non-GI Symptoms Research Articles

A81 GASTROINTESTINAL (GI) FEATURES OF HYPERMOBILE EHLERS-DANLOS SYNDROME (HEDS) AND HYPERMOBILITY SPECTRUM DISORDER (HSD): A SCOPING REVIEW

Abstract Background Ehlers-Danlos syndromes (EDS) are a varied group of hereditable connective tissue disorders (HCTD) typified by skin, joint and vascular features, along with less well-recognized features of chronic pain, immunological dysfunction and chronic GI symptoms. The latest EDS classification (2017) lists 13 EDS types and 19 genetic factors but there is no identified genetic basis for hEDS, the most common type and the most-commonly associated with GI symptoms. There is a need for robust data on the prevalence of GI symptoms and diagnoses in hEDS and HSD. Aims To investigate the extent of evidence on GI symptom prevalence and methods used to establish GI diagnoses in patients with hEDS and HSD. Methods Following the JBI (Joanna Briggs Institute) guide for scoping reviews, a systematic search of Ovid Medline, Embase and Cochrane Library retrieved scoping and systematic reviews, published in English (1974 – Sept 2023), reporting GI symptom prevalence, assessment and complications in EDS or HSD. Abstracts of identified papers were reviewed by NC & DB and discrepancies resolved by YY & DA. As a scoping review, it required no statistical comparisons. Results Duplicate screening of 410 abstracts yielded 10 papers that met inclusion criteria: 1 scoping and 9 systematic reviews. Four systematic reviews reported GI surgical issues related to vascular EDS; none was evaluated further. Two papers reported, specifically, on GI symptoms in patients with postural tachycardia syndrome or eating disorders, some of whom had hEDS or HSD and two papers reported on multiple GI and non-GI symptoms associated with fibromyalgia or functional somatic symptoms. The final 2 papers reported on multiple GI and non-GI symptoms in patients with HSD or multiple EDS types, limited in the latter case to papers published after the latest EDS classification (2017). In general, GI symptoms were characterised as IBS-like symptoms (Rome III or Rome IV) or as typical GI symptoms but without using a validated symptom questionnaire. Conclusions There are few data on GI symptom prevalence in hEDS or HSD and no standardised methods for identifying or characterizing GI symptoms or function in hEDS. The evaluation of GI function and symptoms in EDS is hampered by the absence of a definitive genetic or diagnostic test for hEDS or HSD and by changes in EDS classification over the last 50 years. There is a need for targeted systematic reviews of the prevalence of various GI symptoms in hEDS individuals and of relevant diagnostic methods, to guide further research into the causes of GI dysfunction in hEDS or HSD. Funding Agencies None

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.

Evaluating the Frequency and Cause of Persistent Symptoms in Pediatric Patients with Celiac Disease Adhering to a Long-Term Gluten-Free Diet

Background: Celiac disease (CD) treatment is based on life-long adherence to a gluten-free diet (GFD). Some patients with CD experience persistent symptoms despite adhering to a GFD. This condition is defined as a nonresponsive CD. Objectives: The present study aimed to investigate the prevalence and cause of persistent symptoms in pediatric patients with CD adhering to a GFD in Sistan and Baluchestan province, southeastern Iran. Methods: This descriptive cross-sectional study was conducted on 112 patients with CD selected from all diagnosed CD patients receiving a GFD for 6 months and newly diagnosed cases studied within one year. Gastrointestinal (GI) and extraintestinal (EI) symptoms were recorded on a questionnaire at the onset and during treatment. Data were analyzed by SPSS16 software, independent t-test, univariate t-test, and analysis of variance (ANOVA). Results: A total of 46.43% of our sample were boys, and 53.57% were girls (mean age = 82 ± 4.43 months). Abdominal pain and constipation symptoms were reported more frequently at the time of diagnosis and following one year of treatment. The most commonly observed EI symptoms at the time of diagnosis and during treatment were weight loss and growth failure, respectively. The percentage of treatment non-response in patients with a positive family history was significantly greater than in those with a negative family history. Conclusions: The results showed that GFD had a significant effect on the reduction of GI and non-GI symptoms, but the effect of this regime on insignificant symptoms, particularly at older ages, is negligible.

