Prevalence Of Gastrointestinal Symptoms Research Articles

Effect of cancer stage on health-related quality of life of patients with epithelial ovarian cancer

We compared the quality of life (QoL) of women with early versus advanced epithelial ovarian cancer and examined predicting factors for the poor QoL. We classified 157 participants into 108 with early disease (stage I–II) and 49 with advanced disease (stage III–IV). They completed two questionnaires: EORTC QLQ-C30 and Chiang Mai University (CMU) ovarian cancer QoL. For EORTC QLQ-C30, the study groups were comparable regarding global health status/QoL, functional scales, and summary scores. The advanced group had worse scores on symptom scales specifically appetite loss and constipation. For CMU Ovarian Cancer QoL, the advanced group had worse scores only in the gastrointestinal domain but not in urinary, lymphatic, and sexual/hormonal domains. These findings remained mostly unchanged after excluding those with recurrence. In multivariable analysis, currently receiving treatment was consistently associated with worse QoL scores. The advanced stage had more adverse impact only on the gastrointestinal domains of QoL, mainly during periods of receiving chemotherapy. IMPACT STATEMENT What is already known on this subject? Survival outcome for women with epithelial ovarian cancer varies depending mainly on stage. Those who survive advanced stage disease could expect long-term disease and treatment-related morbidities that significantly affected QoL. However, there has been very limited information regarding QoL of women who have the early disease in comparison to those with more advanced disease especially in the context of Asian culture. What do the results of this study add? Apart from the higher prevalence of gastrointestinal symptoms reported by the patients with advanced disease, the general well-being and other symptom-specific domains of QoL were comparable between women with early and advanced diseases. Receiving treatment is a consistent predictor for poor QoL. What are the implications of these findings for clinical practice and/or further research? In comparison to early-stage epithelial ovarian cancer, the advanced stage had more adverse impact only on the gastrointestinal domains of QoL, mainly during periods of receiving chemotherapy. This information will be useful for patient counselling. Future research should examine the underlying causes of this finding.

Gastrointestinal Symptoms in Association With Hypokalemia Can Be a Predictor of Inferior Outcomes in COVID-19.

The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus disease-2 (SARS-C0V-2), has affected many lives globally. In Singapore, majority of the infected individuals are foreign workers residing in dormitories. A retrospective review conducted over two weeks (April 13 to April 26, 2020) of migrant workers admitted to a public hospital in Singapore revealed that a significant number of them developed hypokalemia. The purpose of this study was to examine any association that might exist between COVID-19 and hypokalemia. Fifty patients in this study had hypokalemia, translating to a prevalence of 28.4% (95% CI: 21.9-35.7). Gastrointestinal (GI) loss was a significant cause of hypokalemia with a prevalence of GI symptoms in the study group (diarrhea, vomiting, poor oral intake) of 5.7% (95% CI: 2.8-10.2). Clinicians should consider screening for hypokalemia in COVID-19 patients and initiate potassium replacement to mitigate any potential arrhythmias.

The gut microbiome: a missing link in understanding the gastrointestinal manifestations of COVID-19?

Coronavirus disease 2019 (COVID-19), which is caused by infection with SARS-CoV-2, presents with a broad constellation of both respiratory and nonrespiratory symptoms, although it is primarily considered a respiratory disease. Gastrointestinal symptoms—including nausea, abdominal pain, vomiting, and diarrhea—rank chief among these. When coupled with the presence of viral RNA in fecal samples, the presence of gastrointestinal symptoms raises relevant questions regarding whether SARS-CoV-2 can productively infect the upper or lower gastrointestinal tract. Despite the well-documented prevalence of gastrointestinal symptoms and the high rate of SARS-CoV-2 fecal RNA shedding, the biological, clinical, and epidemiological relevance of these findings is unclear. Furthermore, the isolation of replication-competent virus from fecal samples has not been reproducibly and rigorously demonstrated. Although SARS-CoV-2 shedding likely occurs in a high proportion of patients, gastrointestinal symptoms affect only a subset of individuals. Herein, we summarize what is known about gastrointestinal symptoms and fecal viral shedding in COVID-19, explore the role of the gut microbiome in other respiratory diseases, speculate on the role of the gut microbiota in COVID-19, and discuss potential future directions. Taking these concepts together, we propose that studying gut microbiota perturbations in COVID-19 will enhance our understanding of the symptomology and pathophysiology of this novel devastating disease.

