Implications of SARS‐CoV‐2 infection for neurogastroenterology

Marasco, Giovanni; Lenti, Marco Vincenzo; Cremon, Cesare; Barbaro, Maria Raffaella; Stanghellini, Vincenzo; Sabatino, Antonio Di; Barbara, Giovanni

doi:10.1111/nmo.14104

Cited by 55 publications

(88 citation statements)

References 154 publications

(343 reference statements)

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“…Alongside common gastrointestinal symptoms such as diarrhea, nausea, and vomiting [1], several case reports have described the occurrence of gastrointestinal bleeding in COVID-19 patients [5][6][7][8][9]. Gastrointestinal bleeding has been reported in a variable proportion, ranging from 2% to 13% in hospitalized patients [10][11][12][13]. A high prevalence of peptic ulcer disease complicated by bleeding was noticed in patients with moderate-to-severe acute respiratory distress syndrome caused by COVID-19 [14,15].…”

Section: Introductionmentioning

confidence: 99%

Gastrointestinal Bleeding in COVID-19 Patients: A Systematic Review with Meta-Analysis

Marasco

Maida²,

Morreale³

et al. 2021

Canadian Journal of Gastroenterology and Hepatology

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The novel coronavirus disease 2019 (COVID-19) has been reported to affect the gastrointestinal system with a variety of symptoms, including bleeding. The prevalence of bleeding in these patients remains unclear. The aim of this meta-analysis is to estimate the rate of gastrointestinal bleeding in COVID-19 patients and its association with mortality. MEDLINE and Embase were searched through December 20, 2020. Studies reporting COVID-19 patients with and without gastrointestinal bleeding were included. Estimated prevalence with 95% confidence intervals (CI) was pooled; heterogeneity was expressed as I2. Metaregression analysis was performed to assess the impact of confounding covariates. Ten studies met the inclusion criteria and were included in the analysis. A total of 91887 COVID-19 patients were considered, of whom 534 reported gastrointestinal bleeding (0.6%) [409 (76.6%) upper and 121 (22.7%) lower gastrointestinal bleeding (UGIB and LGIB, resp.)]. The overall pooled gastrointestinal bleeding rate was 5% [95% CI 2–8], with high heterogeneity (I2 99.2%); “small study effect” was observed using the Egger test ( p = 0.049 ). After removing two outlier studies, the pooled bleeding rate was 2% [95% CI 0–4], with high heterogeneity (I2 99.2%), and no “small study effect” ( p = 0.257 ). The pooled UGIB rate was 1% (95% CI 0–3, I2 98.6%, p = 0.214 ), whereas the pooled LGIB rate was 1% (95% CI 0–2, I2 64.7%, p = 0.919 ). Metaregression analysis showed that overall estimates on gastrointestinal bleeding were affected by studies reporting different sources of bleeding. No significant association between gastrointestinal bleeding and mortality was found. In this meta-analysis of published studies, individuals with COVID-19 were found to be at risk for gastrointestinal bleeding, especially upper gastrointestinal bleeding.

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Section: Introductionmentioning

confidence: 99%

Gastrointestinal Bleeding in COVID-19 Patients: A Systematic Review with Meta-Analysis

Marasco

Maida²,

Morreale³

et al. 2021

Canadian Journal of Gastroenterology and Hepatology

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“…Regarding possible explanations to our findings, we could speculate that the fact that patients complaining of "mucosal" symptoms, such as diarrhoea, conjunctivitis, and anosmia/ ageusia have a mild disease course, seems to suggest that SARS-CoV-2 does not spread to other organs possibly due to an early immunological response sustained by mucosal secretory IgA, as it was recently shown [3]. In particular, the gastrointestinal tract may act as a barrier [4] to the so-called "SARS-CoV-2 sepsis" [5]. Accordingly, patients suffering from immunodeficiencies, especially those affecting the humoral immunity and spleen function, might be at higher risk of having severe COVID-19.…”

Section: Dear Editormentioning

confidence: 66%

COVID-19-related symptom clustering in a primary care vs internal medicine setting

et al. 2021

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“…Several previously published data have shown elevation in both transaminases and bilirubin to a different extent ranging from 1% to 53% (mainly ALT and AST accompanied by slightly increased bilirubin concentrations) [3]. In most published data, severe liver alterations were uncommon [29] and the pooled prevalence of liver injury regarding severity was 12% based on the meta-analysis by Mao et al [3] More severe liver injury was also associated with worse outcomes, including intensive care unit admission and mortality [30].…”

Section: Discussionmentioning

confidence: 99%

A machine learning approach for identification of gastrointestinal predictors for the risk of COVID-19 related hospitalization

Liptak

Bánovčin

Rosolanka

et al. 2021

Preprint

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Background and aim: COVID-19 can be presented with various gastrointestinal symptoms. Shortly after the pandemic outbreak several machine learning algorithms have been implemented to assess new diagnostic and therapeutic methods for this disease. Aim of this study is to assess gas-trointestinal and liver related predictive factors for SARS-CoV-2 associated risk of hospitalization. Methods: Data collection was based on questionnaire from the COVID-19 outpatient test center and from the emergency department at the University hospital in combination with data from inter-nal hospital information system and from the mobile application used for telemedicine follow-up of patients. For statistical analysis SARS-CoV-2 negative patients were considered as controls to three different SARS-CoV-2 positive patient groups (divided based on severity of the disease). Results: Total of 710 patients were enrolled in the study. Presence of diarrhea and nausea was significantly higher in emergency department group than in the COVID-19 outpatient test center. Among liver enzymes only aspartate transaminase (AST) has been significantly elevated in the hospitalized group compared to patients discharged home. Based on random forest algorithm, AST has been identified as the most important predictor followed by age or diabetes mellitus. Diarrhea and bloating have also predictive importance although much lower than AST. Conclusion: SARS-CoV-2 positivity is connected with isolated AST elevation and the level is linked with the severity of the disease. Furthermore, using machine learning random forest algo-rithm, we have identified elevated AST as the most important predictor for COVID-19 related hos-pitalizations.

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Implications of SARS‐CoV‐2 infection for neurogastroenterology

Cited by 55 publications

References 154 publications

Gastrointestinal Bleeding in COVID-19 Patients: A Systematic Review with Meta-Analysis

Gastrointestinal Bleeding in COVID-19 Patients: A Systematic Review with Meta-Analysis

COVID-19-related symptom clustering in a primary care vs internal medicine setting

A machine learning approach for identification of gastrointestinal predictors for the risk of COVID-19 related hospitalization

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