Characteristics of disorders of gut-brain interaction in the Japanese population in the Rome Foundation Global Epidemiological Study.

The aims were to use Japanese data from the Rome Foundation Global Epidemiological Study (RFGES) to test the hypotheses that severity of gastrointestinal (GI) symptoms and psychosocial disturbance are ordered as Rome IV irritable bowel syndrome (IBS) > Rome III IBS > DGBI, not IBS > others. Subjects were 2504 Japanese in the RFGES. We assessed DGBI/IBS diagnoses with Rome IV/III, IBS Symptom Severity Scale (IBS-SSS), Patient Health Questionnaire (PHQ) for anxiety/depression and non-GI somatic symptoms, PROMIS-10 for quality of life (QOL), Work Productivity and Activity Impairment (WPAI) Questionnaire, parts of Self-reported IBS Questionnaire (SIBSQ) for meal effect and stress effect, Food Frequency Questionnaire, and medication questions. The prevalence of Rome IV DGBI was as follows; IBS-C 0.5%, IBS-D 0.8%, IBS-M 0.8%, IBS-U 0.1%, unspecified functional bowel disorder 10.7%, postprandial distress syndrome 2.2%, and epigastric pain syndrome 0.3%. Rome III IBS prevalence; IBS-C 3.0%, IBS-D 3.1%, IBS-M 2.7%, and IBS-U 0.6%. Comparison among Rome IV IBS (n = 54), Rome III IBS (n = 197), other DGBI (n = 746), others (n = 1389) revealed significant order as Rome IV IBS > Rome III IBS > other DGBI > others in IBS-SSS, anxiety/depression, activity impairment, non-GI symptoms, physical QOL, mental QOL, exacerbated symptoms by meals and perceived stress (all p < 0.001). These findings support the study hypotheses. Data from Japan as a culturally homogenous country suggest Rome IV IBS is more severe and hence has more gut-brain psychobehavioral involvement than Rome III IBS.

A comparative study of disorders of gut-brain interaction in Western Europe and Asia based on the Rome foundation global epidemiology study.

Many studies have been published on disorders of the gut-brain interaction (DGBI) in Asia and Western Europe, but no previous study has directly assessed the difference between the two regions. The aim was to compare the prevalence of DGBI in Asia and Western Europe. We used data collected in a population-based Internet survey, the Rome Foundation Global Epidemiology Study, from countries in Western Europe (Belgium, France, Germany, Netherlands, Italy, Spain, Sweden, and the United Kingdom) and Asia (China, Japan, South Korea, and Singapore). We assessed DGBI diagnoses (Rome IV Adult Diagnostic Questionnaire), anxiety/depression (Patient Health Questionnaire-4, PHQ-4), non-GI somatic symptoms (PHQ-12), and access to and personal costs of doctor visits. The study included 9487 subjects in Asia and 16,314 in Western Europe. Overall, 38.0% had at least one DGBI; younger age, female sex, and higher scores on PHQ4 and PHQ12 were all associated with DGBI. The prevalence of having at least one DGBI was higher in Western Europe than in Asia (39.1% vs 36.1%, OR 1.14 [95% CI 1.08-1.20]). This difference was also observed for DGBI by anatomical regions, most prominently esophageal DGBI (OR 1.67 [1.48-1.88]). After adjustment, the difference in DGBI prevalence diminished and psychological (PHQ-4) and non-GI somatic symptoms (PHQ-12) had the greatest effect on the odds ratio estimates. The prevalence of DGBI is generally higher in Western Europe compared to Asia. A considerable portion of the observed difference in prevalence rates seems to be explained by more severe psychological and non-GI somatic symptoms in Western Europe.

