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

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. METHOD...

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Detalles Bibliográficos
Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Endoscopy
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7907837/
https://www.ncbi.nlm.nih.gov/pubmed/33627313
http://dx.doi.org/10.1136/bmjgast-2020-000578
Descripción
Sumario: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, χ(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).

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