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The Digestive System in the Era of COVID-19

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A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Gastroenterology & Hepatology".

Deadline for manuscript submissions: closed (20 September 2023) | Viewed by 21023

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Prof. Dr. Daniel Paramythiotis

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First Propaedeutic Surgical Department, University Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece
Interests: pancreas; surgery
Special Issues, Collections and Topics in MDPI journals

Dr. Eleni Karlafti

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Emergency Department, University Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece
Interests: emergency medicine; internal medicine; diabetes; hypertension
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

In the last few years, the scientific world was forced to find ways to manage the SARS-CoV-2 pandemic and its multiple effects. Even though COVID-19 disease was first considered to be a respiratory disease, it was found to have an extended clinical spectrum, with symptoms in many tissues, and it is now identified as a systematic disease.

It is common for SARS-CoV-2 to also infect the digestive system. This type of infection in patients with COVID-19 has a wide symptom range, from asymptomatic expression to some gastrointestinal symptoms that occur with or before respiratory symptoms. Although respiratory infections are known to cause intestinal immune impairment and gastrointestinal symptoms, our knowledge around SARS-CoV-2 and its effect on the digestive system is limited.

The aim of this Special Issue is to evaluate and discuss the effect of SARS-CoV-2 infection on the digestive system, including its mechanisms, clinical manifestations, diagnosis, outcome, and management. The scope of the articles includes but is not limited to the following topics: clinical, laboratory, imaging and prevention, and treatment of COVID-19 digestive disease in different age groups, chronic digestive disease, high-risk groups, and predictors of digestive disease severity.

We invite colleagues around the world to report their experience and knowledge with original studies, case series or case reports, reviews, or mini reviews on "The Digestive System in the Era of COVID-19” to give support to this fundamental area of clinical practice.

Prof. Dr. Daniel Paramythiotis
Dr. Eleni Karlafti
Guest Editors

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

COVID-19
digestive system infection
microbiota
gastrointestinal involvement
diagnosis
management
disease severity
mechanisms
clinical manifestation
outcome

Published Papers (10 papers)

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Research

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9 pages, 667 KiB

Open AccessArticle

Clostridium difficile Infections in an Emergency Surgical Unit from North-East Romania

by Bogdan Mihnea Ciuntu, Gheorghe G. Balan, Mihaela Buna-Arvinte, Irina Mihaela Abdulan, Adelina Papancea, Ștefan Lucian Toma, Bogdan Veliceasa, Oana Viola Bădulescu, Gabriela Ghiga, Ana Maria Fătu, Mihai Bogdan Vascu, Antonia Moldovanu, Dan Vintilă and Alin Mihai Vasilescu

Medicina 2023, 59(5), 830; https://doi.org/10.3390/medicina59050830 - 24 Apr 2023

Viewed by 1371

Abstract

Background and Objectives: Colitis with Clostridium difficile is an important health problem that occurs with an intensity that varies between mild and severe. Surgical interventions are required only in fulminant forms. There is little evidence regarding the best surgical intervention in these cases. Materials and Methods: Patients with C. difficile infection were identified from the two surgery clinics from the ‘Saint Spiridon’ Emergency Hospital Iași, Romania. Data regarding the presentation, indication for surgery, antibiotic therapy, type of toxins, and post-operative outcomes were collected over a 3-year period. Results: From a total of 12,432 patients admitted for emergency or elective surgery, 140 (1.12%) were diagnosed with C. difficile infection. The mortality rate was 14% (20 cases). Non-survivors had higher rates of lower-limb amputations, bowel resections, hepatectomy, and splenectomy. Additional surgery was necessary in 2.8% of cases because of the complications of C. difficile colitis. In three cases, terminal colostomy was performed and as well as one case with subtotal colectomy with ileostomy. All patients who required the second surgery died within the 30-day mortality period. Conclusions: In our prospective study, the incidence was increased both in cases of patients with interventions on the colon and in those requiring limb amputations. Surgical interventions are rarely required in patients with C. difficile colitis. Full article

(This article belongs to the Special Issue The Digestive System in the Era of COVID-19)

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9 pages, 293 KiB

Open AccessArticle

Could an Increased Percentage of Immature Granulocytes Accompanying Dyspepsia Predict COVID-19?

by Kadir Gisi, Sukru Gungor, Murat Ispiroglu and Bulent Kantarceken

Medicina 2022, 58(10), 1460; https://doi.org/10.3390/medicina58101460 - 15 Oct 2022

