No abstract

The worldwide pandemic of COVID-19, caused by the virus SARS-CoV,-2 has continued to progress, and increasing information is becoming available about the incidence of digestive symptoms as well as abnormal liver-associated enzymes in patients who are infected. These are postulated to be related to the virus's use of ACE-2 receptors located on certain intestinal cells, cholangiocytes, and hepatocytes. This brief review summarizes the available limited data on digestive manifestations of COVID-19. A significant proportion of COVID-19 patients can present initially with only digestive complaints. The most common digestive symptoms are anorexia, nausea, vomiting, and diarrhea. Liver-related transaminases are elevated in a substantial proportion of patients, although generally only mildly elevated. Currently there is no firm evidence to suggest that severity of digestive symptoms corresponds to severity of COVID-19 clinical course, however, more severe alterations in liver enzymes may correlate with worse clinical course. Given use of antiviral and antibacterial agents in sicker patients, drug-induced liver injury cannot be ruled out either in these cases. Although viral RNA can be detected in stool, it is unclear whether fecal-oral transmission can be achieved by the virus. As further data becomes available, our understanding of the digestive manifestations of COVID-19 will continue to evolve.

Background and study aims  The efficacy of per oral endoscopic myotomy (POEM) in non-achalasia esophageal motility disorders such as esophagogastric junction outflow obstruction (EGJOO), diffuse esophageal spasm (DES), and jackhammer esophagus (JE) has not been well demonstrated. The aim of this international multicenter study was to assess clinical outcomes of POEM in patients with non-achalasia disorders, namely DES, JE, and EGJOO, in a large cohort of patients. Patients and methods  This was a retrospective study at 11 centers. Consecutive patients who underwent POEM for EGJOO, DES, or JE between 1/2014 and 9/2016 were included. Rates of technical success (completion of myotomy), clinical response (symptom improvement/Eckardt score ≤ 3), and adverse events (AEs, severity per ASGE lexicon) were ascertained . Results  Fifty patients (56 % female; mean age 61.7 years) underwent POEM for EGJOO (n = 15), DES (n = 17), and JE (n = 18). The majority of patients (68 %) were treatment-naïve. Technical success was achieved in all patients with a mean procedural time of 88.4 ± 44.7 min. Mean total myotomy length was 15.1 ± 4.7 cm. Chest pain improved in 88.9 % of EGJOO and 87.0 % of DES/JE ( P  = 0.88). Clinical success was achieved in 93.3 % of EGJOO and in 84.9 % of DES/JE ( P  = 0.41) with a median follow-up of 195 and 272 days, respectively. Mean Eckardt score decreased from 6.2 to 1.0 in EGJOO ( P  < 0.001) and from 6.9 to 1.9 in DES/JE ( P  < 0.001). A total of 9 (18 %) AEs occurred and were rated as mild in 55.6 % and moderate in 44.4 %. Conclusion  POEM is effective and safe in management of non-achalasia esophageal motility disorders, which include DES, JE, and EGJOO.

T he reported prevalence of gastrointestinal (GI) symptoms, including anorexia, diarrhea, nausea, vomiting, and abdominal pain, in severe acute respiratory syndrome coronavirus 2 infection has been highly variable, ranging from 5% to 61%. 1-7 Although the Centers for Disease Control and Prevention guidelines for testing for coronavirus disease 2019 (COVID-19) include vomiting and diarrhea, to our knowledge, all studies to date have been retrospective, and none have evaluated the prevalence of GI symptoms among patients who tested negative for COVID-19. In this prospective case-control study, we compared the prevalence of GI symptoms between those who tested positive and negative for COVID-19 and determined the association between GI symptoms and COVID-19 diagnosis or outcomes. Methods This was a prospective case-control study performed at a single tertiary care hospital in Baltimore, Maryland, after institutional review board approval. The study population included all adult patients who tested positive (case patients) or negative (control individuals) for COVID-19 by nasopharyngeal swab between March 9, 2020, and April 15, 2020. A telephone survey was conducted to obtain information including demographics, comorbid conditions, GI symptoms, respiratory symptoms, fever, gustatory symptoms, olfactory symptoms, and need for hospitalization by using a predesigned questionnaire. The primary outcome was the prevalence of GI symptoms in COVID-19-positive and-negative patients, and the secondary outcomes were to determine the utility of GI symptoms for COVID-19 screening and the association of GI symptoms with need for hospitalization. Logistic regression and univariate followed by multivariable analysis using a backward model selection approach were conducted to evaluate risk factors of COVID-19, and the area under the receiver operating characteristic (AUROC) for COVID-19 using a combination of different symptoms was determined.