Enteric pathogenic bacteria and resistance gene carriage in the homeless population in Marseille, France.

We aimed to assess the prevalence of pathogenic bacteria and resistance genes in rectal samples collected among homeless persons in Marseille, France. In February 2014 we enrolled 114 sheltered homeless adults who completed questionnaires and had rectal samples collected. Eight types of enteric bacteria and 15 antibiotic resistance genes (ARGs) were sought by real-time polymerase chain reaction (qPCR) performed directly on rectal samples. ARG-positive samples were further tested by conventional PCR and sequencing. We evidenced a 17.5% prevalence of gastrointestinal symptoms, a 9.6% prevalence of enteric pathogenic bacteria carriage, including Escherichia coli pathotypes (8.7%) and Tropheryma whipplei (0.9%). Only 2 persons carried blaCTX-M-15 resistance genes (1.8%), while other genes, including carbapenemase-encoding genes and colistin-resistance genes, (mcr-1 to mcr-6, mcr-8) were not detected. Our results suggest that sheltered homeless persons in Marseille do not have a high risk of harbouring gastrointestinal antibiotic resistant bacteria.

The natural history of glycogen storage disease type Ib in England: A multisite survey.

Glycogen storage disease type Ib (GSDIb) is characterized by hepatomegaly and fasting hypoglycaemia as well as neutropaenia and recurrent infections. We conducted a retrospective observational study on a cohort of patients with GSDIb across England. A total of 35 patients, with a median age of 9.1 years (range 1‐39 years), were included in the study. We examined the genotype and phenotype of all patients and reported 14 novel alleles. The phenotype of GSDIb in England involves a short fasting tolerance that extends into adulthood and a high prevalence of gastrointestinal symptoms. Growth is difficult to manage and neutropaenia and recurrent infections persist throughout life. Liver transplantation was performed in nine patients, which normalized fasting tolerance but did not correct neutropaenia. This is the first natural history study on the cohort of GSDIb patients in England.

Diarrhea Is Associated with Increased Severity of Disease in COVID-19: Systemic Review and Metaanalysis.

COVID-19 has become a pandemic since its emergence in Wuhan, China. The disease process was initially defined by presence of respiratory symptoms; however, it is now well studied and shown in evidence that this is a multisystem process. Involvement of gastrointestinal (GI) system has been identified, and GI symptoms can be the only presenting symptoms in some patients. Hence, it is important to identify and understand the GI symptoms associated with COVID-19 for appropriate care of patient. We conducted a systematic review and metaanalysis to identify the GI symptoms of COVID-19 and identify association of diarrhea with severity of COVID-19. We performed extensive search of Medline and Embase from December 2019 to May 2020 to identify articles reporting GI symptoms in COVID-19 patients. The primary outcome was prevalence of GI symptoms in COVID-19 patients, and secondary outcome was the association of diarrhea with disease severity. A total of 38 studies with 8407 patients were included. Of the total patients, 15.47% patients had at least one GI symptom. The pooled prevalence of nausea/vomiting was 7.53% and diarrhea was 11.52%. On metaanalysis, patients with diarrhea as one of the presenting symptoms were more likely to have severe disease (OR 1.63, 95% CI: 1.11–3.38, p = 0.01). Our systematic review and metaanalysis demonstrated that GI symptoms are common in COVID-19. Presence of diarrhea as a presenting symptom is associated with increased disease severity and likely worse prognosis. Early recognition of patients is needed for prompt management of this at-risk population.Supplementary InformationThe online version contains supplementary material available at 10.1007/s42399-020-00662-w.

Clinical Manifestations of Gastrointestinal Symptoms in COVID-19 Patients: An Integrative Review.

After the outbreak of novel coronavirus disease 2019 (COVID-19) in Wuhan, China, its spread to other countries is rapidly increasing. In this integrative review, we report the prevalence of gastrointestinal symptoms in patients with COVID-19. For this purpose, available articles on gastrointestinal manifestations in patients with COVID-19, which were reported from China, were reviewed. All reviewed articles were searched from December 11, 2019, to June 20, 2020, based on specific key words. Related findings in these articles show that the main target of COVID-19 is lung tissue, as after the virus enters the body, it mainly causes respiratory symptoms in affected patients. But in addition to respiratory symptoms, it is possible that, over time, these patients present with other symptoms, the most obvious of which are gastrointestinal symptoms. It is well documented that diarrhea and vomiting are the most common gastrointestinal symptoms in COVID-19 patients. As part of this report, we also look at the incidence and frequency of gastrointestinal symptoms in COVID-19 patients in Iran. The results can be used by providers as a guideline for better management of gastrointestinal symptoms in these patients.