A86 CANNABIS USE IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE IS HIGHER FOLLOWING LEGALIZATION OF CANNABIS IN CANADA AND IS ASSOCIATED WITH LOWER QUALITY OF LIFE

Abstract Background Patients with inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), often experience fluctuating and unpredictable symptoms. Most individuals require chronic therapy with immunomodulators or novel biologics to maintain disease remission. In addition to conventional medical therapy, many patients also seek out alternative therapies such as cannabis. Reports in the USA suggest that cannabis is used by ~12% of UC and ~16% of CD patients, despite it being legally prohibited. Purpose The aim of our study is to evaluate the use of cannabis in a cohort of patients with IBD following its legalization in Canada, and to assess its effects on IBD disease severity. Method We conducted a prospective cohort study of adult IBD patients seen in clinic at a tertiary care center in London, ON. Patients completed an online 40-question survey that collected data on demographics, IBD disease history, cannabis use, and included the Short Inflammatory Bowel Disease Questionnaire (SIBDQ). The survey was distributed and collected by the REDCap platform maintained by Western University. The study was approved by the Western University Ethics Committee. Result(s) Completed surveys were obtained from 254 individuals (148 individuals with CD, 90 with UC and 16 with indeterminate colitis). Over half of participants were between 35-64 years of age and female. Fifty-three percent of participants reported life-time cannabis use and 51% of users started using cannabis only in the preceding 3 years. Individuals with CD had higher rates of recent use, defined as use within the past 6 months, when compared with UC (41% vs 31%). Cannabis was taken multiple times per week by 57% of users. Cannabis was used to treat GI symptoms by 30% of users, as well as to help with sleep (26%) and for recreation (27%). Despite side effects such as dry mouth, anxiety and concentration issues, 79% of users felt the benefits of cannabis outweighed its harms. Interestingly, only 46% of cannabis users discussed their use with their family physician or gastroenterologist. Recent cannabis users did not differ in the use of IBD medication or self-reported rates of GI symptoms. Furthermore, recent users did not differ in the rates of surgical procedures for IBD (recent 35% vs non-recent 32%). Recent cannabis users did have a significantly lower quality of life as indicated by SIBDQ scores when compared to non-recent users (recent use 37 vs non-recent use 40). Conclusion(s) Cannabis use among patients with IBD after its legalization is more than double the rate previously reported in the literature. Importantly, physicians are likely to be unaware of its prevalence in their practice. Cannabis was used by patients to treat GI and non-GI symptoms, and it was associated with lower SIBDQ scores. Our results suggest that physicians should inquire about Cannabis use amongst their patients with IBD, and that further studies are required to determine its effects on disease severity. Please acknowledge all funding agencies by checking the applicable boxes below CIHR Disclosure of Interest None Declared

Clinical Significance of Gastrointestinal Symptoms in Hospitalized Patients With Covid-19 Infection

Objective: To determine the clinical significance of gastrointestinal (GI) symptoms in mild hospitalized patients with Covid-19 infection. &#x0D; Material and Methods: This study included adult patients who were hospitalized with a confirmed diagnosis of Covid-19 infection. The demographical features, symptoms, clinical presentations, medical history, medications and clinical progress and outcomes were noted using data collection form by the clinicians. The effect of GI symptoms on clinical outcomes in patients with mild Covid-19 infection was statistically evaluated. &#x0D; Results: 307 patients were included to the study. 159 of patients (51.7%) had an at least one GI symptoms, 18.2% of those presented only GI symptoms while 21.2% only non-GI symptoms. 27% were asymptomatic at admission. The most common GI symptom was loss of appetite that presenting 16.9% patients. The second and third most common GI symptoms were diarrhea in 15% patients, nausea and loss of taste in 14% patients, respectively. There was no significant difference in laboratory parameters between GI and non-GI symptoms groups. When age, gender, smoking status, and comorbidities of patients with GI and non-GI symptoms groups were compared, there was no difference in mean age, gender, smokers, and comorbidities. In addition, the length of hospital stay (p=0.377), complete healing (p=0.372) and mortality (p=0.351) was similar in patients with GI and non-GI symptoms groups respectively. &#x0D; Conclusion: Early diagnosis of Covid-19 infection presenting with GI symptoms can help prevent infection spread. The majority of these symptoms were mild, and their presence was not associated with worse clinical outcomes.

