Prevalence Of Gastrointestinal Manifestations Research Articles

Frequency of Gastrointestinal Signs and Symptoms in Patients with Dengue Fever in Tertiary Care Hospital

Objective: The objective behind this study was to determine the frequency of gastrointestinal signs and symptoms in patients with dengue fever in tertiary care hospital Methods: A cross sectional observational study was conducted on all adult patients diagnosed with dengue disease after taken informed consent from the patients and approval from the ethical committee of the hospital. All these patients were evaluated for the presence or absence of gastrointestinal (GI) manifestations. Those who had GI symptoms were further evaluated for the frequency of different types of GI symptoms. All baseline and clinical data were taken using a structured questionnaire and then entered & analysed using SPSS v. 26. Results: A total of 174 patients who were dengue virus positive were included for final analysis. Overall mean age and SD was 29.22±8.14 years and majority belongs to young age group, ≥16 – 40 years (60.11%, n = 104). Most of our study participants were males (75.86%, n = 132). Hypertension was the most common comorbid condition observed in our study participants (12.06%, n = 21). The overall prevalence of GI manifestations in our study who were dengue positive was 62.64% (n = 109). The most common GI symptom was presence of nausea/vomiting (70.64%, n = 77). Conclusion: The prevalence of GI manifestations in patients with dengue is quite high. Nausea/vomiting was the most common GI manifestation while patients with hepatomegaly and GI bleeding were also prevalent. Keywords: Dengue fever, gastrointestinal symptoms, clinical manifestation, Pakistan

S1307 Clinical Characteristics and Gastrointestinal Manifestations Among Veterans Admitted With COVID-19 in Detroit, Michigan

INTRODUCTION: Prevalence of gastrointestinal manifestations in patients presenting with COVID-19 are reportedly higher in the United States than earlier reports from China. Our study’s objective was to investigate the prevalence of GI manifestations in an older veteran population admitted with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and to establish their effect on clinical outcomes. METHODS: Retrospective medical chart review of all adult veteran patients admitted with SARS-CoV-2 to the Veterans Affairs Medical Center in Detroit, Michigan in March and April 2020. All cases were confirmed COVID-19 positive via RT-PCR assay of a nasopharyngeal swab specimen. GI-manifestation was defined as the presence of nausea, vomiting, diarrhea, abdominal pain, or anorexia on admission. Primary clinical outcomes for admitted patients was a composite of admission to ICU or death. RESULTS: 108 patients were diagnosed with COVID-19 with a mean age of 67.0 (SD 12.7) years, 93.5% male, and 86.1% African American, Table 1. For every one-year increase in patient age the odds of having GI-manifestations decreased by 4.9%, OR 0.951 (P = 0.016). 61.1% of admitted patients had GI-manifestations, 41.7% had anorexia, 32.4% had diarrhea, 20.4% had nausea or vomiting, and 12.0% had abdominal pain, Table 2. Patients with GI-manifestations had a longer duration of overall symptoms, median 7.0 vs. 3.0 days (P = 0.002). There was no significant difference in the levels of liver transaminases, bilirubin, or alkaline phosphatase among patients in the two groups, nor were there any differences in the primary clinical outcome, 28.8% vs 28.6% (P = 0.981), Table 3. Furthermore, there were no differences in the secondary outcomes of hospital or ICU length of stay and intubation rate. CONCLUSION: Our study revealed that more than 60% of admitted COVID-19 patients had GI-manifestations. These patients had a longer median duration of symptoms (both respiratory and non-respiratory) than patients who did not present with GI-manifestations. High rate of GI-manifestations can be explained by the SARS-CoV-2 virus’s tropism for angiotensin-converting-enzyme 2 receptor, abundantly expressed on colonic and ileal epithelial cells. Despite the high prevalence of GI-manifestations, our analysis failed to reveal any significant difference in clinical outcomes, contrary to published literature, and can provide reassurance to patients and providers caring for an older veteran population with COVID-19 who present with GI-manifestations.Table 1.: Baseline clinical characteristics of COVID-19 veteran patient populationTable 2.: Admission symptoms and laboratory investigationsTable 3.: Hospitalization outcomes

Gastrointestinal manifestations associated with systemic sclerosis: results from the nationwide inpatient sample.