Severe manifestations of SARS-CoV-2 in children and adolescents: from COVID-19 pneumonia to multisystem inflammatory syndrome: a multicentre study in pediatric intensive care units in Spain

BackgroundMultisystem inflammatory syndrome temporally associated with COVID-19 (MIS-C) has been described as a novel and often severe presentation of SARS-CoV-2 infection in children. We aimed to describe the characteristics of children admitted to Pediatric Intensive Care Units (PICUs) presenting with MIS-C in comparison with those admitted with SARS-CoV-2 infection with other features such as COVID-19 pneumonia.MethodsA multicentric prospective national registry including 47 PICUs was carried out. Data from children admitted with confirmed SARS-CoV-2 infection or fulfilling MIS-C criteria (with or without SARS-CoV-2 PCR confirmation) were collected. Clinical, laboratory and therapeutic features between MIS-C and non-MIS-C patients were compared.ResultsSeventy-four children were recruited. Sixty-one percent met MIS-C definition. MIS-C patients were older than non-MIS-C patients (p = 0.002): 9.4 years (IQR 5.5–11.8) vs 3.4 years (IQR 0.4–9.4). A higher proportion of them had no previous medical history of interest (88.2% vs 51.7%, p = 0.005). Non-MIS-C patients presented more frequently with respiratory distress (60.7% vs 13.3%, p < 0.001). MIS-C patients showed higher prevalence of fever (95.6% vs 64.3%, p < 0.001), diarrhea (66.7% vs 11.5%, p < 0.001), vomits (71.1% vs 23.1%, p = 0.001), fatigue (65.9% vs 36%, p = 0.016), shock (84.4% vs 13.8%, p < 0.001) and cardiac dysfunction (53.3% vs 10.3%, p = 0.001). MIS-C group had a lower lymphocyte count (p < 0.001) and LDH (p = 0.001) but higher neutrophil count (p = 0.045), neutrophil/lymphocyte ratio (p < 0.001), C-reactive protein (p < 0.001) and procalcitonin (p < 0.001). Patients in the MIS-C group were less likely to receive invasive ventilation (13.3% vs 41.4%, p = 0.005) but were more often treated with vasoactive drugs (66.7% vs 24.1%, p < 0.001), corticosteroids (80% vs 44.8%, p = 0.003) and immunoglobulins (51.1% vs 6.9%, p < 0.001). Most patients were discharged from PICU by the end of data collection with a median length of stay of 5 days (IQR 2.5–8 days) in the MIS-C group. Three patients died, none of them belonged to the MIS-C group.ConclusionsMIS-C seems to be the most frequent presentation among critically ill children with SARS-CoV-2 infection. MIS-C patients are older and usually healthy. They show a higher prevalence of gastrointestinal symptoms and shock and are more likely to receive vasoactive drugs and immunomodulators and less likely to need mechanical ventilation than non-MIS-C patients.

Newly Reported Studies on the Increase in Gastrointestinal Symptom Prevalence withCOVID-19 Infection: A Comprehensive Systematic Review and Meta-Analysis.

