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BMJ Open Gastroenterology

Publication date: 2021-01-01
Publisher: BMJ Publishing Group

Author:

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

Keywords:

Science & Technology, Life Sciences & Biomedicine, Gastroenterology & Hepatology, endoscopy, mucosal infection, gastrointestinal tract, covid-19, CORONAVIRUS, Aged, COVID-19, Colitis, Ischemic, Cross-Sectional Studies, Duodenum, Endoscopy, Gastrointestinal, Female, Gastric Mucosa, Gastrointestinal Hemorrhage, Humans, Male, Middle Aged, Pandemics, Prospective Studies, Risk Factors, SARS-CoV-2, Stomach Ulcer, 3202 Clinical sciences, 4206 Public health

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, χ2 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).