COVID-19 status quo: Emphasis on gastrointestinal and liver manifestations.

The coronavirus disease 2019 (COVID-19) has caused one of the worst public health crises in modern history. Even though severe acute respiratory syndrome coronavirus 2 primarily affects the respiratory tract, gastrointestinal manifestations are well described in literature. This review will discuss the epidemiology, virology, manifestations, immunosuppressant states, and lessons learned from COVID-19. Observations: At the time of writing, COVID-19 had infected more than 111 million people and caused over 2.5 million deaths worldwide. Multiple medical comorbidities including obesity, pre-existing liver condition and the use of proton pump inhibitor have been described as risk factor for severe COVID-19. COVID-19 most frequently causes diarrhea (12.4%), nausea/vomiting (9%) and elevation in liver enzymes (15%-20%). The current data does not suggest that patients on immunomodulators have a significantly increased risk of mortality from COVID-19. The current guidelines from American Gastroenterological Association and American Association for the Study of Liver Diseases do not recommend pre-emptive changes in patients on immunosuppression if the patients have not been infected with COVID-19. Conclusions and relevance: The COVID-19 pandemic has prompted a change in structure and shape of gastroenterology departmental activities. Endoscopy should be performed only when necessary and with strict protective measures. Online consultations in the form of telehealth services and home drug deliveries have revolutionized the field.

Hospital teaching status on the outcomes of patients with esophageal variceal bleeding in the United States.

BACKGROUND: Acute variceal bleeding is a major complication of portal hypertension and is a leading cause of death in patients with cirrhosis. There is limited data on the outcomes of patients with esophageal variceal bleeding in teaching versus nonteaching hospitals. Because esophageal variceal bleeding requires complex management, it may be hypothesized that teaching hospitals have lower mortality. AIM: To assess the differences in mortality, hospital length of stay (LOS) and cost of admission for patients admitted for variceal bleed in teaching versus nonteaching hospitals across the US. METHODS: The National Inpatient Sample is the largest all-payer inpatient database consisting of approximately 20% of all inpatient admissions to nonfederal hospitals in the United States. We collected data from the years 2008 to 2014. Cases of variceal bleeding were identified using the International Classification of Diseases, Ninth Edition, Clinical Modification codes. Differences in mortality, LOS and cost were evaluated for patients with esophageal variceal bleed between teaching and nonteaching hospitals and adjusted for patient characteristics and comorbidities. RESULTS: Between 2008 and 2014, there were 58362 cases of esophageal variceal bleeding identified. Compared with teaching hospitals, mortality was lower in non-teaching hospitals (8.0% vs 5.3%, P < 0.001). Median LOS was shorter in nonteaching hospitals as compared to teaching hospitals (4 d vs 5 d, P < 0.001). A higher proportion of non-white patients were managed in teaching hospitals. As far as procedures in nonteaching vs teaching hospitals, portosystemic shunt insertion (3.1% vs 6.9%, P < 0.001) and balloon tamponade (0.6% vs 1.2%) were done more often in teaching hospitals while blood transfusions (64.2% vs 59.9%, P = 0.001) were given more in nonteaching hospitals. Using binary logistic regression models and adjusting for baseline patient demographics and comorbid conditions the mortality, LOS and cost in teaching hospitals remained higher. CONCLUSION: In patients admitted for esophageal variceal bleeding, mortality, length of stay and cost were higher in teaching hospitals versus nonteaching hospitals when controlling for other confounding factors.

Superior Performance of Teaching and Transplant Hospitals in the Management of Hepatic Encephalopathy from 2007 to 2014.

Background and Aims: Hepatic encephalopathy is a liver disease complication with significant mortality and costs. The aim of this study was to evaluate the relative performance of facilities based on their teaching status and transplant capability by correlating their connections to mortality, cost, and length of stay from 2007 to 2014. Methods: The Nationwide Inpatient Sample database was utilized to collect information on (USA) American patients admitted with a primary diagnosis of hepatic encephalopathy from 2007-2014. Hospitals were placed into one of four categories using their teaching and transplant status. Using regression analysis, mortality, length of stay and cost adjusted rate ratios were calculated. Results: The study revealed that teaching transplant centers had a mortality risk ratio of 0.783 (95% confidence interval (CI): 0.750-0.819, p < 0.001). Blacks had the highest mortality risk ratio, of 1.273 (95%CI: 1.217-1.331, p < 0.001). Furthermore, teaching transplant hospitals had a cost rate ratio of 1.226 (95%CI: 1.214-1.238, p < 0.001) and a length of stay rate ratio of 1.104 (95%CI: 1.093-1.115, p < 0.001). Conclusions: It appears that admission to transplant facilities for hepatic encephalopathy is associated with reduced mortality but increased costs and longer stay independent of transplantation. Moreover, factors impacting black mortality should also be examined more closely.

Efficacy of and potential morbidities associated with the use of antacid medications in preterm neonates.

OBJECTIVES: Antacid medications are frequently administered to preterm infants. These medications can change gastric pH levels and can affect regular gastrointestinal function and gut micro-bacterial flora. We hypothesized that preterm infants exposed to antacid medications are at a greater risk of necrotizing enterocolitis (NEC) and sepsis, and set out to determine any association, as well as to assess the clinical efficacy of these medications. MATERIALS AND METHODS: Retrospective chart review of preterm infants ≤30 weeks' gestational age or birth weight ≤1250 g over a 2-year period at New York University Langone Medical Center. Subjects were divided into two groups: those who had been treated with antacid medications and those who had not. We then examined for any difference in NEC (≥Bell stage 2) or culture proven sepsis. RESULTS: The study comprised 65 eligible neonates, 28 in antacid treatment group and 37 in control. The incidence of NEC (21.4% vs. 2.7%, P=0.04) was significantly higher in the antacid group, but these infants tended to be born more prematurely than control subjects. There was a trend toward more culture proven sepsis cases in the antacid group. We found no difference in signs generally associated with neonatal reflux (apnea, bradycardia, and desaturation events) in subjects treated with antacid medications after treatment began. CONCLUSIONS: Treatment of preterm infants with antacid medications is potentially associated with a higher risk of NEC, and possibly sepsis, while appearing to provide little benefit.