BackgroundSystemic sclerosis (SSc) is a multisystem disease associated with significant morbidity and increased mortality. The prevalence of different gastrointestinal (GI) manifestations has been investigated in multiple, but mainly small, retrospective studies. In this study, we investigated the prevalence and risk for a broad spectrum of GI disorders and malignancies in a large sample of inpatients with SSc in the United States.MethodsWe conducted a retrospective analysis using the 2010-2011 Healthcare Cost and Utilization Project – Nationwide Inpatient Sample (HCUP-NIS). SSc patients were identified by ICD-9-CM code 710.1. Non-SSc patients (“controls”) were matched to cases 4:1 by age and sex. We examined demographics, clinical characteristics, and a range of GI conditions.ResultsFrom 15,824,031 total patients, 13,633 cases of SSc were matched to 54,532 controls. The prevalence of GI manifestations among SSc patients was 59.24% compared to 29.96% for controls (P<0.0001). Significantly elevated GI manifestations in SSc patients included dysphagia (4.3% vs. 1.9%, P<0.0001), esophageal reflux (34.8% vs. 15.4%, P<0.0001), Barrett’s esophagus (1.7% vs. 0.3%, P<0.0001), constipation (6% vs. 4.6%, P<0.0001), diarrhea (4.5% vs. 2.4%, P<0.0001), fecal incontinence (0.4% vs. 0.2%, P<0.0001), and celiac disease (0.2% vs. 0%, P<0.0001). Some GI disorders were significantly lower in SSc patients, including cholelithiasis (1.6% vs. 2.1%, P<0.0001) and GI malignancies (1% vs. 2.2%, P<0.0001).ConclusionsOur results emphasize the established association between SSc and esophageal disorders, such as dysphagia and reflux disease. Our analysis indicated a significant positive association between SSc and celiac disease, and a negative association between SSC and cholelithiasis.

Gastrointestinal manifestations in systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is an autoimmune disorder characterized by multisystem involvement, including the gastrointestinal (GI) tract. There is a significant variation in the clinical presentation and severity of GI disorders. When GI symptoms present as the initial manifestation of SLE, there is likely to be a delay in the diagnosis. The cause of these GI manifestations in SLE may be the disease, or the side effects of medications, or infections. In this study we investigated the GI manifestations in a group of SLE patients. Our study was conducted on 40 SLE patients and 30 healthy controls to assess the prevalence of GI symptoms in SLE patients. The prevalence of gastrointestinal manifestations in our study was 42.5%. GI manifestations in our SLE patients were: acute abdominal pain (due to pleurisy and peritonitis), 6%; diffuse abdominal pain, 23.5%; epigastric pain, 29%; epigastric pain with vomiting, 23.5%; epigastric pain with chronic constipation, 6%; chronic constipation, 6%; and diffuse abdominal pain with bleeding per rectum, 6%. In our study, we found a higher incidence of Giardia infestation in SLE patients than in healthy controls, and 10% of these patients were asymptomatic. There was more Giardia infestation in patients with GI symptoms as compared with patients with no GI symptoms, with a P value of 0.009. In our study SLE patients with GI symptoms had a peak systolic velocity (cm/s) with a mean of 108.4 ± 32.1 standard deviation (SD) in the celiac Doppler study. Patients without GI symptoms had a peak systolic velocity with a mean of 111.9 ± 37.7 SD, meaning that our patients mostly had no evidence of celiac trunk stenosis, but there was significant difference between SLE patients without GI symptoms and controls, as the mean was higher in SLE patients than in the controls. Also, the celiac end diastolic velocity was higher in both groups of SLE patients with GI symptoms and those without GI symptoms, compared to controls.

THAOS: gastrointestinal manifestations of transthyretin amyloidosis - common complications of a rare disease.

BackgroundTransthyretin amyloidosis is a systemic disorder caused by amyloid deposits formed by misfolded transthyretin monomers. Two main forms exist: hereditary and wild-type transthyretin amyloidosis, the former associated with transthyretin gene mutations. There are several disease manifestations; however, gastrointestinal complications are common in the hereditary form. The aim of this study was to explore the prevalence and distribution of gastrointestinal manifestations in transthyretin amyloidosis and to evaluate their impact on the patients’ nutritional status and health-related quality of life (HRQoL).MethodsThe Transthyretin Amyloidosis Outcomes Survey (THAOS) is the first global, multicenter, longitudinal, observational survey that collects data on patients with transthyretin amyloidosis and the registry is sponsored by Pfizer Inc. This study presents baseline data from patients enrolled in THAOS as of June 2013. The modified body mass index (mBMI), in which BMI is multiplied with serum albumin, was used to assess the nutritional status and the EQ-5D Index was used to assess HRQoL.ResultsData from 1579 patients with hereditary transthyretin amyloidosis and 160 patients with wild-type transthyretin amyloidosis were analyzed. Sixty-three percent of those with the hereditary form and 15% of those with the wild-type form reported gastrointestinal symptoms at enrollment. Unintentional weight loss and early satiety were the most frequent symptoms, reported by 32% and 26% of those with transthyretin gene mutations, respectively. Early-onset patients (<50 years) reported gastrointestinal complaints more frequently than those with a late onset (p < 0.001) and gastrointestinal symptoms were more common in patients with the V30M mutation than in those with other mutations (p < 0.001). For patients with predominantly cardiac complications, the prevalence of gastrointestinal manifestations was not evidently higher than that expected in the general population. Both upper and lower gastrointestinal symptoms were significant negative predictors of mBMI and the EQ-5D Index Score (p < 0.001 for all).ConclusionsGastrointestinal symptoms were common in patients with hereditary transthyretin amyloidosis and had a significant negative impact on their nutritional status and HRQoL. However, patients with wild-type transthyretin amyloidosis or transthyretin mutations associated with predominantly cardiac complications did not show an increased prevalence of gastrointestinal disturbances.