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

2003. Comparison of Confirmed and Probable Cases of Vibriosis, Tennessee, 2017–2021

Abstract Background Vibriosis causes an estimated 80,000 illnesses and 100 deaths in the United States each year. Commonly reported exposures include consuming raw or undercooked seafood and contact with seawater. To facilitate case ascertainment and better understand the epidemiology of vibriosis, CDC requested inclusion of positive culture-independent diagnostic testing (CIDT) cases to the 2017 case definition. We reviewed confirmed (culture positive) and probable (CIDT positive) cases in Tennessee (TN) from 2017-2021. Methods Vibrio reports from clinical and state public health laboratories were reviewed. Demographic, clinical, and exposure data were collected through routine case interviews using The Cholera and Other Vibrio Illness Surveillance (COVIS) Report. Confirmed and probable cases were described and compared using Epi Info 7. Results A total of 164 Vibrio cases were reported from 44 counties across TN. In total, 135 (82%) cases were interviewed including 72 (53%) confirmed cases (all sources) and 63 (47%) probable cases. Half of cases from each case status were 40-69 years old. Twenty-four percent of probable cases versus 7% of confirmed cases were under 10 years old. Of confirmed cases, 64% were males compared to 51% of probable cases. Most cases (90% of confirmed and 75% of probable cases) were among non-Hispanic white population. Almost all probable cases (97%) reported gastrointestinal (GI) symptoms. Among confirmed cases, 70% reported non-GI symptoms such as cellulitis. Thirty three percent of both confirmed and probable cases were hospitalized. Confirmed cases were more likely to report travel out of state (OR 5.1, p-value &amp;lt; 0.0001) and exposure to seawater (OR 3.4, p-value 0.002) compared to probable cases. When comparing confirmed cases from stool specimens (27 cases) to probable cases, travel out of state remained significant (OR 4.8, p-value 0.0001) as well as seafood consumption (OR 6.8, p-value 0.0008). Conclusion Demographic and clinical features differed between confirmed and probable cases. Out of state travel, seafood consumption, and exposure to seawater were reported more often by confirmed cases. Reflex culturing is recommended to better facilitate case ascertainment and understand the epidemiology of vibriosis. Disclosures All Authors: No reported disclosures.

The COVID-19 Pandemic and Post-Infection Irritable Bowel Syndrome: What Lies Ahead for Gastroenterologists

The COVID-19 Pandemic and Post-Infection Irritable Bowel Syndrome: What Lies Ahead for Gastroenterologists

Disorders of gut-brain interaction: Highly prevalent and burdensome yet under-taught within medical education.

Background and ObjectiveTo determine the population prevalence and associated health impairment of disorders of gut‐brain interaction (DGBI) across Great Britain, and the emphasis placed upon them within medical education.MethodsAn Internet‐based cross‐sectional health survey was completed by 1906 general population adults across Great Britain without self‐reported organic GI disease. The survey enquired for demographics, symptom‐based criteria for Rome IV DGBI, healthcare use, non‐GI somatic symptoms, and quality of life. As a separate analysis, we evaluated which DGBI are considered core knowledge at undergraduate medical school level and post‐graduate specialization level for Gastroenterologists and General Practitioners.ResultsThe overall prevalence of DGBI across Great Britain was 37%, being similar for England (37%), Scotland (33%), and Wales (36%); p = 0.66. There was no difference between English regions (range 33%–43%, p = 0.26). The prevalence of DGBI was highest in those aged 18–40 years (40%), then 40–64 years (37%), and least amongst those ≥65 years (29%); p < 0.001. The most common DGBI were bowel disorders (30%), followed by gastroduodenal (10.5%), anorectal (8.1%) and oesophageal disorders (6.2%). Individuals with DGBI were significantly more likely than those without DGBI to have increased GI‐related healthcare visits, medication use, surgical interventions, non‐GI somatic symptoms, and reduced quality of life. One‐in‐three people with DGBI had multiple GI organ regions involved and this correlated with increased health impairment (p < 0.001).The only DGBI mentioned across all medical training curricula is irritable bowel syndrome, while the General Practitioner and Gastroenterology Curricula also recognise the outdated term non‐ulcer dyspepsia (as opposed to functional dyspepsia). The 2010 Gastroenterology Curriculum also includes functional constipation and disordered defecation, with the incoming 2022 iteration adding in functional upper GI syndromes, functional abdominal pain, and opioid‐induced GI disturbances.ConclusionDisorders of gut‐brain interaction are common across Great Britain and incur substantial health impairment. However, they are generally under‐taught within the British medical education system. Increasing awareness and education of disorders of gut‐brain interaction might improve patient outcomes.

