Frequency Of Gastrointestinal Symptoms Research Articles

Comparison of urine glycosaminoglycan excretion between children with autism spectrum disorder and typically developed children

BackgroundAbnormalities pertaining to glycosaminoglycan metabolism have been demonstrated in children with autism spectrum disorder. The aim of the present study was to compare urine excretion of sulfated glycosaminoglycans in children with autism spectrum disorder, with neurotypical controls and explore its association with co-occurring symptoms. MethodRandom urine samples were collected from children with autism spectrum disorder (n = 61) between the ages of 2 and 6 years, and age- and sex-matched neurotypical controls. Urine glycosaminoglycan levels were quantified by the dimethylmethylene blue (DMMB) dye-binding assay. ResultsMean glycosaminoglycan/creatinine ratio of children with autism spectrum disorder was 22.279 ± 13.044 mg/mmol while that of neurotypical controls was 19.121 ± 7.319 mg/mmol. Eight patients with autism spectrum disorder (13.11%) exhibited abnormally high glycosaminoglycan excretion. Unstandardized urine glycosaminoglycan levels are significantly higher (p = 0.019) in the autism spectrum disorder group when covariates such as age, urinary creatinine, and height are taken into consideration by ANCOVA. However, the outcome showed a trend towards significance when glycosaminoglycan/creatinine ratio was used in ANCOVA (p = 0.058). In neurotypical subjects, the urine glycosaminoglycan levels appear to decline with age, height, and weight while this trend was not apparent in subjects with autism spectrum disorder. Glycosaminoglycan excretion did not correlate with the presence of co-occurring symptoms of autism spectrum disorder; frequent gastrointestinal symptoms, self-injurious behaviors, food aversions, or parent-reported sleep problems. ConclusionsA subset of children with autism spectrum disorder exhibits higher urine glycosaminoglycan excretion. Further research is needed to explore the molecular basis of this finding.

A Study on Footballers: Is the Mediterranean diet a Good Defender of the Gastrointestinal System?

In football, diet has a highly important role in the development of performance. Assessing the nutrition-related knowledge of footballers and increasing their awareness may affect their health and performance. In this study, which was carried out for this purpose, whether the Mediterranean diet had an effect on the gastrointestinal health of professional footballers was investigated. The sample of the study included a total of 196 active licensed male footballers who were professional players in the 2nd and 3rd football leagues of Turkey. The mean age of the participants was 23.46±4.18 and their mean experience in licensed football was 11.73±5.07 years. The adherence of the participants to the Mediterranean diet was assessed using the Mediterranean Diet Adherence Screener, while the frequencies of gastrointestinal symptoms were examined using the Gastrointestinal Symptom Rating Scale. The data were transferred to the SPSS 26.0 program and analyzed using Pearson’s Correlation Analysis, Independent-Samples T-Tests, One-Way ANOVA and descriptive statistics. According to the results of the analyses, no significant relationship was found between adherence to the Mediterranean diet and gastrointestinal symptoms (p>0.05). While the gastrointestinal symptom scores of the participants did not vary significantly based on their league tiers or positions (p>0.05), their Mediterranean diet adherence scores varied significantly based on their league tiers (p<0.05). Consequently, it was determined that the adherence of the participants to the Mediterranean diet increased as their league tier increased, but adherence to the Mediterranean diet did not create any positive or negative effect on their gastrointestinal system symptoms.

Worldwide population prevalence and impact of sub-diagnostic gastrointestinal symptoms.