Background and Aim: Although constitutional and respiratory symptoms such as cough and fever are the most common symptoms in patients infected with COVID-19, gastrointestinal (GI) tract involvement has been observed by endoscopic biopsies. Multiple GI symptoms, including diarrhea, nausea or vomiting and abdominal pain, have also been reported. This review aims to present the currently available data regarding the GI symptoms of COVID-19 patients, and to compare the frequency of GI symptoms in early stage (Eastern) mostly Chinese data to the current stage (Western) non-Chinese data. Methods: We performed a systematic literature search to identify both published studies by using PubMed, Google Scholar, and CNKI (Chinese medical search engine), and yet unpublished studies through medRxiv and bioRxiv. We also reviewed the cross references of the detected articles. We conducted a Medical Subject Headings (MeSH) search up until 20 September 2020. We pooled the prevalence of symptoms of diarrhea, anorexia, nausea, vomiting, and abdominal pain by using the Freeman–Tukey’s transforming random effect model. Results: A total of 118 studies were included in the systematic review and 44 of them were included in the meta-analysis. There was a significant heterogeneity between the studies; therefore, the random effects model was used. The pooled prevalence estimate of any GI symptoms reported was found to be 0.21 (95%CI, 0.16–0.27). Anorexia was the most commonly reported GI symptom at 18% (95%CI, 0.10–0.27) followed by diarrhea at 15% (95%CI, 0.12–0.19). Diarrhea, abdominal pain, nausea/vomiting, and respiratory symptoms were more common in non-Chinese studies. The prevalence of abdominal pain was lower in the “inpatient-only” studies when compared with studies that included outpatients only and those including both inpatients and outpatients. Conclusions: In this comprehensive systematic review and meta-analysis study, we observed higher rates of diarrhea, nausea/vomiting, and abdominal pain in COVID-19 infected patients among non-Chinese studies compared to Chinese studies. We also observed a higher prevalence of GI symptoms in Chinese studies than was reported previously. Non-respiratory symptoms, including GI tract symptoms, should be more thoroughly and carefully evaluated and reported in future studies.

COVID-19 and the gastrointestinal tract: what do we already know?

ABSTRACTThe new coronavirus disease pandemic is defining 2020, with almost 17.5 million infected individuals and 700 thousand deaths up to beginning of August. It is caused by SARS-CoV-2 and the transmission is through the respiratory tract. Those infected may be asymptomatic, present typical symptoms (fever, dry cough and dyspnea), gastrointestinal symptoms (diarrhea, nausea, vomiting and abdominal pain) and viral RNA in stools. The objective of this work was to review the literature related to the prevalence of gastrointestinal symptoms, and to check the possibility of fecal-oral transmission. We searched PubMed® database on COVID-19 and gastrointestinal tract and selected articles using the PRISMA method. We eliminated articles based on titles and abstracts, small number of patients and the mechanism of infection, leaving 14 studies. Comorbidities and laboratory alterations (elevation of hepatic aminotransferases and bilirubin) were related to worsening of the disease. The prevalence of gastrointestinal symptoms ranged from 6.8% to 61.3%, including diarrhea (8.14% to 33.7%), nausea/vomiting (1.53% to 26.4%), anorexia (12.1% to 40.0%) and abdominal pain (0% to 14.5%). The presence of viral RNA in stools was rarely tested, but positive in 0% to 48.1%. The gastrointestinal tract is affected by COVID-19, causing specific symptoms, laboratory alterations and viral presence in the feces. However, the results of prevalence and possibility of fecal-oral transmission were varied, requiring further studies for more assertive conclusions. It is important that healthcare professionals draw attention to this fact, since these changes can help make diagnosis and initiate early treatment.

The Prevalence of Gastrointestinal Symptoms, Abnormal Liver Function, Digestive System Disease and Liver Disease in COVID-19 Infection: A Systematic Review and Meta-Analysis.

The worldwide outbreak of COVID-19 infected millions of people. Some patients had gastrointestinal (GI) symptoms, abnormal liver function, digestive system disease and liver disease. To investigate the prevalence of GI symptoms, abnormal liver function, digestive system disease and liver disease in patients with COVID-19 by a systematic review and meta-analysis. We searched PubMed, Ovid Embase, Medline, and 2 Chinese databases. Primary outcomes were the prevalence of GI symptoms, abnormal liver function, digestive system disease, and liver disease. Different studies were included in different subset analysis. These outcomes were estimated with proportions, odds ratio, 95% confidence interval (CI) and P-value by Stata SE 15.1. Thirty-one studies involving 4682 patients were included. The most significant GI symptoms were diarrhea (0.08, 95% CI: 0.06-0.11) and anorexia (0.17, 95% CI: 0.06-0.27). The most significant abnormal liver function was increased alanine aminotransferase (ALT) (0.25, 95% CI: 0.16-0.33). A total of 5% of the patients had digestive system disease (95% CI: 0.02-0.08). A total of 3% of the patients had liver disease (95% CI: 0.02-0.05). The prevalence of nausea and vomiting, diarrhea, abnormal liver function, digestive system disease, and liver disease was higher in Wuhan group. The prevalence of diarrhea was higher in non-China group. Patients in severe/intensive care unit group were more likely to have diarrhea, anorexia, abdominal pain increased aspartate aminotransferase, and increased ALT. The most significant GI symptoms were anorexia and diarrhea. The most significant abnormal liver function was increased ALT. Severe patients were more likely to have GI symptoms and abnormal liver function.