Gastrointestinal symptoms in patients hospitalized with COVID-19

To characterize outcomes in patients hospitalized with coronavirus disease 2019 (COVID-19) who present with gastrointestinal (GI) symptoms.Clinical outcomes in patients with COVID-19 associated with GI symptoms have been inconsistent in the literature.The study design is a retrospective analysis of patients, age 18 years or older, admitted to the hospital after testing positive for COVID-19. Clinical outcomes included intensive care unit requirements, rates of discharges to home, rates of discharges to outside facilities, and mortality.Seven hundred fifty patients met the inclusion criteria. Three hundred seventy three (49.7%) patients presented with at least one GI symptom and 377 (50.3%) patients presented with solely non-GI symptoms. Patients who presented with at least one GI symptom had significantly lower ICU requirements (17.4% vs 20.2%), higher rates of discharges home (77.2% vs 67.4%), lower rates of discharges to other facilities (16.4% vs 22.8%), and decreased mortality (6.4% vs 9.8%) compared with patients with non-GI symptoms. However, patients who presented with solely GI symptoms had significantly higher ICU requirements (23.8% vs 17.0%), lower rates of discharges home (52.4% vs 78.7%), higher rates of discharges to facilities (28.6% vs 15.6%), and higher mortality (19.0% vs 5.7%) compared with those with mixed GI and non-GI symptoms.Although patients with COVID-19 requiring hospitalization with GI symptoms did better than those without GI symptoms, those with isolated GI symptoms without extra-GI symptoms had worse clinical outcomes. COVID-19 should be considered in patients who present with new onset or worsening diarrhea, nausea, vomiting, and abdominal pain even without pulmonary symptoms.

Altered Metabolomics in Bipolar Depression With Gastrointestinal Symptoms.

ObjectiveAlthough gastrointestinal (GI) symptoms are very common in patients with bipolar disorder (BD), Few studies have researched the pathomechanism behind these symptoms. In the present study, we aim at elucidate the pathomechanism of GI symptoms in BD through metabolomic analysis.MethodBD patients were recruited from Shanxi Bethune Hospital that divided into two groups, each group assessed with the 24-item Hamilton Depression Rating Scale (HAMD-24) according to the presence or absence of GI symptoms. Healthy controls were recruited from the medical examination center of the same hospital. Differential metabolites were identified and further analyzed using Metabo Analyst 3.0 to identify associated metabolic pathways.ResultsThere were significantly higher HAMD-24 scores in the GI symptoms group than that of non-GI symptoms group (p = 0.007). Based on metabolomic analysis results, we found that the common disturbances metabolic pathway of both two patients groups was ketone body metabolism, and the unique disturbances metabolic pathways of BD with GI symptoms were fatty acid biosynthesis and tyrosine metabolism, and these changes were independent of dietary habits.ConclusionBD patients with GI symptoms exhibited disturbances in fatty acid and tyrosine metabolism, perhaps suggesting that the GI symptoms in BD patients are related to disturbances of the gut microbiome. Both groups of patients jointly exhibit disturbances of ketone body metabolism, which may serve as a biomarker for the pathogenesis of BD patients.

A Randomised, Double-Blind, Placebo-Controlled Trial Evaluating Concentrated Phytochemical-Rich Nutritional Capsule in Addition to a Probiotic Capsule on Clinical Outcomes among Individuals with COVID-19—The UK Phyto-V Study

