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1.
Gastroenterol Hepatol (N Y) ; 18(7): 380-387, 2022 Jul.
Article in English | MEDLINE | ID: mdl-36397771

ABSTRACT

Multiple studies and extensive clinical experience have shown that COVID-19 can impact the hepatobiliary system, with most reports describing primarily hepatocellular injury with elevations of aspartate aminotransferase and alanine aminotransferase. In addition to hepatocellular injury, recent literature has described a pattern of severe biliary tract injury resulting in patients with COVID-19. This novel syndrome, termed COVID-19 cholangiopathy, may have severe consequences for affected patients. This article will examine the literature describing this novel entity, its relationship to secondary sclerosing cholangitis, clinical outcomes, and proposed mechanisms underlying this form of biliary injury.

2.
Am J Gastroenterol ; 116(7): 1414-1425, 2021 07 01.
Article in English | MEDLINE | ID: mdl-33993134

ABSTRACT

INTRODUCTION: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 virus, is a predominantly respiratory tract infection with the capacity to affect multiple organ systems. Abnormal liver tests, mainly transaminase elevations, have been reported in hospitalized patients. We describe a syndrome of cholangiopathy in patients recovering from severe COVID-19 characterized by marked elevation in serum alkaline phosphatase (ALP) accompanied by evidence of bile duct injury on imaging. METHODS: We conducted a retrospective study of COVID-19 patients admitted to our institution from March 1, 2020, to August 15, 2020, on whom the hepatology service was consulted for abnormal liver tests. Bile duct injury was identified by abnormal liver tests with serum ALP > 3x upper limit of normal and abnormal findings on magnetic resonance cholangiopacreatography. Clinical, laboratory, radiological, and histological findings were recorded in a Research Electronic Data Capture database. RESULTS: Twelve patients were identified, 11 men and 1 woman, with a mean age of 58 years. Mean time from COVID-19 diagnosis to diagnosis of cholangiopathy was 118 days. Peak median serum alanine aminotransferase was 661 U/L and peak median serum ALP was 1855 U/L. Marked elevations of erythrocyte sedimentation rate, C-reactive protein, and D-dimers were common. Magnetic resonance cholangiopacreatography findings included beading of intrahepatic ducts (11/12, 92%), bile duct wall thickening with enhancement (7/12, 58%), and peribiliary diffusion high signal (10/12, 83%). Liver biopsy in 4 patients showed acute and/or chronic large duct obstruction without clear bile duct loss. Progressive biliary tract damage has been demonstrated radiographically. Five patients were referred for consideration of liver transplantation after experiencing persistent jaundice, hepatic insufficiency, and/or recurrent bacterial cholangitis. One patient underwent successful living donor liver transplantation. DISCUSSION: Cholangiopathy is a late complication of severe COVID-19 with the potential for progressive biliary injury and liver failure. Further studies are required to understand pathogenesis, natural history, and therapeutic interventions.


Subject(s)
COVID-19/complications , Cholangitis, Sclerosing/epidemiology , End Stage Liver Disease/epidemiology , Jaundice/epidemiology , Adult , Aged , Alanine Transaminase/blood , Alkaline Phosphatase/blood , Bile Ducts/diagnostic imaging , Bile Ducts/immunology , Bile Ducts/pathology , Biopsy , COVID-19/diagnosis , COVID-19/immunology , COVID-19/virology , COVID-19 Nucleic Acid Testing , Cholangiopancreatography, Magnetic Resonance , Cholangitis, Sclerosing/diagnosis , Cholangitis, Sclerosing/immunology , Cholangitis, Sclerosing/therapy , Disease Progression , End Stage Liver Disease/diagnosis , End Stage Liver Disease/immunology , End Stage Liver Disease/surgery , Female , Humans , Jaundice/diagnosis , Jaundice/immunology , Jaundice/therapy , Liver Function Tests , Liver Transplantation , Male , Middle Aged , Prognosis , Retrospective Studies , SARS-CoV-2/genetics , SARS-CoV-2/isolation & purification , Severity of Illness Index
3.
Med Clin North Am ; 105(1): 55-73, 2021 Jan.
Article in English | MEDLINE | ID: mdl-33246523

ABSTRACT

Primary care physicians frequently evaluate patients with constipation. The history is crucial in uncovering warning symptoms and signs that warrant colonoscopy. Particular elements in the history and rectal examination also can provide clues regarding the underlying etiology. Regardless of etiology, lifestyle modifications, fiber, and laxatives are first-line therapies. Patients who fail first-line therapies can be offered second-line treatments and/or referred for testing of defecatory function. In those with severely refractory symptoms, referrals to a gastroenterologist and a surgeon should be considered.


Subject(s)
Constipation/diagnosis , Constipation/drug therapy , Adult , Colonoscopy , Constipation/etiology , Constipation/physiopathology , Cost of Illness , Dietary Fiber/therapeutic use , Digital Rectal Examination , Female , Humans , Laxatives/therapeutic use , Male , Manometry , Middle Aged , Primary Health Care , Quality of Life , Risk Factors
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