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COVID-19 is mainly a respiratory illness caused by the SARS-CoV-2 but can also lead to GI symptoms. The primary host receptor which mediates the mechanism as SARS-CoV-2 enters the cell is the ACE2 receptor. Therefore, GI symptoms can be common in COVID-19, and in some cases, they are the first manifestation even before fever and respiratory symptoms. In addition, the liver function tests alteration often is related to a worse prognosis. The exact incidence of GI symptoms is a matter of debate. Moreover, wide variation concerning GI symptoms frequency exists, but the predominant ones seem to be diarrhea, anorexia, nausea, vomiting, and abdominal pain or discomfort.This review summarizes the most relevant findings of COVID-19 on the digestive system, including the liver, biliary tract, pancreas, the most common GI symptoms, and the atypical clinical GI manifestations.Copyright © 2022 Sociedad Medica del Hospital General de Mexico. Published by Permanyer.
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Introduction: The global spread of the SARS-CoV-2 virus has resulted in a worldwide pandemic with important socio-health repercussions. Current clinical experience and several published retrospective studies suggest that digestive symptoms are common in infected patients. [1][2] The aim of this study was to evaluate the frequency of gastrointestinal (GI) symptoms and complications in patients with COVID-19 disease managed on an outpatient basis. Aims & Methods: International, multicenter, prospective cohort study was conducted in 18 centers from Latin America, Asia, Africa and Europe. Subjects ≥18 years old, with COVID-19 disease, managed on an outpatient basis were included. Followed up period was 6 months. Baseline characteristics, comorbidities, GI symptoms or complications, hospital admission, ICU admission and mortality data were collected. A descriptive analysis of the study results was performed. A multivariate analysis was carried out, evaluating the association of GI symptoms and complications with age, baseline characteristics, comorbidity and COVID-19 treatments received. The adjusted Odd Ratio (ORa) was calculated assuming a significance level of p <0.05. Results: The preliminary analysis included a total of 436 patients. The median age was 35 years, interquartile range (IQR) 27-48 years. Two hundred and ten patients (48.2%) were male. The median of age-adjusted Charlson Comorbidity Index was 0 (IQR 0-1). The most frequent GI symptoms were anorexia 216 (49.5%), diarrhea 207 (47.5%), nausea 134 (30.7%), abdominal pain 122 (28%) and abdominal distension 121 (27.8%). At 4-week follow- up, symptoms resolved in most cases. Multivariate analysis showed that nausea was associated with Ivermectin treatment ORa 3.24 (95% CI 1.11-9.43) p= 0.030;abdominal pain was associated with Hydroxychloroquine treatment ORa 5.27 (95% CI 1.52-18.19) p= 0.009;diarrhea was associated with age ORa 0.966 (95% CI 0.93-0.99), p= 0.020 and Hydroxychloroquine treatment ORa 6.9 (95% CI 1.55-30.79), p= 0. 011;abdominal distension was associated with body mass index ORa 1.147 (95% CI 1.05-1.24), p< 0.001 and Hydroxychloroquine treatment ORa 7.6 (95% CI 2.00-29.51), p= 0.003. Digestive complications were infrequent (1 gastritis, 2 duodenitis, 1 jejunal ulcer, 3 hypertransaminasemia, 1 enteritis, 1 colitis). Twenty-three patients (5.3%) required hospital admission, of whom 4 (0.9%) required ICU admission and 2 (0.5%) died. Conclusion: Anorexia, diarrhea, nausea, abdominal pain and abdominal bloating were common symptoms in patients with COVID-19 disease managed on an outpatient basis. GI complications were infrequent in patients with COVID-19 who do not require hospitalization. Treatment with Hydroxychloroquine and Ivermectin was associated with more GI symptoms in COVID-19 outpatients.
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Introduction: Some patients with SARSCov-2 infection develop severe disease (SARS);however, the factors associated with severity are not yet fully understood. Some reports indicate that liver injury may be a poor prognostic factor. Aim: To identify the biochemical factors related to the development of SARS with mechanical ventilation (MV) requirement in patients with SARSCov-2 and COVID-19. Methods Type of study: Observational. Cohort study. Procedure: Data from COVID-19 patients were collected at admission time to a tertiary care center. Differential factors were identified between seriously ill SARS+MV patients versus stable patients without MV. Transformation to the natural logarithm of significant variables was performed and multiple linear regression was applied, then a predictive model of severity called AAD (Age-AST-D dimer) was constructed. Results: 166 patients were included, 114(68.7%) men, mean age 50.6±13.3 years-old, 27(16.3%) developed SARS+MV. In the comparative analysis between those with SARS+MV versus stable patients without MV we found significant raises of ALT (225.4±341.2 vs. 41.3±41.1;P=0.003), AST 325.3±382.4 vs. 52.8±47.1;P=0.001), LDH (764.6±401.9 vs. 461.0±185.6;P=0.001), D dimer (7765±9109 vs. 1871±4146;P=0.003), age (58.6±12.7 vs. 49.1±12.8;P=0-001). The results of the regression are shown in the Table, where model 3 was the one that best explained the development of SARS+MV;with these variables was constructed the model called AAD, where: [AAD= 3.896 + ln(age)x-0.218 + ln(AST)x-0.185 + ln(DD)x0.070], where a value ≤ 2.75 had sensitivity=0.797 and 1-specificity= 0.391, AUROC=0.74 (95%CI: 0.62-0.86;P<0.0001), to predict the risk of developing SARS+MV (OR=5.8, 95%CI: 2.2-15.4;P=0.001). Conclusions: Elevation of AST (probable marker of liver damage) is an important predictor of progression to SARS, together with elevation of D-dimer and age early (at admission) and efficiently predict which patients will potentially require MV.
