3 vs. 44.0%; P = 0.038). Regarding liver damage, aspartate aminotransferase (AST) was elevated in 65.2% of patients and alanine aminotransferase (ALT) in 62.7%, but these patients did not present a more severe disease (elevated AST P = 0.062; elevated ALT P = 0.276). CONCLUSION: A significant portion of COVID-19 patients have digestive symptoms, mostly at presentation. This should be taken into account in order to keep a high level of suspicion to reach an early diagnosis and setup infection control measures to control the transmission rate. This subgroup of patients appears to have a less severe disease course.


Subject(s)
COVID-19/physiopathology , Diarrhea/physiopathology , Vomiting/physiopathology , Abdominal Pain/epidemiology , Abdominal Pain/metabolism , Abdominal Pain/physiopathology , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , Ageusia/epidemiology , Ageusia/metabolism , Ageusia/physiopathology , Alanine Transaminase/metabolism , Aspartate Aminotransferases/metabolism , C-Reactive Protein/metabolism , COVID-19/metabolism , Diarrhea/epidemiology , Diarrhea/metabolism , Female , Hemoglobins/metabolism , Humans , Male , Middle Aged , Nausea/epidemiology , Nausea/metabolism , Nausea/physiopathology , Portugal/epidemiology , Retrospective Studies , SARS-CoV-2 , Severity of Illness Index , Vomiting/epidemiology , Vomiting/metabolism , Young Adult
11.
J Gastroenterol ; 56(5): 409-420, 2021 05.
Article in English | MEDLINE | ID: covidwho-1147593

ABSTRACT

Although primarily a respiratory illness, several studies have shown that COVID-19 causes elevation of liver enzymes and various gastrointestinal (GI) symptoms. The aim of this study was to undertake a systematic review and meta-analysis to determine whether the presence of gastrointestinal (GI) symptoms contributed toward COVID-19 severity, and identify the GI symptoms characteristic of severe COVID-19. We conducted a literature search of PubMed from December 1, 2019, to June 30, 2020, and identified all reports with GI symptoms reported. A meta-analysis comparing the severity of COVID-19 with the presence of liver enzyme elevation and GI symptoms was performed using RevMan version 5.4. Pooled data from 15,305 unique reverse transcriptase-polymerase chain reaction positive COVID-19 patients from 44 studies were analyzed. We found that the severe COVID-19 patients significantly had abdominal pain compared to the non-severe COVID-19 patients (OR = 2.70, 95% CI 1.17-6.27, Z = 2.32, p = 0.02, I2 = 0%) by analyzed 609 patients of 4 studies who reported both abdominal pain and COVID-19 severity. However, there was no significant difference in the incidence of diarrhea, nausea, or vomiting between the two groups. Thus, this systematic review and meta-analysis demonstrated that abdominal pain could be characteristic of severe COVID-19 infections. Compared with other viral infections that primarily infect the respiratory system, patients with COVID-19 have a slightly lower frequency of diarrheal symptoms with abdominal pain. However, to confirm this, further studies with COVID-19 patients across various countries and ethnicities are required.


Subject(s)
COVID-19/complications , Gastrointestinal Diseases/epidemiology , Liver/enzymology , Abdominal Pain/etiology , COVID-19/physiopathology , Diarrhea/epidemiology , Diarrhea/virology , Gastrointestinal Diseases/virology , Humans , Liver/virology , Nausea/epidemiology , Nausea/virology , Severity of Illness Index , Vomiting/epidemiology , Vomiting/virology
12.
Medicine (Baltimore) ; 100(11): e24897, 2021 Mar 19.
Article in English | MEDLINE | ID: covidwho-1138016