Cited by 1 | Viewed by 2854

Abstract

Background and Aim: Although vaccination practices continue at a fast pace around the world, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) still threatens people’s lives. In this study, we aimed to determine the presence of SARS-CoV-2 in patients who do not have the typical symptoms of the novel coronavirus disease 2019 (COVID-19), but only present with dyspepsia, and to investigate the role of immature granulocytes in the early diagnosis of these patients. Material and Methods: Adult and pediatric patients suffering from dyspepsia were included in the study. The patients were divided into two groups, ‘‘positive’’ and ‘‘negative’’, based on their SARS-CoV-2 polymerase chain reaction test results. Immature granulocyte count (IG), immature granulocyte percentage (IG%), C-reactive protein (CRP), and neutrophil-to-lymphocyte ratio (NLR) values were recorded. Results: A total of 238 patients, including 25 (10.5%) pediatric and 213 (89.5%) adult patients, were included in the study. A total of 2 (8%) pediatric patients and 17 (7.9%) adult patients tested positive for SARS-CoV-2. The IG, IG%, and CRP parameters were significantly higher in the SARS-CoV-2-positive patients compared to the SARS-CoV-2-negative patients. The optimal cut-off value predictive of COVID-19 infection was determined to be ≥0.650 (sensitivity: 52.6% and specificity: 95.5%, p = 0.001) for IG%. Conclusions: It should be noted that dyspepsia may also be a COVID-19 symptom. IG% values, which can be determined with a hemogram test, a cheap and easily accessible test, may be a warning in the early detection of patients who do not have the typical symptoms of COVID-19. Full article

(This article belongs to the Special Issue The Digestive System in the Era of COVID-19)

Review

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13 pages, 2982 KiB

Open AccessReview

Small Bowel Diverticulosis and COVID-19: Awareness Is the Key: A Case Series and Review of the Literature

by Petros Bangeas, Nikolaos Konstantinidis, Tania Chrisopoulou, Despoina Karatzia, Alexandros Giakoustidis and Vasileios N. Papadopoulos

Medicina 2024, 60(2), 229; https://doi.org/10.3390/medicina60020229 - 29 Jan 2024

Viewed by 1054

Abstract

Small bowel non-Meckelian diverticulosis is a rare condition with only a few published cases despite being described over 200 years ago. In the midst of the COVID-19 pandemic, studies suggested that many patients may experience gastrointestinal manifestations. Intestinal symptoms could worsen the inflammation and infection associated with small bowel diverticulitis. Here we present three cases: one with inflammation and rupture in a COVID-19 patient and another as an asymptomatic detection. The third case involved recurrence after the first laparoscopic lavage approach. Furthermore, we provide a mini-review of the literature to emphasize the importance of considering this entity in the differential diagnosis of an acute abdomen. In the majority of cases involving small bowel diverticula, conservative management is the preferred approach. However, when complications arise, surgical intervention, including enteroctomy and primary anastomosis, may be necessary to achieve optimal outcomes. Full article

(This article belongs to the Special Issue The Digestive System in the Era of COVID-19)

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14 pages, 14453 KiB

Open AccessReview

Gastrointestinal Imaging Findings in the Era of COVID-19: A Pictorial Review

by Xanthippi Mavropoulou, Elisavet Psoma, Angeliki Papachristodoulou, Nikoletta Pyrrou, Ekaterini Spanou, Maria Alexandratou, Maria Sidiropoulou, Anastasia Theocharidou, Vasileios Rafailidis, Theofilos Chrysanthidis and Panos Prassopoulos

Medicina 2023, 59(7), 1332; https://doi.org/10.3390/medicina59071332 - 19 Jul 2023

Cited by 2 | Viewed by 1742

Abstract

The potentially fatal COVID-19 pandemic has been associated with a largespectrum of clinical presentations. Beyond the classical pulmonary manifestations, gastrointestinal tract-related symptoms suchas nausea, diarrhea, abdominal distention and pain have been observed in patients, as a consequence of the binding of SARS-CoV-19 to Angiotensin-converting Enzyme 2 (ACE2) receptors in the gastrointestinal (GI) tract. The early recognition ofspecific imaging features, including hepatobiliary involvement, pancreatic involvement, development of solid organ infarcts, ischemic bowel changes and vascular occlusion, plays a key role through the course of the disease. Also, suspicious symptoms, especially in critically ill patients with clinical and biochemical markers of hypovolemia, necessitate timely imaging for bleeding complications. The aim of this pictorial review is to illustrate the spectrum of the GIimaging findings in patients with COVID-19. Awareness of diagnostic imaging hallmarks is crucial to optimize the management of these patients. Full article