The Rome Foundation Global Epidemiology Study (RFGES) found that 40.3% of adults in 26 internet-surveyed countries met Rome IV criteria for disorders of gut-brain interaction (DGBI). However, additional people not meeting DGBI criteria may also be burdened by frequent gastrointestinal symptoms. To explore the prevalence and demographic distribution of sub-diagnostic gastrointestinal symptoms, and the hypothesised associated effects on quality of life (QoL), life functioning and healthcare needs. We analysed data from the RFGES survey, which included the Rome IV diagnostic questionnaire and QoL, psychological, work productivity and healthcare questions. Of the 50,033 people without a history of organic gastrointestinal disorders, 25.3% classified in the sub-diagnostic group (no DGBI but one or more frequent gastrointestinal symptoms), 41.4% had DGBI and 33.4% had no frequent gastrointestinal symptoms (non-GI group). Sub-diagnostic prevalence in different world regions ranged from 22.2% (North America) to 30.5% (Middle East), was slightly higher among males than females and decreased with age. The sub-diagnostic group was intermediate between the non-GI and DGBI groups, and significantly different from both of them on QoL, anxiety, depression, somatisation, healthcare utilisation and life and work impairment. One in four adults without organic gastrointestinal disorders or DGBI report frequent gastrointestinal symptoms. This sub-diagnostic group has reduced QoL, greater psychological and non-GI bodily symptoms, impaired work productivity and life activities and greater healthcare use compared to non-GI individuals. This suggests that many in this sub-diagnostic group might benefit from healthcare services or symptom self-management advice.

The Frequency and Severity of Gastrointestinal Symptoms in Rugby Players.

This study aimed to assess the self-reported frequency and severity of gastrointestinal symptoms (GIS) at rest and around rugby training and match play in male and female rugby union players. An online questionnaire was sent to registered rugby union players (sevens or fifteens). Thirteen GIS were assessed alongside perceptions of appetite around rugby and rest using Likert and visual analog scales. Questions investigating a range of medical and dietary factors were included. Three hundred and twenty-five players (male n=271, female n=54) participated in the study. More frequent GIS (at least one GIS experienced weekly/more often) was reported by players at rest (n=203; 62%) compared to around rugby (n=154; 47%). The overall severity of GIS was low (mild discomfort), but a portion of players (33%) did report symptoms of moderate severity around rugby. Female players reported more frequent and severe symptoms compared to male counterparts (p<0.001). Self-reported appetite was significantly lower after matches compared to training. There were no dietary or medical factors associated with GIS severity scores. This study describes GIS characteristics in male and female rugby union players. Half of the players assessed experienced some form of GIS that may affect nutrition, training, or performance, and should thus be a consideration for practitioners supporting this cohort.

Gastrointestinal symptoms, diagnostic evaluations, and abdominal pathology in children with sickle cell disease.

Children with sickle cell disease (SCD) frequently present with acute pain. The abdomen, a common site of acute SCD-related pain, may be present in a variety of gastrointestinal (GI) pathologies. Limited data exist on prevalence and workup of abdominal pain in patients with SCD during acute pain events. Determine prevalence of GI symptoms, GI-specific evaluation and risks of hospitalization in children with SCD presenting to the emergency department (ED) or hospitalized with abdominal pain. Retrospective study of children less than 21years presenting to the ED or hospitalized with pain in our center over 2years. Descriptive statistics were used to report clinical characteristics, frequency of GI symptoms, workup by age (<5 vs. ≥5years), and genotype (sickle cell anemia [SCA] vs. non-SCA). Logistic regression models were used to identify risks associated with hospitalization. A total of 1279 encounters in 378 patients were analyzed; 23% (n=291) encounters were associated with abdominal pain. More abdominal pain-associated hospitalizations occurred in older children, SCA, children with lower mean hemoglobin (8.7±1.9 vs. 9.6±1.6g/dL, p<.001) and higher mean white blood cell (WBC) count (14.9±6.6 vs. 13.2±5.3×103 /μL, p=.02). We identified that less than 50% of patients presenting to the ED with abdominal pain received a GI-specific evaluation. Children with SCD frequently present with abdominal pain and other GI symptoms, with limited GI evaluations performed. GI-specific evaluation may increase diagnosis of GI pathologies, rule out GI pathologies, and contribute to the limited knowledge of the abdomen as a primary site of SCD pain.

