Gastrointestinal mucosal damage in patients with COVID-19 undergoing endoscopy: an international multicentre study
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Published:2021-02
Issue:1
Volume:8
Page:e000578
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ISSN:2054-4774
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Container-title:BMJ Open Gastroenterology
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language:en
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Short-container-title:BMJ Open Gastroenterol
Author:
Vanella GiuseppeORCID, Capurso Gabriele, Burti Cesare, Fanti Lorella, Ricciardiello Luigi, Souza Lino Andre, Boskoski Ivo, Bronswijk Michiel, Tyberg Amy, Krishna Kumar Nair Govind, Angeletti Stefano, Mauro Aurelio, Zingone Fabiana, Oppong Kofi W., de la Iglesia-Garcia Daniel, Pouillon Lieven, Papanikolaou Ioannis S., Fracasso Pierluigi, Ciceri Fabio, Rovere-Querini Patrizia, Tomba Carolina, Viale Edi, Eusebi Leonardo Henry, Riccioni Maria Elena, van der Merwe Schalk, Shahid Haroon, Sarkar Avik, Yoo Jin Woo (Gene), Dilaghi Emanuele, Speight R. Alexander, Azzolini Francesco, Buttitta Francesco, Porcari Serena, Petrone Maria Chiara, Iglesias-Garcia Julio, Savarino Edoardo V., Di Sabatino Antonio, Di Giulio Emilio, Farrell James J., Kahaleh Michel, Roelandt Philip, Costamagna Guido, Artifon Everson Luiz de Almeida, Bazzoli Franco, Testoni Per Alberto, Greco Salvatore, Arcidiacono Paolo Giorgio
Abstract
BackgroundAlthough evidence suggests frequent gastrointestinal (GI) involvement during coronavirus disease 2019 (COVID-19), endoscopic findings are scarcely reported.AimsWe aimed at registering endoscopic abnormalities and potentially associated risk factors among patients with COVID-19.MethodsAll consecutive patients with COVID-19 undergoing endoscopy in 16 institutions from high-prevalence regions were enrolled. Mann-Whitney U, χ2 or Fisher’s exact test were used to compare patients with major abnormalities to those with negative procedures, and multivariate logistic regression to identify independent predictors.ResultsBetween February and May 2020, during the first pandemic outbreak with severely restricted endoscopy activity, 114 endoscopies on 106 patients with COVID-19 were performed in 16 institutions (men=70.8%, median age=68 (58–74); 33% admitted in intensive care unit; 44.4% reporting GI symptoms). 66.7% endoscopies were urgent, mainly for overt GI bleeding. 52 (45.6%) patients had major abnormalities, whereas 13 bled from previous conditions. The most prevalent upper GI abnormalities were ulcers (25.3%), erosive/ulcerative gastro-duodenopathy (16.1%) and petechial/haemorrhagic gastropathy (9.2%). Among lower GI endoscopies, 33.3% showed an ischaemic-like colitis.Receiver operating curve analysis identified D-dimers >1850 ng/mL as predicting major abnormalities. Only D-dimers >1850 ng/mL (OR=12.12 (1.69–86.87)) and presence of GI symptoms (OR=6.17 (1.13–33.67)) were independently associated with major abnormalities at multivariate analysis.ConclusionIn this highly selected cohort of hospitalised patients with COVID-19 requiring endoscopy, almost half showed acute mucosal injuries and more than one-third of lower GI endoscopies had features of ischaemic colitis. Among the hospitalisation-related and patient-related variables evaluated in this study, D-dimers above 1850 ng/mL was the most useful at predicting major mucosal abnormalities at endoscopy.Trial registration numberClinicalTrial.gov (ID: NCT04318366).
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