ABSTRACT

ABSTRACT: The prevalence of children exhibiting coronavirus disease 2019 (COVID-19) with digestive system involvement remains unknown. Therefore, we aimed to quantify the impact of COVID-19 on the digestive system of children.In this meta-analysis, we searched PubMed, Embase, and Web of Science from January 1, 2020, to June 31, 2020. We also searched for COVID-19 publications in specific journals for more comprehensive results. We included studies that reported the epidemiological and clinical characteristics of COVID-19, and we excluded duplicate publications, reviews, animal studies, case reports, publications without the full text, studies with incomplete information, and studies from which data extraction was impossible.We conducted a meta-analysis of the incidence of gastrointestinal symptoms and changes in liver function involving 19 studies. The pooled prevalence of diarrhea was 10% (95% CI: 7-14; I2  = 84%), that of nausea or vomiting was 7% (95% CI: 5-11; I2  = 77%), and that of abdominal pain was 4% (95% CI: 2-9; I2  = 79%). In addition, the pooled incidence of increased alanine aminotransferase was 8% (95% CI: 5-15; I2  = 46%), and the pooled incidence of increased AST was 15% (95% CI: 9-26; I2  = 66%). The pooled rate of recovery was 97% (95% CI: 94-100; I2  = 86%), and the pooled rate of death, which was 1% (95% CI: 1-4; I2  = 48%), was much smaller than the recovery rate.Our research shows that digestive system symptoms and function in children with COVID-19 are not uncommon. More attention should be paid to this unique group of patients.


Subject(s)
COVID-19/epidemiology , Digestive System Diseases/epidemiology , Abdominal Pain/epidemiology , Adolescent , Child , Child, Preschool , Diarrhea/epidemiology , Digestive System/physiopathology , Female , Gastrointestinal Diseases/epidemiology , Humans , Incidence , Infant , Infant, Newborn , Liver Diseases/epidemiology , Male , Nausea/epidemiology , Prevalence , SARS-CoV-2 , Vomiting/epidemiology
13.
Drug Saf ; 43(12): 1309-1314, 2020 12.
Article in English | MEDLINE | ID: covidwho-1092869

ABSTRACT

INTRODUCTION: In late 2019, a new coronavirus-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-was discovered in Wuhan, China, and the World Health Organization later declared coronavirus disease 2019 (COVID-19) a pandemic. Numerous drugs have been repurposed and investigated for therapeutic effectiveness in the disease, including those from "Solidarity," an international clinical trial (azithromycin, chloroquine, hydroxychloroquine, the fixed combination lopinavir/ritonavir, and remdesivir). OBJECTIVE: Our objective was to evaluate adverse drug reaction (ADR) reporting for drugs when used in the treatment of COVID-19 compared with use for other indications, specifically focussing on sex differences. METHOD: We extracted reports on COVID-19-specific treatments from the global ADR database, VigiBase, using an algorithm developed to identify reports that listed COVID-19 as the indication. The Solidarity trial drugs were included, as were any drugs reported ≥ 100 times. We performed a descriptive comparison of reports for the same drugs used in non-COVID-19 indications. The data lock point date was 7 June 2020. RESULTS: In total, 2573 reports were identified for drugs used in the treatment of COVID-19. In order of frequency, the most reported ADRs were electrocardiogram QT-prolonged, diarrhoea, nausea, hepatitis, and vomiting in males and diarrhoea, electrocardiogram QT-prolonged, nausea, vomiting, and upper abdominal pain in females. Other hepatic and kidney-related events were included in the top ten ADRs in males, whereas no hepatic or renal terms were reported for females. COVID-19-related reporting patterns differed from non-pandemic reporting for these drugs. CONCLUSION: Review of a global database of suspected ADR reports revealed sex differences in the reporting patterns for drugs used in the treatment of COVID-19. Patterns of ADR sex differences need further elucidation.


Subject(s)
Antiviral Agents/adverse effects , COVID-19/drug therapy , Drug-Related Side Effects and Adverse Reactions/epidemiology , Abdominal Pain/chemically induced , Abdominal Pain/epidemiology , Adenosine Monophosphate/adverse effects , Adenosine Monophosphate/analogs & derivatives , Alanine/adverse effects , Alanine/analogs & derivatives , Antibodies, Monoclonal, Humanized/adverse effects , Azithromycin/adverse effects , Chemical and Drug Induced Liver Injury/epidemiology , Chemical and Drug Induced Liver Injury/etiology , Chloroquine/adverse effects , Databases, Pharmaceutical , Diarrhea/chemically induced , Diarrhea/epidemiology , Drug Combinations , Drug Eruptions/epidemiology , Drug Eruptions/etiology , Drug Repositioning , Female , Humans , Hydroxychloroquine/adverse effects , Long QT Syndrome/chemically induced , Long QT Syndrome/epidemiology , Lopinavir/adverse effects , Male , Nausea/chemically induced , Nausea/epidemiology , Oseltamivir/adverse effects , Ritonavir/adverse effects , Sex Distribution , Sex Factors , Vomiting/chemically induced , Vomiting/epidemiology
14.
Epidemiol Prev ; 44(5-6 Suppl 2): 216-225, 2020.
Article in English | MEDLINE | ID: covidwho-1068142