Patient-Reported Gastrointestinal Symptoms and the Association With Quality of Life Following Kidney Transplantation

BackgroundThere has been limited study of the prevalence of gastrointestinal symptoms and their impact on the quality of life (QOL) in kidney transplant recipients. The aim of this study was to examine the prevalence and predictors of gastrointestinal symptoms and the association with QOL in kidney transplant recipients.MethodsAll chronic kidney transplant recipients at the Princess Alexandra Hospital were provided with 3 questionnaires, the Gastrointestinal Quality of Life Index (GIQLI), the Gastrointestinal Symptoms Rating Scale (GSRS), and Structured Assessment of Gastrointestinal Symptoms (SAGIS) scale, to ascertain QOL impairment and to screen gastrointestinal symptom severity. Linear regression was used to determine the predictors of gastrointestinal QOL and gastrointestinal symptom severity.ResultsOf the 343 participants, the median age was 47 (interquartile range [IQR] 36–55) years, 58% were men, 79% were white, 39% had chronic glomerulonephritis, 83% had received their first graft, and median time since transplant was 6.3 (IQR 1.8–13.1) years. Using GSRS, 88% of participants reported at least 1 gastrointestinal symptom, most commonly indigestion (57%) and diarrhea (54%). Using GIQLI, 42% and 38% of participants reported mild and moderate QOL impairment, respectively. Gastrointestinal symptoms were predicted by female sex (coefficient −0.11, 95% CI −0.21 to −0.02) and mycophenolate (coefficient 0.0001, 95% CI 0.0001 to 0.0002), and were associated with poorer QOL (coefficient −0.38, 95% CI −0.45 to −0.30). Similar findings were observed using SAGIS for gastrointestinal symptoms.ConclusionsGastrointestinal symptoms are frequent in kidney transplant recipients, particularly in women and those receiving mycophenolate, and are strongly associated with poorer QOL.

Gastrointestinal symptoms and fecal nucleic acid testing of children with 2019 coronavirus disease: a systematic review and meta-analysis

In order to understand the clinical manifestations and incidence of gastrointestinal symptoms of coronavirus disease (COVID-19) in children and discuss the importance of fecal nucleic acid testing.We retrospectively analyzed studies on gastrointestinal symptoms and fecal nucleic acid detection in pediatric COVID-19 patients from January 1, 2020 to August 10, 2020, including prospective clinical studies and case reports. The results of fecal nucleic acid detection were analyzed systematically. Stata12.0 software was used for meta-analysis.The results showed that the most common gastrointestinal symptoms in children with COVID-19 were vomiting and diarrhea, with a total incidence of 17.7% (95% Cl 13.9–21.5%). However, the prevalence of gastrointestinal symptoms in other countries (21.1%, 95% CI 16.5–25.7%) was higher compared to China (12.9%, 95% CI 8–17.7%). In Wuhan, the pooled prevalence was much higher (41.3%, 95% CI 3.2–79.4%) compared to areas outside Wuhan in China (7.1%, 95% CI 4.0–10.3%). The positive rate of fecal nucleic acid testing in COVID-19 children was relatively high at 85.8% (91/106). Additionally, 71.2% (52/73) were still positive for fecal nucleic acid after respiratory tract specimens turned negative. One and two weeks after the respiratory tract specimens turned nucleic acid-negative, 45.2% (33/73) and 34.2% (25/73) patients, respectively, remained fecal nucleic acid-positive. The longest interval between the respiratory tract specimens turning negative and fecal specimens turning negative exceeded 70 days. Conclusions and relevance: gastrointestinal symptoms in pediatric COVID-19 are relatively common. Attention should be paid to the detection of fecal nucleic acids in children. Fecal nucleic acid-negative status should be considered as one of the desegregation standards.

Frequency and burden of gastrointestinal symptoms in familial dysautonomia.

