COVID-19-associated changes in the gastrointestinal tract: a comparison of ultrasound and morphological data: a pilot study

Abstract

INTRODUCTION: COVID-19-associated gastrointestinal tract involvement has been reported in 11.4–61.1% of cases. However, there is no data on the incidence of COVID-19-associated pathology in different parts of the gastrointestinal tract, and there’s little understanding about the appearance of COVID-19-associated gastrointestinal lesions on ultrasound diagnostic images.OBJECTIVE: To study of the radiologic pattern of COVID-19-associated changes in the gastrointestinal tract based on the comparison of ultrasound and morphological autopsy data.MATERIALS AND METHODS: The study was approved by the ethical committee of Gomel State Medical University (protocol № 2 of 24.03.2021). For the purposes of this study gastric and intestinal pathological examination was performed in 11 subjects (average age 64.6±10.1 years) who died of COVID-19 infection and 11 subjects who had no clinical or laboratory confirmed signs of COVID-19 infection (average age 67.2±8.8 уears). Using the ImageJ computer program, we determined the surface area of the whole studied object subject, and the affected areas (foci of hyperemia with fine-point hemorrhages), determined the percentage of organ mucosal lesions and also performed an ultrasound examination of the gastric and intestinal wall samples. Statistic: analysis was performed using the Statistica 10.0 software (StatSoft, Inc., USA).RESULTS: The incidence of COVID-19-associated lesions in different parts of the gastrointestinal tract was as follows: stomach, 100.0%; duodenum, 25.0%; jejunum, 55.0%; ileum, 35.0%; cecum, 18%; ascending colon, 15%; transverse colon, 15% descending colon, 41% sigmoid colon, 55%; rectum, 75%. The lesion surface area in different parts of the gastrointestinal tract was as follows (%): stomach, 86,0 (75.0; 90.0); duodenum, 48,0 (39.0; 66.0); jejunum, 55.0 (50.0; 59.0); ileum, 35.0 (30.0; 41.0); cecum, 59.0 (55.0; 69.0); ascending colon, 34,0 (29.0; 41.0); transverse colon 36,0 (30.0; 42.0); descending colon 40.0 (34.0; 47.0); sigmoid colon 65,0 (61.0; 71.0); rectum 69.0 (65.0; 73.0). Ultrasound pattern in COVID-19-associated pathology of the gastrointestinal tract was uniform. Most often, foci of reduced echogenicity with indistinct and uneven margins were detected in the mucosa. Histologically, foci of lymphoid infiltration and formation of lymphoid clusters of B-lymphocytes were found in these areas.CONCLUSION: The most frequent ultrasound pattern in COVID-19-associated gastrointestinal tract involvement is the presence in the mucosa areas of reduced echogenicity with indistinct and uneven margins.