Prevalence of gastrointestinal symptoms in autism spectrum disorder: A meta-analysis

IntroductionA high prevalence of gastrointestinal (GI) symptoms has been described in children and adolescents with autism spectrum disorder (ASD). In addition, there is evidence that presence of GI symptoms is associated to greater severity of ASD. However, the frequency of GI symptoms in children and adolescents with ASD varies widely across studies, and their true prevalence is unknown. Therefore, the objective of this study was to estimate the prevalence of GI symptoms in children and adolescents with ASD. Material and methodWe conducted a meta-analysis following the PRISMA guidelines. We carried out a rapid systematic search for recent clinical and observational studies published from August 2012 in PubMed. The statistical analyses were performed with the software R. ResultsOf 91 potentially eligible articles, only 8 met our inclusion criteria. The prevalence of GI symptoms ranged between 0% and 69%, with an estimated general prevalence of 33% (95% CI, 13%–57%), higher than that reported by a previous meta-analysis for the general paediatric population. This difference is even greater in the specific comparison of studies that applied the paediatric version of the ROME III questionnaire (QPGS-ROME III). ConclusionsThe results confirmed the hypothesis that there is a higher prevalence of functional GI symptoms in paediatric patients with ASD compared to their neurotypical peers.

Prevalencia de síntomas gastrointestinales en trastornos del espectro del autismo: un metaanálisis

IntroductionA high prevalence of gastrointestinal (GI) symptoms has been described in children and adolescents with autism spectrum disorder (ASD). In addition, there is evidence that presence of GI symptoms is associated to greater severity of ASD. However, the frequency of GI symptoms in children and adolescents with ASD varies widely across studies, and their true prevalence is unknown. Therefore, the objective of this study was to estimate the prevalence of GI symptoms in children and adolescents with ASD. Material and methodWe conducted a meta-analysis following the PRISMA guidelines. We carried out a rapid systematic search for recent clinical and observational studies published from August 2012 in PubMed. The statistical analyses were performed with the software R. ResultsOf 91 potentially eligible articles, only 8 met our inclusion criteria. The prevalence of GI symptoms ranged between 0% and 69%, with an estimated general prevalence of 33% (95% CI, 13%-57%), higher than that reported by a previous meta-analysis for the general paediatric population. This difference is even greater in the specific comparison of studies that applied the paediatric version of the ROME III questionnaire (QPGS-ROME III). ConclusionsThe results confirmed the hypothesis that there is a higher prevalence of functional GI symptoms in paediatric patients with ASD compared to their neurotypical peers.

Compliance with a high-protein and energy-dense oral nutritional supplement in patients with disease-related malnutrition: a randomized open-label crossover trial.

Patient compliance with oral nutritional supplements (ONS) is not optimal for meeting energy and nutritional requirements in a high proportion of patients with disease-related malnutrition (DRM). Energy density or prescribed volume of ONS may impact compliance. A randomized, open-label crossover trial was conducted in outpatients with DRM to compare compliance with a high energy-dense ONS (edONS, 2.4 kcal/mL) and a reference ONS (heONS, 2.0 kcal/mL; NCT05609006). Patients were randomly assigned to two 8-week treatment sequences of four-weeks periods: edONS + heONS (sequence A) or heONS + edONS (sequence B). Patients daily reported the amount of product left over gastrointestinal tolerance and satisfaction with ONS. A non-inferiority analysis was performed to compare the compliance rate (percentage of consumed energy over the prescribed) for each period and sequence. Fifty-three patients were assigned to sequence A and 50 to sequence B (55.7 ± 13.9 years, 37.0% female, 67.1% oncology patients). In sequence A, the compliance rates were 88.6% ± 14.3% vs. 84.1 ± 21.8% (p = 0.183), while in sequence B, they were 78.9% ± 23.8% vs. 84.4% ± 21.4% (p < 0.01). In both sequences, the lower range of the confidence interval for compliance with edONS was greater than the non-inferiority threshold (for sequence A ΔCompA was 4.5% [95% CI, -2.0% to 10.0%], and for sequence, B ΔCompB was 5.6% [95% CI, -3.0% to 14.0%]). The total discarded cost for each ONS was higher for heONS than edONS, being the difference statistically significant in sequence B. BMI increased slightly and not significantly in both sequences, and the percentage of patients with severe malnutrition was reduced. The frequency of gastrointestinal symptoms was low for both sequences, and satisfaction with ONS was slightly higher for edONS. Our findings highlight that edONS was non-inferior to heONS in terms of consumed energy over the prescribed, with a lower amount of edONS discarded, which suggests a higher efficiency of edONS.

