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Gastrointestinal mucosal damage in patients with COVID-19 undergoing endoscopy: an international multicentre study.


ABSTRACT:

Background

Although evidence suggests frequent gastrointestinal (GI) involvement during coronavirus disease 2019 (COVID-19), endoscopic findings are scarcely reported.

Aims

We aimed at registering endoscopic abnormalities and potentially associated risk factors among patients with COVID-19.

Methods

All consecutive patients with COVID-19 undergoing endoscopy in 16 institutions from high-prevalence regions were enrolled. Mann-Whitney U, ?2 or Fisher's exact test were used to compare patients with major abnormalities to those with negative procedures, and multivariate logistic regression to identify independent predictors.

Results

Between February and May 2020, during the first pandemic outbreak with severely restricted endoscopy activity, 114 endoscopies on 106 patients with COVID-19 were performed in 16 institutions (men=70.8%, median age=68 (58-74); 33% admitted in intensive care unit; 44.4% reporting GI symptoms). 66.7% endoscopies were urgent, mainly for overt GI bleeding. 52 (45.6%) patients had major abnormalities, whereas 13 bled from previous conditions. The most prevalent upper GI abnormalities were ulcers (25.3%), erosive/ulcerative gastro-duodenopathy (16.1%) and petechial/haemorrhagic gastropathy (9.2%). Among lower GI endoscopies, 33.3% showed an ischaemic-like colitis.Receiver operating curve analysis identified D-dimers >1850?ng/mL as predicting major abnormalities. Only D-dimers >1850?ng/mL (OR=12.12 (1.69-86.87)) and presence of GI symptoms (OR=6.17 (1.13-33.67)) were independently associated with major abnormalities at multivariate analysis.

Conclusion

In this highly selected cohort of hospitalised patients with COVID-19 requiring endoscopy, almost half showed acute mucosal injuries and more than one-third of lower GI endoscopies had features of ischaemic colitis. Among the hospitalisation-related and patient-related variables evaluated in this study, D-dimers above 1850 ng/mL was the most useful at predicting major mucosal abnormalities at endoscopy.

Trial registration number

ClinicalTrial.gov (ID: NCT04318366).

SUBMITTER: Vanella G 

PROVIDER: S-EPMC7907837 | biostudies-literature | 2021 Feb

REPOSITORIES: biostudies-literature

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Publications

Gastrointestinal mucosal damage in patients with COVID-19 undergoing endoscopy: an international multicentre study.

Vanella Giuseppe G   Capurso Gabriele G   Burti Cesare C   Fanti Lorella L   Ricciardiello Luigi L   Souza Lino Andre A   Boskoski Ivo I   Bronswijk Michiel M   Tyberg Amy A   Krishna Kumar Nair Govind G   Angeletti Stefano S   Mauro Aurelio A   Zingone Fabiana F   Oppong Kofi W KW   de la Iglesia-Garcia Daniel D   Pouillon Lieven L   Papanikolaou Ioannis S IS   Fracasso Pierluigi P   Ciceri Fabio F   Rovere-Querini Patrizia P   Tomba Carolina C   Viale Edi E   Eusebi Leonardo Henry LH   Riccioni Maria Elena ME   van der Merwe Schalk S   Shahid Haroon H   Sarkar Avik A   Yoo Jin Woo Gene JWG   Dilaghi Emanuele E   Speight R Alexander RA   Azzolini Francesco F   Buttitta Francesco F   Porcari Serena S   Petrone Maria Chiara MC   Iglesias-Garcia Julio J   Savarino Edoardo V EV   Di Sabatino Antonio A   Di Giulio Emilio E   Farrell James J JJ   Kahaleh Michel M   Roelandt Philip P   Costamagna Guido G   Artifon Everson Luiz de Almeida ELA   Bazzoli Franco F   Testoni Per Alberto PA   Greco Salvatore S   Arcidiacono Paolo Giorgio PG  

BMJ open gastroenterology 20210201 1


<h4>Background</h4>Although evidence suggests frequent gastrointestinal (GI) involvement during coronavirus disease 2019 (COVID-19), endoscopic findings are scarcely reported.<h4>Aims</h4>We aimed at registering endoscopic abnormalities and potentially associated risk factors among patients with COVID-19.<h4>Methods</h4>All consecutive patients with COVID-19 undergoing endoscopy in 16 institutions from high-prevalence regions were enrolled. Mann-Whitney U, χ<sup>2</sup> or Fisher's exact test we  ...[more]

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