High Prevalence of Ischaemic-Like Gastrointestinal Injury in Patients With SARS-CoV-2

October 16, 2020

By Shazia Qureshi

AMSTERDAM, the Netherlands -- October 15, 2020 -- In a study of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection who underwent gastrointestinal (GI) endoscopy, significant acute mucosal injuries in the GI tract were observed in almost half of cases, researchers reported at the 2020 United European Gastroenterology Week (UEGW) Virtual Congress.

“This is in line with increasing evidence suggesting endothelial involvement and a microvascular thrombo-inflammatory syndrome in coronavirus disease 2019 (COVID-19),” wrote Giuseppe Vanella, MD, IRCCS San Raffaele Scientific Institute, Milan, Italy, and colleagues.

The study included 114 patients (mean age, 69 years; 71.9% male) with COVID-19 who were treated at 1 of 16 hospitals in Italy between February and May 2020. Half of the patients were classified with severe systemic disease, defined as having a score of 3 on the American Society of Anesthesiologists (ASA) physical status classification system. A third of the patients were admitted to the intensive care unit.

All patients had undergone GI endoscopy (87 of the upper GI tract and 27 of lower GI) due to urgent cases of GI bleeding in more than half (55.3%) of the patients. GI symptoms, mainly abdominal pain and/or diarrhoea, were reported by 41.8% of patients.

Using the World Endoscopy Organization’s standard terminology system, the researchers classified the endoscopic findings as chronic, minor, or normal (CMN) in 43% of patients. However, another substantial proportion of patients (45.6%) had their findings classified as acute-major. The endoscopies of the remaining 11.4% of patients showed GI bleeding from pre-existing conditions (classified as acute-on-chronic).

The most common acute-major finding from the lower GI tract was ischaemic-like colopathy, in 9 patients.

For endoscopies of the upper GI tract, gastroduodenal ulcers were the most common acute-major case (26.4%), followed by erosive/ulcerative gastroduodenopathy (14.9%), petechial/haemorrhagic gastropathy (9.2%), and esophagitis (8%). Dieulafoy lesion and erosive/ulcerative jejunopathy were seen in 1 patient each.

Among patients whose upper GI tract showed minor abnormalities, erythematous/oedematous gastroduodenopathy was the most common finding (29.9%).

In a comparison between the acute-major group versus the CMN group, the results showed that GI symptoms were significantly more common among patients with acute-major GI endoscopies than in the CMN group (53.1% vs 30%; P = .03).

In addition, patients with acute-major findings were more likely to show blood tests with a D-dimer level >1850 ng/mL (48.6% vs 22.6%; P = .03) and a platelet count P = .03).

Across all patients examined, hypertension as a comorbidity was present in 52.3% of patients and diabetes in 21.6%.

The researchers then evaluated the risk factors associated with an acute-major result on GI endoscopy. Factors that appeared to increase the risk of acute-major GI endoscopy were having a platelet count 1850 ng/mL (OR = 5.8), and the presence of any GI symptom (OR = 7.5).

The authors said that other studies have shown that the receptor for the SARS-CoV-2 virus shows high levels of expression in the GI tract, which could explain why GI symptoms have frequently been reported during this pandemic, despite it being primarily a respiratory disease.

[Presentation title: High Prevalence of Ischemic-Like Gastrointestinal Injury Among Patients With SARS-CoV-2 Infection: Results From an International Multicentre Endoscopy Registry. Abstract P1474]