Cannabis and Palliative Care Utilization among Non-Terminal Cancer Patients in the Illinois Medical Cannabis Program

High-quality palliative care has been shown to provide benefits for cancer patients, including greater longevity when initiated earlier in treatment. Previous research conducted among terminal patients in the Illinois Medical Cannabis Program has suggested that cannabis may be used as a complement to palliative care and as an alternative to prescription opioid medications. However, there is little research exploring this phenomenon among non-terminal cancer patients receiving palliative care. In this study, we used primary cross-sectional survey data to (1) identify the factors associated with the utilization of palliative care, (2) examine the associations between the utilization of palliative care and self-reported improvements in physical and psychological symptoms, and (3) estimate the differences in the average 30-day pain levels for non-terminal cancer patients receiving palliative care who reported using opioids compared with other non-terminal cancer patients in palliative care who did not report using opioids. In our sample, 87 out of 542 (16%) non-terminal cancer patients were receiving palliative care, and of these 87 patients, 54 (62%) reported opioid use in the past 12 months. Non-terminal cancer patients in the sample who reported low psychological well-being, frequent gastrointestinal symptoms, and prescription opioid use in the past 12 months had greater odds of palliative care utilization. Palliative care utilization was also positively associated with self-reported improvements in gastrointestinal symptoms. The concurrent use of cannabis and prescription opioids was associated with higher average 30-day pain levels and with higher average pain levels at the initiation of cannabis use among those non-terminal cancer patients engaged in palliative care services.

Self-reported prevalence of fructan food hypersensitivity in university students from the State of Mexico

To determine the self-reported prevalence of fructans food hypersensitivity in a sample of Mexican university students and to investigate the most frequent symptoms, the related foods involved, risk factors and gastrointestinal function status. A cross-sectional, descriptive study was conducted in a convenience sample of 412 university students aged from 18 to 35 years. Data were collected about their personal and family history of gastrointestinal diseases, the presence of symptoms after consumption of certain foods, and the severity of their symptoms. The prevalence of fructans food hypersensitivity was 31.1 %; it was higher in women than in men. The most frequent gastrointestinal symptoms were bloating and flatulence. The most frequent extra-intestinal symptoms were fatigue and stress. The food groups related to the occurrence of symptoms were legumes, vegetables, and fruits. Significant association was found between female sex, personal and family history of gastrointestinal diseases and the presence of fructans food hypersensitivity (p < 0.05). Most individuals with fructans food hypersensitivity had mild gastrointestinal dysfunction (67.2 %). FFH is a common condition, it was found in one third of university students and occurs mainly in women. More research and diffusion about this pathology is required.

Review of Interventional Therapies for Refractory Pediatric Migraine.

This is a review of the latest and seminal evidence in pediatric migraine. It covers the etiology and pathophysiology known today, and then will review treatment options, efficacy and safety, quality of data and indications. Though migraine is usually regarded as an infliction in adults, it is not uncommon in the pediatric population and affects up to 8% of children. Children may experience migraine differently than adults, and present not only with headache but also frequent gastrointestinal symptoms. They are frequently shorter in duration than in adults. Traditional migraine treatment in adults is less effective in children. In this population, adjunct therapies - such as interventional techniques - should be considered when traditional treatment fails, including Botulinum Toxin A (BTA) injections, peripheral nerve and ganglion blocks. BTA injections are FDA approved for migraine prophylaxis in adults, but currently not in children; however, recent evidence shows efficacy and safety in pediatric migraine management. Nerve blocks stop nociceptive afferent fibers through injection of local anesthetics, and it may be associated with the local injection of corticosteroids. Although more common in adults, recent data suggests they are safe and effective in children and adolescents. Blocking the sphenopalatine ganglion can be achieved through nasal approach, and achieves a similar action by blocking the entire ganglion. Interventional techniques may provide a key component in the alleviation of this otherwise debilitating chronic migraine pain. Though most studies have been performed in adults, new studies provide encouraging results for treatment in children.