Gut microflora dysbiosis affects the majority of individuals after COVID-19, contributing to both gastro-intestinal (GI) and non-GI symptoms. Natural phytochemicals have reported anti-viral properties and favourable effects on inflammatory and oxidative pathways, both important for tissue damage post-viral pneumonia. This study involved 147 participants with symptomatic COVID-19, randomised to receive a placebo (P) or a phytochemical-rich concentrated food capsule (PC) in addition to a pre/probiotic lactobacillus capsule. Participants taking the PC had an almost two-fold reduction in mean fatigue scores compared to P [p = 0.02], a three-fold reduction in cough score and more than a double improvement in overall well-being scores [p = 0.02]. Two (1.5%) participants reported mild, increased bloating which they felt was attributable to the capsules, although GI symptoms improved in 25 of 31 participants (82%) who reported them at baseline. Sedentary, older, previously hospitalised men with GI symptoms had a statistically significantly improvement among those given the probiotic. Although some participants with early disease would have improved spontaneously, such a rapid improvement observed in the majority of participants, who had been suffering for an average of 108 days, was clinically relevant and welcomed, especially among those more likely to have pre-existing gut dysbiosis. We are now evaluating whether this blend could also enhance antibody titres post-COVID-19 vaccination.

Global prevalence and burden of meal-related abdominal pain

BackgroundPatients with disorders of gut-brain interaction (DGBI) report meal intake to be associated with symptoms. DGBI patients with meal-related symptoms may have more severe symptoms overall and worse health outcomes, but this subgroup has not been well characterized. We aimed to describe the global prevalence of meal-related abdominal pain and characterize this subgroup.MethodsThe data analyzed originated from the Internet survey component of the population-based Rome Foundation Global Epidemiology Study, completed in 26 countries (n = 54,127). Adult subjects were asked whether they had abdominal pain and how often this was meal-related. Respondents were categorized into “no,” “occasional,” and “frequent” meal-related abdominal pain groups based on 0%, 10–40%, and ≥50% of the pain episodes being meal-related, respectively. DGBI diagnoses, frequency of other GI symptoms, psychological distress, non-GI somatic symptoms, quality of life, and healthcare utilization were compared between groups. Mixed linear and ordinal regression was used to assess independent associations between psychological distress, non-GI somatic symptoms, quality of life, other GI symptoms, and meal-related abdominal pain.ResultsOverall, 51.9% of the respondents reported abdominal pain in the last 3 months, and 11.0% belonged to the group with frequent meal-related abdominal pain, which included more females and younger subjects. DGBI diagnoses were more common in subjects with frequent meal-related abdominal pain, and the frequency of several GI symptoms was associated with having more frequent meal-related abdominal pain. Having meal-related abdominal pain more frequently was also associated with more severe psychological distress, non-GI somatic symptoms, and a poorer quality of life. The group with frequent meal-related abdominal pain also more often consulted a doctor for bowel problems compared to the other groups of meal-related abdominal pain.ConclusionReporting frequent meal-related abdominal pain is common across the globe and associated with other GI and non-GI somatic symptoms, psychological distress, healthcare utilization, and a poorer quality of life. Individuals who frequently experience meal-related abdominal pain also more frequently fulfill the diagnostic criteria for DGBI. Assessing meal-related symptoms in all DGBI patients could be of major importance to improve and individualize symptom management.

Comparison of laboratory characteristics of gastrointestinal symptoms and nongastrointestinal symptoms in patients infected with COVID-19: a systematic review and meta-analysis.

Background:The Coronavirus Disease 2019 (COVID-19) pandemic poses a massive crisis to global public health. Gastrointestinal (GI) symptoms are increasingly reported in COVID-19. The characteristics of laboratory findings of COVID-19 are critical for clinical diagnosis and treatment.Objectives:The study aimed to summarize laboratory features in COVID-19 with GI symptoms and non-GI symptoms.Design:This study was a systematic review and meta-analysis. Electronic literature searches were conducted for studies that included patients infected COVID-19 with GI symptoms and non-GI symptoms. GI symptoms included diarrhea, abdominal pain, nausea and vomiting, and anorexia. This study used a random-effects model to assess pooled data.Data sources and methods:We systematically searched PubMed, Embase, Cochrane, Web of Science for studies through 31 October 2021, with no language restrictions. We used the following search terms: ‘COVID-19’ OR ‘2019-nCoV’ OR ‘SARS-CoV-2’ OR ‘coronavirus 2019’ OR ‘severe acute respiratory syndrome coronavirus 2’ OR ‘coronavirus’ OR ‘novel coronavirus’ OR ‘nCoV’ AND ‘gastrointestinal symptoms’ OR ‘digestive symptoms’ AND ‘clinical feature’ OR ‘clinical characteristics.’ Data mostly originated from Chinese and American studies.Results:Of 796 identified studies, 14 were eligible and were included in our analysis (N = 8396 participants). Meta-analysis showed that GI symptoms group had an elevated alanine aminotransferase (ALT) [pooled mean difference (MD), 4.5 U/L; 95% confidence interval, [0.45, 8.55]; p = 0.03; I2 = 87%]. No publication bias was detected by Begg’s and Egger’s regression test (p = 0.130). COVID-19 with the GI symptoms also showed a trend toward decreased white blood cell count, lymphopenia, neutrophilia, thrombocytopenia and elevated total bilirubin.Conclusion:GI symptoms are common in COVID-19. No significant differences were found in most laboratory indicators except elevated ALT.Registration:CRD42020209039 (PROSPERO).