ABSTRACT

OBJECTIVES: to explore clinical and epidemiological characteristics associated with an imaging feature of COVID-19 pneumonia at disease onset, in order to identify factors that may be evaluable by general practitioners at patient's home, and which may lead to identify a more severe disease, needing hospitalization. DESIGN: this is a retrospective/prospective observational hospital cohort. SETTING AND PARTICIPANTS: the study population includes all patients consecutively admitted to the emergency department of Città della salute e della scienza University Hospital from 01.03 to 31.05.2020 with a confirmed diagnosis of SARS-CoV-2 infection. MAIN OUTCOME MEASURES: patients were classified in two groups according to the findings of X-ray imaging, lung ultrasound and chest computer tomography, as pneumonia or not pneumonia patients. RESULTS: in multivariable analysis, factors most strongly associated with emergency department admission with pneumonia were age, oxygen saturation <90% (adj OR 4.16 ;95%CI 1.44-12.07), respiratory rate >24 breaths/min (adj OR 6.50; 95%CI 2.36-17.87), fever ≥38° (adj OR 3.05; 95%CI 1.53-6.08) and the presence of gastroenteric symptoms (vomiting and diarrhea). A delay (> 7 days) between the appearance of the initial lung symptoms (cough and dyspnea) and the admission to the emergency department was also related to a higher probability of receiving a positive imaging report (OR 4.99; 95%CI 2,02-12,34). CONCLUSIONS: in order to reorganize the management of COVID-19 patients in Italy, in view of the risk of a second wave of epidemic or of local outbreaks, it would be desirable to relocate the triage, and possibly the patient's care, from hospital to home. In this scenario it is important to identify all symptoms and signs associated with COVID-19 pneumonia that would facilitate the decision-making process of GPs leading to patients hospitalization.


Subject(s)
COVID-19/epidemiology , Pandemics , Pneumonia, Viral/epidemiology , Adult , Aged , Aged, 80 and over , COVID-19/blood , Comorbidity , Diarrhea/epidemiology , Diarrhea/etiology , Dyspnea/epidemiology , Dyspnea/etiology , Emergency Service, Hospital/statistics & numerical data , Female , Hospitals, University/statistics & numerical data , Humans , Italy/epidemiology , Leukocyte Count , Male , Middle Aged , Nervous System Diseases/epidemiology , Nervous System Diseases/etiology , Oxygen/blood , Pneumonia, Viral/blood , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/virology , Prospective Studies , Respiratory Rate , Retrospective Studies , Symptom Assessment , Time Factors , Vomiting/epidemiology , Vomiting/etiology
15.
Cir Pediatr ; 34(1): 3-8, 2021 Jan 01.
Article in English, Spanish | MEDLINE | ID: covidwho-1052678

ABSTRACT

OBJECTIVE: To describe our experience in the diagnostic and therapeutic management of patients with acute abdomen as the main manifestation of SARS-CoV-2 infection. MATERIAL AND METHODS: A descriptive study of patients with clinical signs of acute abdomen diagnosed with COVID-19 and admitted at out healthcare facility from April 1 to May 10, 2020 was carried out. Clinical records were reviewed for data collection purposes. RESULTS: A series of 14 patients (9 male and 5 female) with a median age of 9.5 years was analyzed. All patients had abdominal pain. There were 11 patients with fever, 9 patients with vomit or diarrhea, and 9 patients with clinically suspected surgical pathology (acute appendicitis or peritonitis). Increased acute phase reactants and coagulation disorders were a common characteristic at blood tests. An abdominal ultrasonography was carried out in all patients, and a CT-scan was performed in 4 patients, which demonstrated inflammatory signs in the terminal ileum, the ileocecal valve and the ascending colon, as well as gallbladder edema. Conservative management was decided upon in all patients except one, and eight patients required intensive care admission for support treatment. CONCLUSIONS: Gastrointestinal symptoms can be the primary manifestation of the new coronavirus infection, which simulates an acute abdomen with a potentially unfavorable evolution. For an accurate diagnosis to be achieved, a good clinical record and a comprehensive physical exploration, as well as complementary tests in search of characteristic findings of COVID-19, should be carried out.


