TY - JOUR
T1 - Gastrointestinal mucosal damage in patients with COVID-19 undergoing endoscopy: An international multicentre study
AU - Vanella, Giuseppe
AU - Capurso, Gabriele
AU - Burti, Cesare
AU - Fanti, Lorella
AU - Ricciardiello, Luigi
AU - Souza Lino, Andre
AU - Boskoski, Ivo
AU - Bronswijk, Michiel
AU - Tyberg, Amy
AU - Krishna Kumar Nair, Govind
AU - Angeleti, Stefano
AU - Mauro, Aurelio
AU - Zingone, Fabiana
AU - Oppong, Kofi W.
AU - De La Iglesia-Garcia, Daniel
AU - Pouillon, Lieven
AU - Papanikolaou, Ioannis S.
AU - Fracasso, Pierluigi
AU - Ciceri, Fabio
AU - Rovere-Querini, Patrizia
AU - Tomba, Carolina
AU - Viale, Edi
AU - Eusebi, Leonardo Henry
AU - Riccioni, Maria Elena
AU - Van Der Merwe, Schalk
AU - Shahid, Haroon
AU - Sarkar, Avik
AU - Yoo, Jin Woo Gene
AU - Dilaghi, Emanuele
AU - Speight, R. Alexander
AU - Azzolini, Francesco
AU - Buttitta, Francesco
AU - Porcari, Serena
AU - Petrone, Maria Chiara
AU - Iglesias-Garcia, Julio
AU - Savarino, Edoardo V.
AU - Di Sabatino, Antonio
AU - Di Giulio, Emilio
AU - Farrell, James J.
AU - Kahaleh, Michel
AU - Roelandt, Philip
AU - Costamagna, Guido
AU - De Almeida Artifon, Everson Luiz
AU - Bazzoli, Franco
AU - Testoni, Per Alberto
AU - Greco, Salvatore
AU - Arcidiacono, Paolo Giorgio
PY - 2021
Y1 - 2021
N2 - 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).
AB - 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).
KW - Aged
KW - COVID-19
KW - Colitis, Ischemic
KW - Cross-Sectional Studies
KW - Duodenum
KW - Endoscopy, Gastrointestinal
KW - Female
KW - Gastric Mucosa
KW - Gastrointestinal Hemorrhage
KW - Humans
KW - Male
KW - Middle Aged
KW - Pandemics
KW - Prospective Studies
KW - Risk Factors
KW - SARS-CoV-2
KW - Stomach Ulcer
KW - covid-19
KW - endoscopy
KW - gastrointestinal tract
KW - mucosal infection
KW - Aged
KW - COVID-19
KW - Colitis, Ischemic
KW - Cross-Sectional Studies
KW - Duodenum
KW - Endoscopy, Gastrointestinal
KW - Female
KW - Gastric Mucosa
KW - Gastrointestinal Hemorrhage
KW - Humans
KW - Male
KW - Middle Aged
KW - Pandemics
KW - Prospective Studies
KW - Risk Factors
KW - SARS-CoV-2
KW - Stomach Ulcer
KW - covid-19
KW - endoscopy
KW - gastrointestinal tract
KW - mucosal infection
UR - http://hdl.handle.net/10807/219794
U2 - 10.1136/bmjgast-2020-000578
DO - 10.1136/bmjgast-2020-000578
M3 - Article
SN - 2054-4774
VL - 8
SP - e000578-N/A
JO - BMJ Open Gastroenterology
JF - BMJ Open Gastroenterology
ER -