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Background and aim: Some patients with SARSCov-2 infection develop severe disease (SARS);however, the factors associated with severity are not yet fully understood. Some reports indicate that liver injury may be a poor prognostic factor. AIM: To identify the biochemical factors related to the development of SARS with mechanical ventilation (MV) requirement in patients with SARSCov-2 and COVID-19. Methods. Type of Study: Observational. Cohort study. Procedure: Data from COVID-19 patients were collected at admission time to a tertiary care center. Differential factors were identified between seriously ill SARS + MV patients versus stable patients without MV. Transformation to the natural logarithm of significant variables was performed and multiple linear regression was applied, then a predictive model of severity called AAD (Age-AST-D dimer) was constructed. Result(s): 166 patients were included, 114(68.7%) men, mean age 50.6 +/- 13.3 years-old, 27(16.3%) developed SARS + MV. In the comparative analysis between those with SARS + MV versus stable patients without MV we found significant raises of ALT (225.4 +/- 341.2 vs. 41.3 +/- 41.1;P = 0.003), AST 325.3 +/- 382.4 vs. 52.8 +/- 47.1;P = 0.001), LDH (764.6 +/- 401.9 vs. 461.0 +/- 185.6;P = 0.001), D dimer (7765 +/- 9109 vs. 1871 +/- 4146;P = 0.003), age (58.6 +/- 12.7 vs. 49.1 +/- 12.8;P = 0-001). The results of the regression are shown in the Table, where model 3 was the one that best explained the development of SARS + MV;with these variables was constructed the model called AAD, where: [AAD = 3.896 + ln(age)x-0.218 + ln(AST)x-0.185 + ln(DD)x0.070], where a value = 2.75 had sensitivity = 0.797 and 1-specificity = 0.391, AUROC = 0.74 (95%CI: 0.62-0.86;P 0.0001), to predict the risk of developing SARS + MV (OR = 5.8, 95%CI: 2.2-15.4;P = 0.001). Conclusion(s): Elevation of AST (probable marker of liver damage) is an important predictor of progression to SARS, together with elevation of D-dimer and age early (at admission) and efficiently predict which patients will potentially require MV. Conflicts of interest: The authors have no conflicts of interest to declare. [Formula presented] [Formula presented] Copyright © 2020
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Background and aim: SARSCov-2 infection, currently responsible virus for the pandemic, can have a multi-organic impact, recent studies show that liver injury could be a manifestation of the disease, and liver disease could also be related to a worst prognosis. AIM: To compare the characteristics of patients with severe COVID-19 due to SARSCov-2 disease requiring intubation versus stable patients. Methods. Type of Study: Observational, a case-control, nested in a cohort study. Procedure: Complete medical records of patients admitted for COVID-19 at a third level center were reviewed. Clinical and biochemical data were collected and then characteristics between seriously ill patients who required intubation were compared versus stable patients without mechanical ventilation. Result(s): We included 166 patients with COVID-19 due to SARSCov-2 infection, 114(68.7%) were men, mean age was 50.6 +/- 13.3 years old, 27(16.3%) were assessed as seriously ill patients requiring intubation for SARS. The comparative analysis between those who required intubation versus those who remained without requiring intubation showed significant elevation of ALT, AST, LDH and D-dimer, also older age, see Table. Conclusion(s): This is the first study in a Mexican cohort, which demonstrate that seriously ill patients have significant raises of liver enzymes (AST, ALT) with prognostic implications in the SARSCov-2 disease course. Conflicts of interest: The authors have no conflicts of interest to declare.Copyright © 2020
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The recommendations for face-To-face medical attention in the post-pandemic COVID-19 should be taken up in a different reality. It should be borne in mind that the return of the medical doctor to consult after the COVID-19 pandemic supposedly ends, acquires a greater risk of becoming infected than if he continued to be confined at home. The decision of when to restart the medical consultation should be made in the context of local circumstances. Prioritizing patient safety will be essential and a great challenge. We must make many changes in our usual lifestyle, to adjust to a "different reality" that represents the return to medical activity in the office. We present some scenarios in the necessary measures that allow the prevention of contagion for the medical doctor, the health team, the staff and the patients. © 2020 Comunicaciones Cientificas Mexicanas S.A. de C.V.. All rights reserved.