OBJETIVOS: Describir nuestra experiencia en el manejo diagnóstico y terapéutico de los pacientes que han presentado abdomen agudo como principal manifestación de la infección por SARS-Cov-2. MATERIAL Y METODOS: Estudio descriptivo de los pacientes ingresados con clínica inicial de abdomen agudo que fueron diagnosticados de COVID-19 entre el 1 de abril y el 10 de mayo de 2020. Se ha realizado la revisión de historias clínicas para la recogida de datos. RESULTADOS: Describimos una serie de 14 pacientes (9 varones y 5 mujeres) con una mediana de edad de 9,5 años. Todos ellos consultaron por dolor abdominal acompañado de fiebre en 11 y vómitos o diarrea en 9, y la sospecha clínica inicial fue de patología quirúrgica (apendicitis aguda o peritonitis) en 9. En la analítica sanguínea se encontró como característica común elevación de reactantes de fase aguda y alteraciones de coagulación. Se realizó ecografía abdominal a todos los pacientes y tomografía computarizada en cuatro observándose signos inflamatorios en íleon terminal, válvula ileocecal, colon ascendente y edema de vesícula biliar. Se optó por un manejo conservador en todos los pacientes menos uno y ocho pacientes precisaron ingreso en cuidados intensivos para tratamiento de soporte. CONCLUSIONES: La infección por el nuevo coronavirus puede producir síntomas gastrointestinales como principal manifestación, simulando un abdomen agudo que en algunos casos puede evolucionar de forma desfavorable. Para el diagnóstico es preciso realizar una buena historia clínica y exploración física, así como pruebas complementarias en busca de hallazgos característicos de COVID-19.


Subject(s)
Abdomen, Acute/diagnosis , Abdominal Pain/etiology , COVID-19 Testing , COVID-19/diagnosis , Abdomen, Acute/surgery , Abdomen, Acute/virology , Abdominal Pain/virology , Adolescent , Appendicitis/diagnosis , COVID-19/complications , Child , Child, Preschool , Diarrhea/epidemiology , Diarrhea/etiology , Female , Fever/epidemiology , Fever/etiology , Humans , Intensive Care Units/statistics & numerical data , Male , Peritonitis/diagnosis , Retrospective Studies , Vomiting/epidemiology , Vomiting/etiology
16.
J Microbiol Immunol Infect ; 54(4): 541-546, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-866907

ABSTRACT

The Coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is an international public health emergency. Although respiratory symptoms predominate the clinical manifestations of COVID-19, gastrointestinal symptoms have been observed in a subset of patients. Notably, some patients have nausea/vomiting as the first clinical manifestation of COVID-19, which is often overlooked by people. It is now clear that not only the lungs, the gastrointestinal tract could also be attacked by SARS-CoV-2. Its host receptor angiotensin-converting enzyme 2 (ACE2), which acts as a gateway to infection, has been found to be highly expressed in the gastrointestinal epithelium and may lead to the development of nausea/vomiting. Raise awareness of these symptoms and take timely intervention would help people combat the pandemic. This review discussed epidemiology, mechanisms, management, and prevention of COVID-19 related nausea and vomiting.


Subject(s)
COVID-19/physiopathology , Nausea/virology , SARS-CoV-2/physiology , Vomiting/virology , Angiotensin-Converting Enzyme 2 , COVID-19/complications , COVID-19/therapy , COVID-19/virology , Humans , Nausea/epidemiology , Vomiting/epidemiology
17.
Aliment Pharmacol Ther ; 51(9): 843-851, 2020 05.
Article in English | MEDLINE | ID: covidwho-832170