Gastrointestinal manifestations in patients with coronavirus disease-2019 (COVID-19): Impact on clinical outcomes.

Background:In this study, we summarized the data on gastrointestinal (GI) involvement and the potential association with clinical outcomes among the patients admitted to Khorshid Hospital.Materials and Methods:We investigated 1113 inpatients (≥18 years old) diagnosed with coronavirus disease-2019 (COVID-19) from March to June 2020 in Khorshid Hospital. We collected demographic details, clinical information, vital signs, laboratory data, treatment type, and clinical outcomes from patients’ medical records. The data of patients with GI symptoms were compared with those without GI symptoms.Results:A total of 1113 patients were recruited (male = 648). GI symptoms were observed in 612 (56.8%) patients (male = 329), the most common of which were nausea 387 (34.7%), followed by diarrhea 286 (25.7%), vomiting 260 (23.4%), and abdominal pain 168 (15.0%). The most prominent non-GI symptoms were cough 796 (71.5%), fever 792 (71.2%), shortness of breath 653 (58.7%), and body pain 591 (53.1%). The number of patients who were discharged, died, and were admitted to intensive care unit was significantly different in groups on the basis of GI and non-GI symptoms (P = 0.002, 0.009, 0.003).Conclusion:While COVID-19 was predominantly diagnosed in males, GI symptoms were more commonly reported by females. The results indicated that GI symptoms in COVID-19 patients are common, and the symptoms are not correlated with the severity of the disease. Moreover, the presence of GI symptoms was positively related to milder disease. Among COVID-19 positive patients, the clinical outcomes of the GI group were promising, compared to those of non-GI group.

Overlap between irritable bowel syndrome and hypermobile Ehlers-Danlos syndrome: An unexplored clinical phenotype?

Irritable bowel syndrome (IBS) is common, but its cause remains unknown. IBS patients present with gastrointestinal (GI) symptoms such as abdominal pain with altered bowel habits; however, some patients also have non-GI symptoms including muscle and joint pains. It is thus plausible that within large IBS cohorts, subgroups exist with distinct clinical phenotypes. Yet, these subgroups have not been clearly identified or characterized. Due to lack of segmentation, treatment-focused symptomatic management is similar for all with IBS and follows indiscriminate algorithms regardless of possible differing clinical phenotype. This universal approach to IBS management may account for the reported lack of efficacy of treatment. One emerging subgroup receiving increasing attention is that with overlap IBS and the underlying heritable connective tissue disorder, hypermobile Ehlers-Danlos syndrome (hEDS). Current evidence suggests that up to 62% of patients with hEDS suffer from IBS. However, despite recognition of the presence of IBS in hEDS, this overlap IBS/hEDS group has not been characterized and these patients are managed in a similar way to those with IBS alone. Future studies are required to characterize and deep phenotype in this overlap IBS/hEDS group.