(This article belongs to the Special Issue The Digestive System in the Era of COVID-19)

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15 pages, 400 KiB

Open AccessReview

Risk of New-Onset Liver Injuries Due to COVID-19 in Preexisting Hepatic Conditions—Review of the Literature

by Sandica Bucurica, Florentina Ionita Radu, Ana Bucurica, Calin Socol, Ioana Prodan, Ioana Tudor, Carmen Adella Sirbu, Florentina Cristina Plesa and Mariana Jinga

Medicina 2023, 59(1), 62; https://doi.org/10.3390/medicina59010062 - 28 Dec 2022

Cited by 4 | Viewed by 2699

Abstract

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) impacted the world and caused the 2019 coronavirus disease (COVID-19) pandemic. The clinical manifestations of the virus can vary from patient to patient, depending on their respective immune system and comorbidities. SARS-CoV-2 can affect patients through two mechanisms: directly by targeting specific receptors or by systemic mechanisms. We reviewed data in the latest literature in order to discuss and determine the risk of new-onset liver injuries due to COVID-19 in preexisting hepatic conditions. The particular expression of angiotensin-converting enzyme 2 (ACE2) receptors is an additional risk factor for patients with liver disease. COVID-19 causes more severe forms in patients with non-alcoholic fatty liver disease (NAFLD), increases the risk of cirrhosis decompensation, and doubles the mortality for these patients. The coinfection SARS-CoV-2—viral hepatitis B or C might have different outcomes depending on the stage of the liver disease. Furthermore, the immunosuppressant treatment administered for COVID-19 might reactivate the hepatic virus. The high affinity of SARS-CoV-2 spike proteins for cholangiocytes results in a particular type of secondary sclerosing cholangitis. The impact of COVID-19 infection on chronic liver disease patients is significant, especially in cirrhosis, influencing the prognosis and outcome of these patients. Full article

(This article belongs to the Special Issue The Digestive System in the Era of COVID-19)

14 pages, 1072 KiB

Open AccessReview

Drug-Induced Liver Injury in Hospitalized Patients during SARS-CoV-2 Infection

by Eleni Karlafti, Daniel Paramythiotis, Konstantina Pantazi, Vasiliki Epameinondas Georgakopoulou, Georgia Kaiafa, Petros Papalexis, Adonis A. Protopapas, Eleftheria Ztriva, Varvara Fyntanidou and Christos Savopoulos

Medicina 2022, 58(12), 1848; https://doi.org/10.3390/medicina58121848 - 15 Dec 2022

Cited by 6 | Viewed by 2360

Abstract

In the last few years, the world has had to face the SARS-CoV-2 infection and its multiple effects. Even though COVID-19 was first considered to be a respiratory disease, it has an extended clinical spectrum with symptoms occurring in many tissues, and it is now identified as a systematic disease. Therefore, various drugs are used during the therapy of hospitalized COVID-19 patients. Studies have shown that many of these drugs could have adverse side-effects, including drug-induced liver injury—also known as DILI—which is the focus of our review. Despite the consistent findings, the pathophysiological mechanism behind DILI in COVID-19 disease is still complex, and there are a few risk factors related to it. However, when it comes to the diagnosis, there are specific algorithms (including the RUCAM algorithm) and biomarkers that can assist in identifying DILI and which we will analyze in our review. As indicated by the title, a variety of drugs are associated with this COVID-19-related complication, including systemic corticosteroids, drugs used for the therapy of uncontrolled cytokine storm, as well as antiviral, anti-inflammatory, and anticoagulant drugs. Bearing in mind that hepatotoxicity is very likely to occur during COVID-19, especially in patients treated with multiple medications, we will also refer to the use of other drugs used for DILI therapy in an effort to control and prevent a severe and long-term outcome. Full article

(This article belongs to the Special Issue The Digestive System in the Era of COVID-19)

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Other

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15 pages, 4216 KiB

Open AccessSystematic Review

Anastomotic Leak and Perioperative Outcomes of Esophagectomy for Esophageal Cancer during the COVID-19 Pandemic: A Systematic Review and Meta-Analysis

by Georgios Geropoulos, Stavros Moschonas, Georgios Fanariotis, Aggeliki Koltsida, Nikolaos Madouros, Evgenia Koumadoraki, Kontantinos Katsikas Triantafyllidis, Konstantinos S. Kechagias, Georgios Koimtzis, Dimitrios Giannis, Athanasios Notopoulos, Efstathios T. Pavlidis and Kyriakos Psarras