ABSTRACT

BACKGROUND: There is little published evidence on the gastrointestinal features of COVID-19. AIMS: To report on the gastrointestinal manifestations and pathological findings of patients with COVID-19, and to discuss the possibility of faecal transmission. METHODS: We have reviewed gastrointestinal features of, and faecal test results in, COVID-19 from case reports and retrospective clinical studies relating to the digestive system published since the outbreak. RESULTS: With an incidence of 3% (1/41)-79% (159/201), gastrointestinal symptoms of COVID-19 included anorexia 39.9% (55/138)-50.2% (101/201), diarrhoea 2% (2/99)-49.5% (146/295), vomiting 3.6% (5/138)-66.7% (4/6), nausea 1% (1/99)-29.4% (59/201), abdominal pain 2.2% (3/138)-6.0% (12/201) and gastrointestinal bleeding 4% (2/52)-13.7% (10/73). Diarrhoea was the most common gastrointestinal symptom in children and adults, with a mean duration of 4.1 ± 2.5 days, and was observed before and after diagnosis. Vomiting was more prominent in children. About 3.6% (5/138)-15.9% (32/201) of adult and 6.5% (2/31)-66.7% (4/6) of children patients presented vomiting. Adult and children patients can present with digestive symptoms in the absence of respiratory symptoms. The incidence of digestive manifestations was higher in the later than in the early stage of the epidemic, but no differences in digestive symptoms among different regions were found. Among the group of patients with a higher proportion of severe cases, the proportion of gastrointestinal symptoms in severe patients was higher than that in nonsevere patients (anorexia 66.7% vs 30.4%; abdominal pain 8.3% vs 0%); while in the group of patients with a lower severe rate, the proportion with gastrointestinal symptoms was similar in severe and nonsevere cases (nausea and vomiting 6.9% vs 4.6%; diarrhoea 5.8% vs 3.5%). Angiotensin converting enzyme 2 and virus nucleocapsid protein were detected in gastrointestinal epithelial cells, and infectious virus particles were isolated from faeces. Faecal PCR testing was as accurate as respiratory specimen PCR detection. In 36% (5/14)-53% (39/73) faecal PCR became positive, 2-5 days later than sputum PCR positive. Faecal excretion persisted after sputum excretion in 23% (17/73)-82% (54/66) patients for 1-11 days. CONCLUSIONS: Gastrointestinal symptoms are common in patients with COVID-19, and had an increased prevalence in the later stage of the recent epidemic in China. SARS-CoV-2 enters gastrointestinal epithelial cells, and the faeces of COVID-19 patients are potentially infectious.


Subject(s)
Coronavirus Infections/complications , Coronavirus Infections/transmission , Feces/virology , Gastrointestinal Diseases/virology , Pneumonia, Viral/complications , Pneumonia, Viral/transmission , Adult , Betacoronavirus , COVID-19 , Child , China/epidemiology , Coronavirus Infections/epidemiology , Diarrhea/epidemiology , Diarrhea/virology , Disease Outbreaks , Gastrointestinal Diseases/epidemiology , Humans , Incidence , Pandemics , Pneumonia, Viral/epidemiology , SARS-CoV-2 , Vomiting/epidemiology , Vomiting/virology
18.
Am J Gastroenterol ; 116(2): 306-310, 2021 02 01.
Article in English | MEDLINE | ID: covidwho-809644

ABSTRACT

INTRODUCTION: The most typical presentation of COVID-19 is an acute respiratory syndrome whose most common symptoms include fever, cough, and dyspnea. However, gastrointestinal symptoms, such as diarrhea and nausea/vomiting, are increasingly reported in patients affected by COVID-19. This study aimed to describe the prevalence and time of onset of gastrointestinal symptoms in patients affected by COVID-19 and to find potential associations between gastrointestinal symptoms and clinical outcomes. METHODS: We performed a prospective single-center cohort study, enrolling patients who received diagnosis of COVID-19 at our institution between March 23, 2020, and April 5, 2020. We collected patient demographics and medical history, laboratory data, and clinical outcomes. Furthermore, we used a specifically designed questionnaire, administered to patients at time of diagnosis, to obtain data on the presence and time of onset of fever, typical respiratory symptoms, gastrointestinal symptoms, and other symptoms (fatigue, headache, myalgia/arthralgia, anosmia, ageusia/dysgeusia, sore throat, and ocular symptoms). RESULTS: In our cohort, 138 (69%) of 190 patients showed at least 1 gastrointestinal symptom at diagnosis; if excluding hyporexia/anorexia, 93 patients (48.9%) showed at least 1 gastrointestinal symptom. Gastrointestinal symptoms, in particular diarrhea, were associated with a lower mortality. At multivariate analysis, diarrhea was confirmed as independent predictive factor of lower mortality. DISCUSSION: Gastrointestinal symptoms are very frequent in patients with COVID-19 and may be associated with a better prognosis. These data suggest that, in some patients, the gastrointestinal tract may be more involved than the respiratory system in severe acute respiratory syndrome coronavirus 2 infection, and this could account for the less severe course of disease.


