Gastrointestinal mucosal damage in patients with COVID-19 undergoing endoscopy: an international multicentre study

BMJ Open Gastroenterol. 2021 Feb;8(1):e000578. doi: 10.1136/bmjgast-2020-000578.

Abstract

Background: Although evidence suggests frequent gastrointestinal (GI) involvement during coronavirus disease 2019 (COVID-19), endoscopic findings are scarcely reported.

Aims: We aimed at registering endoscopic abnormalities and potentially associated risk factors among patients with COVID-19.

Methods: All 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.

Results: Between 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.

Conclusion: In 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 number: ClinicalTrial.gov (ID: NCT04318366).

Keywords: covid-19; endoscopy; gastrointestinal tract; mucosal infection.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • COVID-19 / complications
  • COVID-19 / pathology*
  • Colitis, Ischemic / etiology
  • Colitis, Ischemic / pathology
  • Cross-Sectional Studies
  • Duodenum / pathology
  • Endoscopy, Gastrointestinal*
  • Female
  • Gastric Mucosa / pathology*
  • Gastrointestinal Hemorrhage / etiology
  • Gastrointestinal Hemorrhage / pathology
  • Humans
  • Male
  • Middle Aged
  • Pandemics
  • Prospective Studies
  • Risk Factors
  • SARS-CoV-2
  • Stomach Ulcer / etiology
  • Stomach Ulcer / pathology

Associated data

  • ClinicalTrials.gov/NCT04318366