Medicina 2024, 60(1), 31; https://doi.org/10.3390/medicina60010031 - 24 Dec 2023

Viewed by 1261

Abstract

Background and Objectives: The coronavirus disease-2019 (COVID-19) pandemic influenced the healthcare system tremendously, as well as the number of elective surgical procedures worldwide. The aim of this study is to investigate the COVID-19 pandemic’s impact on esophagectomies. Materials and Methods: The MEDLINE (via PubMed), Cochrane Library, and Google Scholar bibliographical databases were systematically searched. Original clinical studies investigating the outcomes of esophageal cancer surgery during the COVID-19 pandemic were deemed eligible. After exclusion criteria were applied, eight studies were considered eligible for inclusion. Results: Eight studies with non-overlapping populations, reporting on patients undergoing esophagectomy for resectable esophageal cancer during the COVID-19 pandemic, were included in our analysis, with a total of 18548 patients. Background characteristics for age, lung disease, smoking history as well as Body Mass Index and age were equal among the groups. The background of diabetes presented a statistically significant difference among the groups. Perioperative outcomes like reoperation rates, the length of intensive care unit stay, or readmission rates were not significantly increased during the pandemic. The 30-day readmission, and 30- and 90-day mortality were not affected either. The length of hospital stay was significantly lower in the non-pandemic period. Conclusions: The results of our study support the evidence that in the context of the COVID-19 pandemic, esophageal cancer operations took place safely and effectively, similarly to the standards of the non-COVID-19 era. Full article

(This article belongs to the Special Issue The Digestive System in the Era of COVID-19)

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24 pages, 3763 KiB

Open AccessSystematic Review

The Prevalence of Gastrointestinal Bleeding in COVID-19 Patients: A Systematic Review and Meta-Analysis

by Eleni Karlafti, Dimitrios Tsavdaris, Evangelia Kotzakioulafi, Adonis A. Protopapas, Georgia Kaiafa, Smaro Netta, Christos Savopoulos, Antonios Michalopoulos and Daniel Paramythiotis

Medicina 2023, 59(8), 1500; https://doi.org/10.3390/medicina59081500 - 21 Aug 2023

Viewed by 1910

Abstract

Introduction: Severe acute respiratory syndrome coronavirus 2 caused the coronavirus disease of 2019 (COVID-19), which rapidly became a pandemic, claiming millions of lives. Apart from the main manifestations of this infection concerning the respiratory tract, such as pneumonia, there are also many manifestations from the gastrointestinal tract. Of these, bleeding from the gastrointestinal tract is a significant complication quite dangerous for life. This bleeding is divided into upper and lower, and the primary pathophysiological mechanism is the entering of the virus into the host cells through the Angiotensin-converting enzyme 2 receptors. Also, other comorbidities and the medication of corticosteroids and anticoagulants are considered to favor the occurrence of gastrointestinal bleeding (GIB). Methods: This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the studies were searched in two different databases (Scopus and PubMed) from November 2019 until February 2023. All studies that reported GIB events among COVID-19 patients were included. Results: 33 studies were selected and reviewed to estimate the prevalence of GIB. A total of 134,905 patients with COVID-19 were included in these studies, and there were 1458 episodes of GIB. The prevalence of GIB, in these 33 studies, ranges from 0.47% to 19%. This range of prevalence is justified by the characteristics of the COVID-19 patients. These characteristics are the severity of COVID-19, anticoagulant and other drug treatments, the selection of only patients with gastrointestinal manifestations, etc. The pooled prevalence of gastrointestinal bleeding was estimated to be 3.05%, rising to 6.2% when only anticoagulant patients were included. Conclusions: GIB in COVID-19 patients is not a rare finding, and its appropriate and immediate treatment is necessary as it can be life-threatening. The most common clinical findings are melena and hematemesis, which characterize upper GIB. Treatment can be conservative; however, endoscopic management of bleeding with embolization is deemed necessary in some cases. Full article

(This article belongs to the Special Issue The Digestive System in the Era of COVID-19)