Familial dysautonomia (FD) is a rare hereditary sensory and autonomic neuropathy (HSAN-3) that is clinically characterized by impaired pain and temperature perception and abnormal autonomic function. Patients with FD have gastrointestinal dysmotility and report a range of gastrointestinal symptoms that have yet to be systematically evaluated. The aim of this study was to establish the frequency and severity of gastrointestinal symptoms in patients with FD. The validated National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS) survey questionnaire, together with additional FD-specific questions, were distributed to 202 living patients with genetically confirmed FD who had been identified from the New York University FD Patient Registry or, when relevant, to their respective caretaker. As a comparison group, we used a general US adult population for whom PROMIS scores were available (N = 71,812). Of the 202 questionnaires distributed, 77 (38%) were returned, of which 53% were completed by the patient. Median age of the respondents was 25years, and 44% were male. Gastrostomy tube was the sole nutrition route for 25% of the patients, while 53% were reliant on the gastrostomy tube only for liquid intake. The prevalence of gastrointestinal symptoms was significantly higher in each of the eight domains of PROMIS in patients with FD than in the controls. Gastrointestinal symptoms as measured by raw scores on the PROMIS scale were significantly less severe in the FD patient group than in the control population in all domains with the exception of the abdominal pain domain. The surveys completed by caregivers reported the same burden of symptoms as those completed only by patients. Gastrointestinal symptoms affect nearly all patients with FD. Gastrointestinal symptoms are more prevalent in adult patients with FD than in the average US adult population but are less severe in the former.

S1239 Is There a Gender-Based Difference in the Prevalence of Gastrointestinal Symptoms in COVID-19? A Retrospective Cohort Study

INTRODUCTION: Since its discovery in Wuhan, China in December of 2019, the novel Coronavirus has progressed to become one of the worst pandemics seen in the last 100 years Recently the gastrointestinal manifestations of COVID-19 have been well documented We aimed to see if there is a gender-based difference in the prevalence of gastrointestinal symptoms in COVID-19 METHODS: This is a descriptive retrospective cohort study of 130 consecutive adult patients with a positive COVID PCR test admitted between March 16th, 2020 to May 14th, 2020 at a tertiary care university hospital We only included the inpatients and excluded those who tested COVID-19 positive but were not admitted to the hospital The Chi-square test was used for comparing categorical variables and analysis was done using SAS version 9 4 (SAS Institute, Cary, NC) RESULTS: Out of 130 patients, 59(45 4%) were female and 71 (55 6%) were male The most common gastrointestinal symptoms were diarrhea (26 2%) and anorexia (26 2%) followed by nausea (24 6%), abdominal pain (16 2%), and anosmia &/or ageusia (6 9%) The demographic of the study population is seen in Table 1 Women experienced significantly more anosmia and ageusia as compared to men (11 8% vs 2 8%, P = 0 04) There was no statistically significant difference in the presence of any other symptoms based on gender The gender-based difference is depicted in Table 2 CONCLUSION: Our study showed that anosmia&/or ageusia was more likely to be prevalent in women with COVID-19 as compared to men There was no gender predominance found when comparing other gastrointestinal symptoms Our study also showed that diarrhea and anorexia were the most common gastrointestinal symptoms which are in line with other studies (Table Presented)

S1326 Effect of Gastric Acid Suppression in Gastrointestinal Manifestations of COVID-19

INTRODUCTION: The pandemic caused by the Coronavirus Disease 2019 (COVID-19) has led to over 5 million cases and 340,000 deaths globally as of May 2020. There are increasing reports of gastrointestinal symptoms including diarrhea, nausea, and abdominal pain suggestive of gastrointestinal infection by COVID-19. In vitro studies developed for the safe handling of the COVID-19 virus have reported inactivation of coronavirus in highly acidic conditions (pH < 3) such as the human stomach which has a pH range between 1.0 to 3.5. Proton pump inhibitor (PPI) and H2 receptor blocker (H2B) medications are ubiquitous in clinical practice and have been shown to be highly effective in raising intragastric pH. We hypothesize that acid-suppressing medications taken prior to COVID-19 infection lead to increased gastrointestinal symptoms due to altered gastric pH potentially influencing viral load. METHODS: This was a single center retrospective cohort study. Adult patients with confirmed COVID-19 infection admitted from March to April 2020 were identified and charts were reviewed for patient demographics, outpatient medication list, symptoms associated with COVID-19 infection, and hospital course. The primary outcome was prevalence of gastrointestinal symptoms (abdominal pain, nausea, diarrhea) between the acid-suppressed patients and non-acid-suppressed patients. Secondary outcomes compared need for intensive care, length of stay, and mortality. RESULTS: We reviewed 100 consecutive patients admitted with COVID-19. Twenty-four patients were taking acid-reducing medications prior to admission. There were more females in the acid-suppressed group (41.7%) compared to the non-acid-suppressed group (34.2%) and average age was approximately 59 years for both (Table 1). Overall, GI symptoms occurred in 33.3% of acid-suppressed patients and 34.2% of the non-acid suppressed patients (P = 0.937) (Figure 1). No significant differences in specific GI symptoms were observed between the groups. Need for intensive care, length of stay, and mortality did not differ (Table 1). CONCLUSION: While in vitro studies suggest a potential deleterious effect for patients taking acid-suppressive medications prior to COVID-19 infections, no association was noted in gastrointestinal symptoms, acuity of care, length of stay, or mortality in patients taking PPI or H2 blocker medications prior to admission for COVID-19 infection in our cohort.Table 1.: Demographics and outcomes of COVID-19 patientsFigure 1.: Gastrointestinal Symptoms of Acid-Suppressed Patients vs. Non-Acid-Suppressed Patients.