Gastrointestinal symptoms among patients with COVID-19 and their relation with co-morbidities

Background: Initially, coronavirus disease 2019 (COVID-19) was considered as respiratory disease; later on, it was seen that a large number of patients develop gastro-intestinal (GI) symptoms. Many patients with COVID-19 have underlying co-morbidities. This study was conducted to evaluate the frequency of GI symptoms in COVID-19 patients and to find out its relation with co-morbidities.&#x0D; Methods: This cross-sectional study was done among consecutive COVID-19 positive patients admitted in Mugda Medical College Hospital, Dhaka, Bangladesh from July to September 2020. Information regarding patients’ symptoms and co-morbidities were collected in predesigned structured questionnaire.&#x0D; Results: Among 166 COVID-19 patients, 69% had GI symptoms. Common GI symptoms were anorexia (69%), ageusia (38%), diarrhea (35%) and nausea (31%). Sixty percent patients with GI symptoms had comorbidities; common comorbidities were hypertension (55%) and diabetes mellitus (47%). Comorbidities were more common among patients with GI symptoms (69%) than those without GI symptoms (31%) (p 0.001).&#x0D; Conclusion: This study reflects that over two-thirds of COVID-19 patients developed GI symptoms. More than half of the patients with GI symptoms had co-morbidities. Co-morbidities were common among patients with GI symptoms than non-GI symptoms.&#x0D; BIRDEM Med J 2023; 13(1): 12-15

Severe gastrointestinal injury associated with SARS-CoV-2 infection: Thrombosis or Inflammation?: A retrospective case series study.

Objectives:Acute gastrointestinal injury (AGI) associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has a low incidence of complications in patients admitted to the intensive care unit (ICU). Pathophysiological knowledge related to AGI is limited, as few studies have been published on this topic. Therefore, this study was carried out to identify the clinical and histopathological features of patients with SARS-CoV-2 infection and grade IV AGI.Methods:This is a retrospective case study of fifteen patients with SARS-CoV-2 infection and grade IV AGI who underwent emergency surgery.Results:This study revealed a mortality rate of 62.5%. The most frequent gastrointestinal symptoms were abdominal distension (100%) and increased gastric residual volume (93.3%). Distended bowel loops on plain abdominal radiography (90%) and intestinal pneumatosis on computed tomography (50%) were the most frequent imaging findings. Surgical exploration revealed intestinal ischemia (66.6%) and necrosis (46.6%), and histopathology showed ischemic and liquefactive necrosis with mixed inflammatory involvement and absence of thrombosis as the cause of AGI.Conclusions:AGI associated with severe SARS-CoV-2 infection has a high mortality rate and poses a diagnostic challenge in the ICU. The complex pathophysiology and histopathological findings indicate an associated inflammatory phenomenon as the main alteration in the absence of thrombosis, as per the intestinal biopsies of the cases studied. Further clinical studies are required to gain a better understanding of this pathology.

Association between early and current gastro-intestinal symptoms and co-morbidities in children and adolescents with Angelman syndrome.

Angelman syndrome (AS) is a neurogenetic disorder that causes severe intellectual disability, expressive language deficits, motor impairment, ataxia, sleep problems, epileptic seizures and a happy disposition. People with AS frequently experience gastrointestinal (GI) symptoms. This study used data from the Global Angelman Syndrome Registry to explore the relationship between early and current GI symptoms and co-morbidity in children and adolescents with AS (n=173). Two groups that experienced a high (n=91) and a low (n=82) frequency of GI symptoms were examined in relation to feeding and GI history in infancy, sleep and toileting problems, levels of language and communication and challenging behaviours. Predictors of GI symptoms were then investigated using a series of logistic regressions. This analysis found that constipation and gastroesophageal reflux affected 84% and 64%, of the sample, respectively. The high frequency of GI symptoms were significantly associated with: 'refusal to nurse', 'vomiting', 'arching', 'difficulty gaining weight', gastroesophageal reflux, 'solid food transition', frequency of night-time urinary continence and sleep hyperhidrosis during infancy. GI symptoms were not significantly associated with sleep, toileting, language or challenging behaviours. Significant predictors of high frequency GI symptoms were gastroesophageal reflux and sleep hyperhidrosis. Future research needs to investigate the association between AS and GI co-morbidity in adults with AS.