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8 pages, 424 KiB

Open AccessBrief Report

Antibody Kinetics after Three Doses of SARS-CoV-2 mRNA Vaccination in Patients with Inflammatory Bowel Disease

by Evangelos Tsipotis, Ankith Maremanda, Laura Bowles Zeiser, Caoilfhionn Connolly, Sowmya Sharma, Sharon Dudley-Brown, Sarah Frey, Mark Lazarev, Joanna M. Melia, Alyssa M. Parian, Dorry L. Segev, Brindusa Truta, Huimin Yu, William A. Werbel and Florin M. Selaru

Medicina 2023, 59(8), 1487; https://doi.org/10.3390/medicina59081487 - 18 Aug 2023

Viewed by 1217

Abstract

Background: The emergence of new SARS-CoV-2 variants calls for more data on SARS-CoV-2 mRNA vaccine response. Aims: We aimed to assess the response to a third mRNA vaccine dose against SARS-CoV-2 in inflammatory bowel disease (IBD) patients. Methods: This was a single-center, observational prospective study of IBD patients who received a third mRNA vaccine dose against SARS-CoV-2. Antibody titers were taken post-third-dose at one and three months using the Roche Elecsys anti-SARS-CoV-2-S enzyme immunoassay. Titers less than 0.8 units/mL were considered negative according to the manufactures. Titers between 0.8 units/mL and 250 units/mL were considered non-neutralizing. Titers greater than 250 units/mL were considered neutralizing. Results: Eighty-three patients were included, all of whom had detectable antibodies at 3 months post-third dose. A total of 89% showed neutralizing and 11% non-neutralizing titers. Participants with non-neutralizing titers were more likely to be on systemic corticosteroids (p = 0.04). Two participants seroconverted from negative to positive, whereas 86% with non-neutralizing titers boosted to neutralizing levels. Only one participant with neutralizing titers after a third dose had a decrease to a non-neutralizing level within 3 months. Conclusions: Our findings support the ongoing recommendations for additional doses in immunocompromised individuals. However, longitudinal studies with a greater-sized patient population are needed. Full article

(This article belongs to the Special Issue The Digestive System in the Era of COVID-19)

6 pages, 3116 KiB

Open AccessCase Report

Colitis as the Main Presentation of COVID-19: A Case Report

by Vlasta Oršić Frič, Vladimir Borzan, Andrej Borzan, Izabela Kiš, Branko Dmitrović and Ivana Roksandić-Križan

Medicina 2023, 59(3), 576; https://doi.org/10.3390/medicina59030576 - 15 Mar 2023

Viewed by 2167

Abstract

The main symptoms of coronavirus disease (COVID-19) are fever, cough, tiredness, and loss of smell and taste. Gastrointestinal symptoms are less common. A 38-year-old female patient, previously healthy, presented with a history of hematochezia up to 8 times per day, followed by abdominal cramps, urgency, and chills for two days. She did not have any respiratory symptoms and was previously vaccinated for COVID-19. She was afebrile, with normal vital signs. Blood samples showed normal complete blood count and increased C-reactive protein (CRP), fibrinogen, and D-dimer levels (66 mg/L, 4.1 g/L, and 2302 μ/L FEU, respectively). Stool samples for stool culture, C. difficile, and viral examination came back negative. On day 3, she reported a mild cough, fever and loss of smell and taste. Nasopharyngeal swab for SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) PCR test came back positive. On day 6, the patient still had hematochezia accompanied by abdominal cramps, but fever and respiratory symptoms withdrew. CRP, fibrinogen, and D-dimers were still elevated, as well as liver enzyme levels. Sigmoidoscopy was performed with biopsies taken from sigmoid and rectum for histology and PCR SARS-CoV-2 testing. CT angiography showed no signs of thrombosis in mesenteric veins or arteries. PCR test for SARS-CoV-2 virus from rectal biopsy sample was positive. Patient was treated with methylprednisolone iv for two days and peroral prednisone afterwards, with mesalamine, metronidazole and enoxaparin. Sigmoidoscopy was repeated after two weeks showing only mild hyperemia. At that time, the patient had normal stool, normal CRP, liver enzyme, fibrinogen, and D-dimer levels, and normocytic anemia (hemoglobin level of 103 g/L). We wanted to show that severe gastrointestinal symptoms, such as hemorrhagic colitis, can be the main presentation of COVID-19, even in young patients with no prior comorbidities. In such a case, PCR test in biopsy samples can be performed to prove SARS-CoV-2 infection of bowel mucosa. Full article

(This article belongs to the Special Issue The Digestive System in the Era of COVID-19)

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