S0260 The Prevalence of Gastrointestinal Symptoms in Patients Hospitalized With COVID-19

INTRODUCTION: The novel coronavirus (COVID-19) has had a devastating global impact and is a critical area of study for medical professionals Characterization of the disease is important to assist in developing screening protocols and diagnostic tools Studies have shown that similar to SARS and MERS, the COVID-19 virus has a tropism for the gastrointestinal (GI) tract The mechanism of COVID-induced GI symptoms is unknown, though direct viral infection of enterocytes and immunemediated injury have been hypothesized This study evaluated the prevalence of GI symptoms and the frequency at which these symptoms were the initial presentation in hospitalized COVID patients METHODS: A confidential database was created from a registry of patients admitted to an urban university hospital with a diagnosis of COVID-19 Gastrointestinal symptoms, including diarrhea, nausea, vomiting, abdominal pain and loss of appetite were identified A frequency analysis using SAS was performed to determine prevalence of GI symptoms and timing of presentation The study was IRB approved RESULTS: 283 patients were analyzed, with 37 46% having at least one GI symptom prior to admission to the hospital The most common symptom was nausea/vomiting (33 92%) followed by diarrhea (19 08%), loss of appetite (13 07%), and abdominal pain (3 53%) Two or more symptoms were seen in 13 43% of patients GI symptoms were cited as the initial presentation in 23 32% of cases Diarrhea was the most common initial symptom (11 66%) followed by nausea/vomiting (9 19%), loss of appetite (9 19%), and abdominal pain (2 47%) Multiple GI symptoms occurred as the initial presentation in 7 06% of patients CONCLUSION: Gastrointestinal symptoms are an important presentation of COVID-19 that is often overlooked Increased awareness and characterization of GI symptoms in COVID-19 infection is needed to improve screening procedures and protect healthcare workers from potential fecal-oral transmission While diarrhea in COVID-19 infection has become the primary GI focus, this study revealed that nausea/vomiting occurred in one-third of hospitalized patients These results are important because they offer important information about the spectrum of GI manifestations in a diverse U S urban population

Gastrointestinal Manifestations and Dynamics of Liver Enzymes in Children and Adolescents with COVID-19 Infection: A Systematic Review and Meta-Analysis

Objectives: To improve the knowledge on Coronavirus Disease (COVID-19) infection, we aimed to study the prevalence of gastrointestinal symptoms and the dynamics of liver enzymes in children infected with COVID-19. Methods: We performed a systematic search of all the articles published up to May 2020 in the following databases: PubMed-MEDLINE, Scopus, and Cochrane. We chose the fixed- or random-effect model for analysis based on the I2 statistic. The included data were analyzed to identify the prevalence of gastrointestinal symptoms (diarrhea, vomiting or nausea) and to identify the dynamics of liver enzymes in children and adolescents diagnosed with COVID-19. Results: We detected an overall prevalence of all gastrointestinal symptoms of 26% (95% CI: 0.18 - 0.35). The pooled prevalence of diarrhea and nausea/vomiting was 12% (95% CI: 0.08 - 0.16) with no heterogeneity (P = 0.19; I2 = 23.53%) and 11% (95% CI: 0.05 - 0.17), respectively. The pooled prevalence of elevated ALT and AST and LDH was 12% (95% CI: 0.07 - 0.17), 14% (95% CI: 0.10 - 0.18) and 33% (95% CI: 0.12 - 0.54), respectively among the included studies. Conclusions: According to our systematic review and meta-analysis, 26% of the children and adolescents diagnosed with COVID-19 present gastrointestinal symptoms. This paper has provided a comprehensive overview of the prevalence of digestive symptoms of COVID-19 and of the liver enzymes dynamics in children and adolescents.