Subject(s)
COVID-19/diagnosis , Gastrointestinal Diseases/virology , Adult , Aged , Aged, 80 and over , COVID-19/physiopathology , COVID-19 Testing , Diarrhea/diagnosis , Diarrhea/epidemiology , Diarrhea/physiopathology , Diarrhea/virology , Female , Gastrointestinal Diseases/diagnosis , Gastrointestinal Diseases/epidemiology , Gastrointestinal Diseases/physiopathology , Humans , Italy , Logistic Models , Male , Middle Aged , Nausea/diagnosis , Nausea/epidemiology , Nausea/physiopathology , Nausea/virology , Prevalence , Prognosis , Prospective Studies , Time Factors , Vomiting/diagnosis , Vomiting/epidemiology , Vomiting/physiopathology , Vomiting/virology
19.
J Gastroenterol Hepatol ; 36(3): 646-656, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-780938

ABSTRACT

Exclusion of nausea (N) and vomiting (V) from detailed consideration as symptoms of COVID-19 is surprising as N can be an early presenting symptom. We examined the incidence of NV during infection before defining potential mechanisms. We estimate that the overall incidence of nausea (median 10.5%), although variable, is comparable with diarrhea. Poor definition of N, confusion with appetite loss, and reporting of N and/or V as a single entity may contribute to reporting variability and likely underestimation. We propose that emetic mechanisms are activated by mediators released from the intestinal epithelium by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) modulate vagal afferents projecting to the brainstem and after entry into the blood, activate the area postrema (AP) also implicated in anorexia. The receptor for spike protein of SARS-CoV-2, angiotensin 2 converting enzyme (ACE2), and transmembrane protease serine (for viral entry) is expressed in upper gastrointestinal (GI) enterocytes, ACE2 is expressed on enteroendocrine cells (EECs), and SARS-CoV-2 infects enterocytes but not EECs (studies needed with native EECs). The resultant virus-induced release of epithelial mediators due to exocytosis, inflammation, and apoptosis provides the peripheral and central emetic drives. Additionally, data from SARS-CoV-2 show an increase in plasma angiotensin II (consequent on SARS-CoV-2/ACE2 interaction), a centrally (AP) acting emetic, providing a further potential mechanism in COVID-19. Viral invasion of the dorsal brainstem is also a possibility but more likely in delayed onset symptoms. Overall, greater attention must be given to nausea as an early symptom of COVID-19 and for the insights provided into the GI effects of SARS-CoV-2.


Subject(s)
COVID-19 Testing/methods , COVID-19/diagnosis , Nausea/virology , Vomiting/virology , COVID-19/complications , COVID-19/physiopathology , COVID-19/virology , Humans , Incidence , Nausea/epidemiology , Vomiting/epidemiology
20.
Expert Rev Gastroenterol Hepatol ; 15(1): 41-50, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-780246

ABSTRACT

INTRODUCTION: The new Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is the etiologic agent of coronavirus disease 2019. Some authors reported pieces of evidence that patients with SARS-CoV-2 infection could have direct involvement of the gastrointestinal tract, and in symptomatic cases, gastrointestinal symptoms (diarrhea, nausea/vomiting, abdominal pain) could be very common. AREA COVERED: In this article, we reviewed current-published data of the gastrointestinal aspects involved in SARS-CoV-2 infection, including prevalence and incidence of specific symptoms, the presumptive biological mechanism of GI infection, prognosis, clinical management, and public health-related concerns on the possible risk of oral-fecal transmission. EXPERT OPINION: Different clues point to direct virus infection and replication in mucosal cells of the gastrointestinal tract. In vitro studies showed that SARS-CoV-2 could enter into the gastrointestinal epithelial cells by the Angiotensin-Converting enzyme two membrane receptor. These findings, coupled with the identification of viral RNA found in stools of patients, clearly suggest that direct involvement of the gastrointestinal tract is very likely. This can justify most of the gastrointestinal symptoms but also suggest a risk for an oral-fecal route for transmission, additionally or alternatively to the main respiratory route.


Subject(s)
COVID-19/complications , Gastrointestinal Diseases/epidemiology , Gastrointestinal Diseases/virology , RNA, Viral/analysis , SARS-CoV-2/physiology , Abdominal Pain/epidemiology , Angiotensin-Converting Enzyme 2/metabolism , COVID-19/transmission , Diarrhea/epidemiology , Epithelial Cells/metabolism , Feces/chemistry , Gastrointestinal Tract/cytology , Humans , Incidence , Nausea/epidemiology , Prevalence , SARS-CoV-2/isolation & purification , Spike Glycoprotein, Coronavirus/metabolism , Virus Attachment , Vomiting/epidemiology
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