Associations between gastrointestinal symptoms, medication use, and spontaneous drug discontinuation in patients with major depressive disorder in China

BackgroundThe study was designed to investigate the associations between gastrointestinal (GI) symptoms, medication use, and spontaneous drug discontinuation (SDD) in patients with major depressive disorder (MDD). MethodsThis cross-sectional study included 3256 MDD patients from the National Survey on Symptomatology of Depression (NSSD). Differences in the sociodemographic factors, clinical characteristics, medication use, and self-reported reasons for SDD were compared in patients with different frequencies of GI symptoms. A multiple logistic regression analysis was employed to assess the contribution of GI symptoms to the risk of spontaneous drug discontinuation. ResultsMDD patients with a higher frequency of GI symptoms were prone to have higher proportions of mood stabilizer and benzodiazepine uses (ps for trend < 0.001) but a lower proportion of SNRI use (pfor trend < 0.001). With the increase in GI symptoms, patients were prone to report worries about long-term side effects (pfor trend < 0.001), with the patients stating ineffective treatments (pfor trend = 0.002) and intolerance of adverse drug reactions (pfor trend = 0.022) as the reasons for SDD. Compared with those patients without GI symptoms, all of the MDD patients with GI symptom frequencies of several days (OR = 1.317; 95 % CI: 1.045–1.660), more than half of all days (OR = 1.305; 95 % CI: 1.005–1.695), and nearly every day (OR = 1.820; 95 %: 1.309–2.531) had an increased risk of SDD. ConclusionGI symptoms are highly associated with drug discontinuation in MDD patients. These findings may have important implications for clinical treatment options, as well as for drug adherence management, in MDD patients.

Disrupted Cerebellar-Default Mode Network Functional Connectivity in Major Depressive Disorder With Gastrointestinal Symptoms.

Gastrointestinal (GI) symptoms are one of the common somatic symptoms presented in patients with major depressive disorder (MDD). Higher frequency of GI symptoms and higher GI symptom burden were linked to greater depression severity and increased risk of suicide ideation. However, few studies have explored the underlying mechanisms of GI symptoms in MDD. Based on previous studies, the cerebellar-DMN circuits may play a potentially critical role in GI symptoms comorbid with depression. Fifty-two first-episode drug-naive patients with MDD (35 with GI symptoms and 17 without GI symptoms) and 28 matched healthy controls were recruited in the current study and underwent resting-state functional magnetic resonance imaging scan. Cerebellar seed-based functional connectivity maps were established. Relative to depressed patients without GI symptoms, significantly increased cerebellar-anterior default mode network (DMN) connectivities were found in those with GI symptoms. Both increased and decreased functional connectivities were found between cerebellum and posterior DMN in patients with GI symptoms compared with those without GI symptoms and healthy controls. Moreover, the right Crus I - right superior temporal gyrus connectivity value was related to severity of GI symptoms and depression in all patients with MDD. The support vector machine analysis demonstrated a satisfactory classification accuracy (89%) of the disrupted cerebellar-DMN connectivities for correctly identifying MDD patients with GI symptoms. These results revealed the possible neural mechanisms for the involvement of cerebellar-DMN circuits in GI symptoms co-occurred with MDD.

Prevalence of Gastrointestinal Symptoms, Hepatic Dysfunction, and Outcomes in Hospitalized Patients With COVID-19 Infection: An Early Experience.

