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COVID-19 and Gastrointestinal Disease. Implications for the Gastroenterologist.

ABSTRACT: COVID-19 was initially considered to be a respiratory disease but soon after the pandemic established it became clear that the SARS-CoV-2 virus which caused the disease could lead to serious systemic consequences affecting most of the major organs including the digestive tract, liver and pancreas. This review brings together the new information which is clinically relevant to the gastroenterologist including the origins of the disease, mechanisms of tissue damage and how this affects specific patient groups, including those with inflammatory bowel disease, comorbidities and the role of immunosuppression, chronic liver disease and the risk of decompensation for those with cirrhosis. The impact of COVID-19 for gastrointestinal emergencies is addressed together with the implications for the conduct of endoscopic and other interventional and diagnostic procedures. The importance of fully understanding the pharmacology and therapeutic implications of drugs commonly used by the gastroenterologist and their relationship with COVID-19 are also highlighted. The risk for drug-drug interactions is considerable in patients seriously ill with COVID-19 who are often requiring mechanical ventilation and life-support. Some re-purposed drugs used against SARS-CoV-2 can cause or aggravate some of the COVID-19 GI symptoms and also can induce iatrogenic liver injury. Ongoing clinical studies will hopefully identify effective drugs with a risk-benefit ratio which will be more favorable than many recently tried treatments.

SUBMITTER: Hunt RH

PROVIDER: S-EPMC7705947 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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COVID-19 and Gastrointestinal Disease: Implications for the Gastroenterologist.

Hunt Richard H RH East James E JE Lanas Angel A Malfertheiner Peter P Satsangi Jack J Scarpignato Carmelo C Webb Gwilym J GJ

Digestive diseases (Basel, Switzerland) 20201009 2

<h4>Background</h4>COVID-19 was initially considered a respiratory disease but the SARS-CoV-2 virus can lead to serious systemic consequences affecting major organs including the digestive system.<h4>Summary</h4>This review brings new clinically important information for the gastroenterologist. This includes: the mechanisms of tissue damage seen with the SARS-CoV-2 virus; the consequences of immunosuppression in patients with inflammatory bowel disease (IBD) and chronic liver disease with the ad ...[more]

PMID: 33040064

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Project description:COVID-19 pandemic has profoundly changed the activities and daily clinical scenarios, subverting organizational requirements of our Gastroenterology Units. to evaluate the clinical needs and outcomes of the gastroenterological ward metamorphosis during the COVID-19 outbreaks in a high incidence scenario. we compared the pertinence of gastroenterological hospitalization, modality of access, mortality rate, days of hospitalization, diagnostic and interventional procedures, age, Charlson comorbidity index, and frequency of SARS-CoV-2 infections in patients and healthcare personnel across the first and the second COVID-19 outbreaks in a COVID-free gastroenterological ward in the metropolitan area of Milan, that was hit first and hardest during the first COVID-19 outbreak since March 2020. pertinence of gastroenterological hospitalization decreased both during the first and, to a lesser degree, the second SARS-CoV2 waves as compared to the pre-COVID era (43.6, 85.4, and 96.2%, respectively), as occurred to the admissions from domicile, while age, comorbidities, length of stay and mortality increased. Endoscopic and interventional radiology procedures declined only during the first wave. Hospitalized patients resulted positive to a SARS-CoV-2 nasopharyngeal swab in 10.2% of cases during the first COVID-19 outbreak after a median of 7 days since admission (range 1-15 days) and only 1 out of 318 patients during the second wave (6 days after admission). During the first wave, 19.5% of healthcare workers tested positive for SARS-CoV-2. a sudden metamorphosis of the gastroenterological ward was observed during the first COVID-19 outbreak with a marked reduction in the gastroenterological pertinence at the admission, together with an increase in patients' age and multidisciplinary complexity, hospital stays, and mortality, and a substantial risk of developing a SARS-CoV-2 test positivity. This lesson paved the way for the efficiency of hospital safety protocols and admission management, which contributed to the improved outcomes recorded during the second COVID-19 wave.

Dataset Information

COVID-19 and Gastrointestinal Disease. Implications for the Gastroenterologist.

Publications

COVID-19 and Gastrointestinal Disease: Implications for the Gastroenterologist.

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