Clinical Case Series of Gastrointestinal Symptoms in Patients With Novel Coronavirus 2019 Infection

Background: Various digestive symptoms have been frequently reported in a significant portion of patients infected with the virus since the outbreak of Coronavirus Disease 2019 (COVID-19). Most patients with COVID-19 have a fever accompanied by respiratory signs and symptoms, such as cough and dyspnea. We present 36 cases with a chief complaint of Gastrointestinal (GI) symptoms along with respiratory symptoms. In this study, we aimed at investigating the prevalence and outcomes of COVID-19 patients with digestive symptoms. Methods: A variety of observed GI symptoms included nausea and vomiting (72.2%), diarrhea (25%), abdominal pain (19.4%), loss of appetite (14%), and anosmia (14%). The most nonGI symptoms were dyspnea (66.7%), fever (66.7%), dry cough (58.3%), myalgia (52.4%), and others. Six patients (16.6%) were critically ill, 7 (19.4%) were in stable condition, and 23 patients (64%) showed moderate symptoms. Among the patients, 7 (19.5%) needed critical care and were admitted to ICU. Leucopenia, lymphopenia, and elevated acute-phase proteins were other features observed in these patients. The most common antiviral regimen was hydroxychloroquine and oseltamivir. Finally, 32 patients (89%) were discharged, and 4 (11%) died. Conclusion: This case series study highlights that patients with COVID-19 are prone to GI symptoms along with fever and respiratory symptoms. Patients may even present with digestive symptoms and without any respiratory symptoms. Hence, clinicians should pay more attention to these patients and help diagnose COVID-19 earlier to start prompt treatment before the occurrence of severe disease.

S1435 Outcomes in Patients With COVID-19 Presenting With Gastrointestinal Symptoms

Introduction: Coronavirus Disease 2019 (COVID-19) can present with a variety of symptoms. We investigated outcomes in patients with COVID-19 presenting with gastrointestinal (GI) symptoms. Methods: We retrospectively analyzed inpatients age >18 years with COVID-19 from March 2020 to June 2020 in our urban, academic, safety-net hospital. Patients were stratified based on whether they presented with only GI (Only-GI), only non-GI (Non-GI), or a combination (Mixed-Sxs) of symptoms. GI symptoms included abdominal pain, diarrhea, nausea, and vomiting. Non-GI symptoms included generalized (anorexia, fatigue, fever), pulmonary (cough, dyspnea), and head & neck (anosmia, dysgeusia) symptoms. Results: Of 750 patients admitted during the study period, 373 (49.7%) had GI symptoms: 106 patients with abdominal pain, 219 with diarrhea, 196 with nausea, and 123 with vomiting. 21 (2.8%), 377 (50.3%), and 352 (46.9%) patients were in the Only-GI, Non-GI, and Mixed-Sxs cohorts, respectively, with mortality rates of 19.0%, 9.8%, and 5.7% (P = 0.006). Comparing patients with GI symptoms, the Only-GI cohort had higher intensive care unit (ICU) requirements (23.8% vs 17.0%), lower rates of discharges to home (52.4% vs 78.7%), higher rates of discharges to other facilities (28.6% vs 15.6%), and higher mortality (19.0% vs 5.7%) compared to the Mixed-Sxs cohort (P = 0.02, Table 1). Univariate logistic regression analysis found higher mortality rates in the Only-GI group compared to the Mixed-Sxs group (OR: 3.9, 95% CI: 1.1-11.8, P = 0.02). Comparing patients with any GI symptoms (Only-GI and Mixed-Sxs cohorts) and no GI symptoms (Non-GI), those with GI symptoms had lower ICU requirements (17.4% vs 20.2%), higher rates of discharges to home (77.2% vs 67.4%), lower rates of discharges to other facilities (16.4% vs 22.8%), and lower mortality rates (6.4% vs 9.8%) [P = 0.02, Table 1]. Mortality associated with multi-organ dysfunction was higher in patients with GI symptoms (41.7% vs 5.4%) and respiratory failure was higher in patients without GI symptoms (70.3% vs 45.8%) [P = 0.02]. Conclusion: Half of our patients hospitalized for COVID-19 presented with GI symptoms. Patients who presented with only GI symptoms comprised a small minority (2.8%); however, these patients had worse outcomes compared to those who presented with concomitant GI and non-GI symptoms. These patients also had the higher ICU requirements (23.8%) and mortality rates (19.0%) than those with mixed symptoms (17.0%, 5.7%) and Non-GI symptoms (20.2%, 9.8%).Table 1.: Patient outcomes comparing those with GI symptoms and mixed symptoms as well as those with any GI symptoms and no GI symptoms.