Background and objectiveCoronavirus disease 2019 (COVID-19) was first reported in China two years ago as primarily a lung infection associated with cough and fever. It spread rapidly across the world and was declared a pandemic in early 2020, with 131 million people infected and 2.85 million deaths worldwide. To date, approximately 550,000 deaths have occurred due to COVID-19 in the United States and the numbers continue to rise. The extrapulmonary manifestations of this disease such as acute kidney injury (AKI), cardiovascular events, and gastrointestinal (GI) indications were not emphasized initially. However, subsequent studies from the United States and Canada have noted GI involvement in this disease in a large number of cases. Our group, taking care of these patients during the early phase of the pandemic in 2020, observed the frequent presentations of GI symptoms such as diarrhea and hepatic dysfunction and this study examines the same.MethodsWe undertook a retrospective study of 184 consecutive adult patients who were hospitalized at our center with confirmed COVID-19 infection, with a view to further elucidate the GI and hepatic involvement during the early breakout (March 17-May 17, 2020) of this illness.ResultsMajor comorbidities associated with this illness in our cohort of patients included hypertension (HTN, 66%), diabetes mellitus (DM, 44%), obesity (41%), and chronic kidney disease (CKD, 17%). The most common GI manifestation was diarrhea (25%) and, interestingly, more than two-thirds of the patients had at least one liver function abnormality. The most common liver function abnormality was elevated serum aspartate aminotransferase (AST). Elevated AST was significantly correlated (p<0.05) with inflammatory markers such as D-dimer, lactate dehydrogenase (LDH), and ferritin, as well as AKI by bi-variate analysis. Salient observations from our study include higher mortality, frequent AKI, and cardiovascular events in male patients (p<0.05). The liver injury in our cohort was suspected to be multifactorial, involving excessive cytokine release, viral infiltration of the hepatocytes, and cholangiocytes playing a role in transaminitis. The mean (±SD) duration of hospital stay was 13.5 ±15 days with 33% admissions to the ICU. The overall mortality was around 27%, with no significant difference between African Americans and Caucasians. However, patients admitted to the ICU had a very high mortality rate (54%) compared to those admitted to intermediate care (IMC)/acute care who had less severity of illness and associated pulmonary complications.ConclusionsThis study evaluates the presence of comorbidities such as DM, HTN, and obesity in patients hospitalized with COVID-19 at a community hospital in the Mid-Atlantic region of the United States. Statistical analysis of the data obtained for this cohort revealed a high frequency of GI symptoms, with diarrhea as the predominant common initial manifestation of the disease. Serum AST elevations were common and correlated with inflammatory markers and AKI. Male gender was also significantly associated with the development of AKI, higher frequency of cardiovascular events, and increased mortality. Overall mortality was noted to be 27%, with higher mortality in patients admitted to the ICU (54%) as compared to the IMC/floor (13%). These observations should spur future investigations into the role of these comorbidities, development of diarrhea, and hepatic dysfunction in COVID-19.

Increased Antibiotic Resistance in Children with Helicobacter pylori Infection: A Retrospective Study.

Children with recurrent abdominal pain may be suffering from a Helicobacter pylori (HP) infection. The gold standard for confirming HP gastritis is histological evaluation and microbiological tests performed on specimens collected by esophagogastroduodenoscopy (EGD). The aim of this study was to analyze HP positive cultures and antibiograms with regard to clinical and histopathological correlates. The data of 124 subjects with frequent gastrointestinal symptoms who underwent an EGD were retrospectively collected and analyzed. The mean age of the patients was 13 ± 3.6 years. The most frequent complaints were epigastric pain (84%; n = 100/119) and dyspepsia (79%; n = 94/119). HP gastritis was diagnosed in 54% (n = 67). Interestingly, 40% (n = 49) of the isolates were resistant to at least one antibiotic: amoxicillin (20%; n = 10/49), clarithromycin (45%; n = 22/49), or metronidazole (59%; n = 29/49). Isolates were resistant to two or more antibiotics in 16% (n = 20) of cases. In conclusion, we revealed remarkably high resistance rates to amoxicillin, metronidazole, and clarithromycin in our cohort. The presence of antibiotic resistance to more than one antibiotic was substantially increased in our HP-infected patients and this may negatively affect eradication treatment.

