Gastrointestinal disorders in patients with COVID-19: diagnoses and treatment during the pandemic

Abstract

Background. The pandemic caused by the coronavirus disease 2019 (COVID-19) is a topic that is currently in the spotlight of the world community. The use of non-steroidal anti-inflammatory drugs (NSAIDs) in combination with new oral anticoagulants (dabigatran, rivaroxaban, apixaban, etc.) and acetylsalicylic acid by the significant number of patients during the pandemic, caused by COVID-19, raises the question about the safety of the influence of each drug on the occurrence of gastrointestinal complications. The development of algorithms to prevent damage to the gastrointestinal mucosa on the background of these drugs is becoming a priority. The purpose was to examine the presence of gastrointestinal disorders using the Gastrointestinal Symptom Rating Scale (GSRS) in convalescents after COVID-19 and to evaluate the effectiveness of esomeprazole for correction of these disorders. Materials and methods. We surveyed 92 (48 men and 44 women) convalescents after COVID-19. The mean age of individuals was (49.2±2.0) years. To conduct a survey of patients who had COVID-19, we developed a questionnaire which included patient’s passport data, age, gender. In addition, patients reported how COVID-19 was diagnosed, what drugs they were taking during treatment, and whether they needed oxygen therapy. Subsequently, convalescents after COVID-19 answered questions from the GSRS. Information was collected and the questionnaire was completed by telephone survey. Depending on the data of GSRS, esomeprazole (Ezonexa) was prescribed to patients at a dose of 20 mg 1 time per day, 30 minutes before meals, for 30 days. During the follow-up survey on day 30 of esomeprazole intake, patients re-answered the GSRS questions. Results. Thirty days after starting esomeprazole intake at a dose of 20 mg 1 time per day, 92 convalescents after COVID-19 showed a significant reduction (p<0.001) in the manifestations of reflux, abdominal pain and dyspeptic syndromes compared to the results before treatment ((2.3±0.1), (4.3±0.2), (5.7±0.3) versus (4.3±0.3), (9.3±0.4), (8.6±0.6), respectively). Esomeprazole was equally effective (p>0.05) in influencing the severity of reflux, abdominal pain, dyspeptic, diarrheal and constipation syndromes in both men and women: (2.3±0.1), (4.3±0.2), (5.7±0.3), (3.9±0.3), (3.0±0.1) versus (2.4±0.1), (4.2±0.2), (6.0±0.4), (4.0±0.4), (3.1±0.1), respectively. Esomeprazole was also equally effective (p>0.05) in the impact on the severity of reflux, abdominal pain, dyspeptic, diarrheal and constipation syndromes among patients receiving acetylsalicylic acid and those treated with rivaroxaban: (2.5±0.2), (4.2±0.2), (5.6±0.2), (3.9±0.4), (3.1±0.1) versus (2.2±0.1), (4.4±0.3), (6.4±0.6), (4.2±0.4), (3.0±0.1), respectively. Esomeprazole at a dose of 20 mg 1 time per day was equally effective (p>0.05) in relation to the dynamics of the severity of syndromes in patients receiving paracetamol and one NSAID and in those receiving paracetamol and 2 NSAIDs. In particular, in people receiving paracetamol and one NSAID, on the background of esomeprazole administration, the severity of reflux, abdominal pain, dyspeptic, diarrheal and constipation syndromes were (2.4±0.1), (4.3±0.2), (5.8±0.3), (4.1±0.3), (3.1±0.1) and in patients taking paracetamol and 2 NSAIDs— (2.1±0.2), (4.5±0.4), (6.7±0.7), (4.4±0.7), (3.0±0.1), respectively. Conclusions. Esomeprazole (Ezonexa) effectively reduces (p<0.001) the severity of reflux, abdominal pain and dyspeptic syndromes in convalescents after COVID-19. The use of Esomeprazole (Ezonexa) demonstrates the same efficacy (p>0.05) in men and women when receiving both ASA and rivaroxaban and during the treatment with both paracetamol and one NSAID and paracetamol and 2 NSAIDs.