Gastroesophageal reflux disease in pediatric esophageal atresia: Assessment of clinical symptoms and pH-impedance data.

BACKGROUNDEsophageal atresia (EA) is the most common congenital anomaly of the gastrointestinal tract. Gastroesophageal reflux disease (GERD) is a frequent and lifelong problem in these patients. GERD can be asymptomatic and the incidence of esophageal gastric and intestinal metaplasia (Barrett’s esophagus) is increased in adults with EA compared with the general population. Timely and accurate diagnosis of GERD is important to reduce long-term problems and this may be achieved by pH-impedance testing.AIMTo assess symptoms and pH-impedance data in children after EA, in order to identify their specific features of GERD.METHODSThis study was conducted from November 2017 to February 2020 and involved 37 children who had undergone EA via open surgical repair (51.35% boys, 48.65% girls; age range: 1-14 years, median: 4.99 years). GERD diagnosis was made based on multichannel intraluminal impedance/pH study and two groups were established: EA without GERD, n = 17; EA with GERD, n = 20. A control group was established with 66 children with proven GERD (68.18% boys, 31.82% girls; median age: 7.21 years), composed of a nonerosive reflux disease (referred to as NERD) group (n = 41) and a reflux esophagitis group (n = 25). Upper gastrointestinal endoscopy with a mucosal esophageal biopsy was performed on all patients.RESULTSThe most frequently observed symptom in EA patients with GERD and without GERD was cough (70% and 76.5% respectively). The number of patients with positive symptom association probability in the EA groups was significantly larger in the EA without GERD group (P = 0.03). In the control reflux esophagitis group, prevalence of gastrointestinal symptoms was significantly higher than in the NERD group (P = 0.017). For both EA groups, there was strong correlation with index of proximal events (IPE) and total proximal events (EA with GERD: 0.96, P < 0.001; EA without GERD: 0.97, P < 0.001) but level of IPE was significantly lower than in GERD patients without any surgical treatment (P < 0.001). Data on distal mean nocturnal baseline impedance were significantly different between the EA with GERD group (P < 0.001) and the two control groups but not between EA without GERD and the two control groups.CONCLUSIONMean nocturnal baseline impedance may have diagnostic value for GERD in EA children after open surgical repair. IPE might be an additional parameter of pH-impedance monitoring.

The prevalence of gastrointestinal symptoms among patients with COVID-19 and the effect on the severity of the disease.

Background and AimCOVID‐19 is a new pandemic disease recognized by the World Health Organization. It mainly affects the respiratory system, but it can also affect other systems. The gastrointestinal system has been found to be affected in many patients. This study investigated the COVID‐19‐related gastrointestinal manifestations and the effect of gastrointestinal involvement on the course and outcome of the disease.MethodsThis was a retrospective descriptive study conducted on 140 COVID‐19 polymerase chain reaction‐positive symptomatic individuals admitted to Al‐Shafa Hospital – Medical City Complex in Baghdad, Iraq during the period 2 March 2020 to 12 May 2020. Demographic data and clinical presentation and laboratory data were extracted from the case sheets of the patients and were also obtained from direct communication with the patients, their families, and medical staff.ResultsGastrointestinal (GI) symptoms alone were detected in 23.6% of the patients; 44.3% of the patients presented with only respiratory symptoms, and 32.1% presented with both respiratory and GI symptoms. Patients with only GI symptoms had less severe disease compared with those who had both GI and respiratory symptoms, who had more severe disease with higher mortality. Overall mortality was 8.6%, with no mortality in the GI symptoms alone group. The highest severity and mortality were in patients with both GI and respiratory symptoms (48.39 and 13.33%, respectively).ConclusionsCOVID‐19‐related gastrointestinal symptoms are common, and their presence alone carries a better prognosis, but their presence with respiratory symptoms is associated with higher morbidity and mortality.