BackgroundCoronavirus disease 2019 (COVID-19) is widely recognized as a disease that affects the respiratory system, although it can also present with significant extrapulmonary symptoms. Very few studies have suggested an increased risk of gastrointestinal (GI) bleeding. This study aimed to elucidate the incidence, etiology, risk factors, and outcomes of clinically significant GI bleeding requiring endoscopic intervention in patients with COVID-19. MethodsThis is a case-control (1:2) retrospective analysis of all hospitalized adult patients with COVID-19 infection admitted between March 1, 2020, and January 5, 2021, in which we compared patients with upper and lower GI bleeds to those without. Cases are defined as patients hospitalized with COVID-19 who had a GI bleed requiring intervention while controls are defined as patients hospitalized with COVID-19 who did not have a GI bleed. Of 1002 patients admitted to the Albany Medical Center with COVID-19 infection, there were 76 confirmed cases of GI bleeding. These patients were compared to a control group composed of randomly selected patients with COVID-19 infection who were admitted to Albany Medical Center over the same time period. We assessed patients for in-hospital mortality, ventilator-free days on day 28, ICU-free days on day 28, and hospital-free days on day 28. Additional information collected included demographic information, comorbid conditions, COVID-19 treatments received, endoscopy findings, endoscopic treatment received, and if the patients required a packed red blood cell transfusion. ResultsOut of 1007 patients hospitalized with COVID-19, 76 (8%) had a GI bleed requiring endoscopic intervention. Peptic ulcer disease in the stomach or duodenum was the most common finding. The use of steroids, antiplatelet agents, and anticoagulation was not associated with an increased risk of GI bleed in COVID-19 patients. The GI bleed group required ICU care in 37% (28/76) compared with 21% (32/152) in the control group, which was statistically significant (p=0.012; chi-square test). Length of hospital stay was longer in the GI bleed group (median 16 days IQR: 8 to 29 versus 7 days, IQR:4 to 16; p<0.001, Mann Whitney test). ConclusionLength of hospital stay and ICU level of care was higher in the GI bleed group of patients with COVID-19. ICU level of care was noted to be associated with an increased risk of GI bleeding. A GI bleed in COVID-19 patients could be from the virus's direct effect on the gut mucosa or stress-induced bleeding like any other severely sick ICU patient; however, this needs to be explored in future studies.
BackgroundIrritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) have a strong relationship with psychological stress. Studies have shown increased stress levels in patients with IBS and IBD during the SARS-CoV-2 (COVID-19) pandemic. The current literature on the impact of work environment on IBD and IBS symptoms is limited, particularly during the current pandemic. ObjectiveThis study aims to analyze how the pandemic impacted patients with IBS and IBD in the setting of staying home versus working outside the home. MethodsAfter Institutional Review Board (IRB) approval, a retrospective review of 245 patients with IBS and IBD who followed with our gastroenterology clinic in the past year was performed. Patients were asked about symptoms including, but not limited to, worsening diarrhea, constipation, and abdominal pain. Pearson's chi-squared test was used for analysis. ResultsOf the 245 patients in our study, 67 had IBS, 166 had IBD, and 12 had both. The male-to-female ratio was 1:1.4. A total of 136 (55.5%) patients worked from home during the pandemic, while 109 (44.5%) patients worked outside. Eighty-three patients working from home reported no change in symptoms, 35 reported worsening symptoms, and 18 reported an improvement in symptoms. Sixty-eight patients working outside the home reported no change in symptoms, 26 reported worsening symptoms, and 15 reported improvements. Working outside the home had a statistically significant relationship with COVID-19 infection. Thirty patients were infected, of which 22 (73.3%) worked outside the home (p=0.01). Overall, 203 (82.8%) patients received the vaccine, and only 14 of these patients reported worsening gastrointestinal (GI) symptoms one week after receiving the vaccine. Comparable results were seen after dividing the data into cohorts of IBS and IBD patients. Of the patients with IBD staying at home, 15.9% had depression (p=0.01). ConclusionMost patients had symptoms at baseline. There was no statistically significant correlation between change in symptoms and work settings. Patients were less likely to be infected with COVID-19 while staying home. Our patient population showed a high vaccination rate of 82.9% as compared to the national average of 59.2% (source: Centers for Disease Control and Prevention (CDC)). Only 5.7% of the patients reported new or worsening gastrointestinal symptoms in the week following vaccination. The limitations of the study included its retrospective design and poor correlation in general between symptoms and disease activity in IBD patients.
Among the many potential causes and risk factors for acute portal venous thrombosis, viral hepatitis has been regarded as a rare associated condition. We present the first case in the literature of a 30-year-old previously healthy male who presented with acute portal venous thrombosis associated with acute hepatitis A virus (HAV) infection, describing the probable pathophysiology mechanism, work-up and treatment pursued. We encourage that hepatitis A serological markers should be routinely included in the investigation for acute portal venous thrombosis of unknown aetiology, in unvaccinated patients with risk factors of a recent HAV exposure.
Introduction: Polyethylene glycol 3350 and electrolytes (PEG) is a perceived safe and commonly prescribed solution prior to colonoscopy, yet case reports suggest the potential for volume overload. We describe a patient with cardiopulmonary comorbidities who developed pulmonary edema and acute hypoxic respiratory failure (AHRF) due to PEG administration. Case Description/Methods: A 55-year-old man with interstitial lung disease (ILD), mild pulmonary hypertension (pHTN), and coronary artery disease (CAD) with multiple coronary stents was admitted to our tertiary academic hospital with cough and constitutional symptoms. He had a brain natriuretic peptide (BNP) of 50 pg/mL, was found to be in AHRF and intubated due to labored breathing. He received broadspectrum antibiotics and corticosteroids with clinical improvement and within 4 days was extubated. Given his severe ILD, he was evaluated for lung transplant. As part of this evaluation, mandatory colon cancer screening was needed in the form of computed tomography (CT) colonography. He had difficulty consuming Golytely at an appropriate rate. Despite 16 liters (L) of PEG over 3 days, the stools were not clear. He then re-developed hypoxia and tachypnea and BNP rise to 475 pg/mL. Chest X-ray (CXR) showed new bilateral opacities concerning for pulmonary edema. Echocardiography demonstrated an IVC greater than 2.0 cm without respiratory variation consistent with volume overload. His bowel prep was held, and he was given diuretics with improvement in his respiratory status, BNP, and CXR. The patient was re-trialed on 6L PEG by nasogastric tube successfully without cardiopulmonary complications and his CT colonography showed no colonic polyps or malignancy. He eventually underwent successful bilateral orthotopic lung transplant. Discussion: Prior research has shown that consumption of 6-8 L of PEG increases mean plasma volume by 5.88% on average, but up to 29.8% in some patients. In this case, our patient consumed double that amount of PEG, with subsequent increase in plasma volume, resulting in pulmonary edema and AHRF due to limited respiratory reserve from his severe ILD, pHTN, and CAD. Literature review shows less than 10 cases worldwide with similar findings. In high-risk patients such as the one described, providers must consider judicious use of PEG for colonoscopy preparation and be quick to identify PEG-associated pulmonary edema as an etiology for respiratory decompensation.
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