Gastrointestinal manifestations of long COVID: A systematic review and meta-analysis.

Background:Prolonged symptoms after COVID-19 are an important concern due to the large numbers affected by the pandemic.Objectives:To ascertain the frequency of gastrointestinal (GI) manifestations as part of long GI COVID.Design:A systematic review and meta-analysis of studies reporting GI manifestations in long COVID was performed.Data Sources and Methods:Electronic databases (Medline, Scopus, Embase, Cochrane Central Register of Controlled Trials, and Web of Science) were searched till 21 December 2021 to identify studies reporting frequency of GI symptoms in long COVID. We included studies reporting overall GI manifestations or individual GI symptoms as part of long COVID. We excluded pediatric studies and those not providing relevant information. We calculated the pooled frequency of various symptoms in all patients with COVID-19 and also in those with long COVID using the inverse variance approach. All analysis was done using R version 4.1.1 using packages ‘meta’ and ‘metafor’.Results:A total of 50 studies were included. The frequencies of GI symptoms were 0.12 [95% confidence interval (CI), 0.06–0.22, I2 = 99%] and 0.22 (95% CI, 0.10–0.41, I2 = 97%) in patients with COVID-19 and those with long COVID, respectively. The frequencies of abdominal pain, nausea/vomiting, loss of appetite, and loss of taste were 0.14 (95% CI, 0.04–0.38, I2 = 96%), 0.06 (95% CI, 0.03–0.11, I2 = 98%), 0.20 (95% CI, 0.08–0.43, I2 = 98%), and 0.17 (95% CI, 0.10–0.27, I2 = 95%), respectively, after COVID-19. The frequencies of diarrhea, dyspepsia, and irritable bowel syndrome were 0.10 (95% CI, 0.04–0.23, I2 = 98%), 0.20 (95% CI, 0.06–0.50, I2 = 97%), and 0.17 (95% CI, 0.06–0.37, I2 = 96%), respectively.Conclusion:GI symptoms in patients were seen in 12% after COVID-19 and 22% as part of long COVID. Loss of appetite, dyspepsia, irritable bowel syndrome, loss of taste, and abdominal pain were the five most common GI symptoms of long COVID. Significant heterogeneity and small number of studies for some of the analyses are limitations of the systematic review.

Gastrointestinal manifestations among hospitalized coronavirus disease 2019 patients in Vadodara, Gujarat, India

Background: SARS-CoV-2 is an RNA virus that causes coronavirus disease 2019 (COVID-19) which was initially detected in the province of Wuhan, China, and World Health Organization ultimately determined the outbreak to be labeled as a “pandemic” in March 2020. It lead to various clinical manifestations among COVID-19 patients and so, this study was conducted with the objective to study gastrointestinal (GI) symptoms among hospitalized COVID-19 patients. Materials and Methods: This retrospective study was conducted at a tertiary-level hospital in Vadodara. Hospital records of hospitalized COVID-19 patients from September to November 2020 were reviewed and included in the study. Clinical profiles including GI symptoms, respiratory symptoms, comorbidities, and length of hospital stay were extracted from the records. Results: A total record of 439 COVID-19 positive patients admitted during the study duration were reviewed. Out of 439 patients, 264 were males and 175 were females. Almost one-fifth (21.2%) of total patients had GI manifestations. The most common GI symptom was anorexia, followed by diarrhea, vomiting, and abdominal pain. Other less frequent GI symptoms include nausea and blood in stools. Around 30% of patients showing GI symptoms had comorbidities of diabetes mellitus or hypertension or both. The length of hospital stay was higher among patients with one or more comorbidities as compared to patients without any comorbidities. Conclusions: The proportion of having GI manifestations in hospitalized COVID-19 patients was 21.2%. The common GI symptoms were diarrhea, vomiting, anorexia, nausea, abdominal pain, and blood in stools. Patients with comorbidities had an elongated length of hospital stay.