Post-COVID-19 cholangiopathy:A systematic review

BACKGROUND The recent and still ongoing pandemic caused by the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)entailed various long-term complications,including post-infectious cholangiopathy.AIM To identify the available studies concerning post-coronavirus disease 2019(COVID-19)cholangiopathy.METHODS An extensive bibliographical search was carried out in PubMed and in Cochrane Library to identify the articles(retrospective and prospective studies,cohort studies,case series and case reports)published between January 1,2020 and August 22,2022,using both MeSH terms and free-language keywords:cholangiopathy;COVID-19;post-COVID-19 cholangiopathy;SARS-CoV-2.RESULTS Thirteen studies fulfilled the inclusion criteria,which included 64 patients suffering from this condition.The patients were male in 82.8%of cases.Liver transplant was executed in 6 patients and scheduled in 7 patients,while 2 patients refused the surgical approach.Therefore in 23.4%of the cases,performing this procedure appeared to be necessary.CONCLUSION This review has revealed that generally the involvement of the liver in the course of SARS-CoV-2 infection is mild and transient,inducing cholestasis of cholangiocytes but can also be severe enough to cause organ failure in some cases.

Hypertransaminasemia in the course of infection with SARS-CoV-2:Incidence and pathogenetic hypothesis

In patients infected with severe acute respiratory syndrome coronavirus 2,the respiratory symptoms,such as fever,cough and dyspnea,are the most frequent clinical manifestations.These patients may also present with less well-defined symptoms like diarrhea,nausea,vomiting and/or abdominal discomfort both at the time of diagnosis and during the clinical course.In a few cases,these symptoms may also present before the appearance of respiratory symptoms.To penetrate the body,Severe acute respiratory syndrome coronavirus 2 uses ACE2 receptors,which are present not only in respiratory epithelium but also in gastrointestinal mucosa and liver cholangiocytes.In several cases,viral RNA is detectable in the stool of patients with coronavirus disease 2019(COVID-19).The liver damage seems to show a multifactorial origin.About 2%-11%of patients with COVID-19 have known underlying hepatic pathologies.In 14%-53%of COVID-19 cases,there is an alteration of the indices of liver cytolysis and is more frequently observed in severe forms of COVID-19,especially during hospitalization.

Paradoxical relationship between proton pump inhibitors and COVID-19: A systematic review and meta-analysis

BACKGROUND The proton pump inhibitors(PPIs),used to reduce gastric acid secretion,represent one of the most widely used pharmaceutical classes in the world.Their consumption as a risk factor for the evolution of severe forms of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection has been investigated as well as the mortality of these patients.These risks also appear to be linked to the duration and the dosage.On the other hand,several studies have emerged with regard to the protective or therapeutic effects of these drugs.More and more evidence underlines the immunomodulatory and anti-fibrotic role of PPIs.In addition,their ability to alkalize the contents of endosomes and lysosomes serves as an obstacle to the entry of the virus into the host cells.AIM To identify studies on the relationship between the intake of PPIs and coronavirus disease 2019(COVID-19)in patients affected by SARS-CoV-2 infection,with the main objective of evaluating the outcomes related to severity and mortality.METHODS A literature review was performed in November 2020.The MEDLINE/PubMed,Cochrane Library,EMBASE and Google Scholar databases were searched for all relevant articles published in English on this topic.The search terms were identified by means of controlled vocabularies,such as the National Library of Medicine’s MESH(Medical Subject Headings)and keywords.The MESH terms and keywords used were as follows:“COVID-19”,“proton pump inhibitors”,“PPIs”,“SARS-CoV-2”,“outcomes”,“severity”and“mortality”.The inclusion criteria regarding the studies considered in our analysis were:meta-analysis,casecontrol,hospital-based case-control,population-based case-control,retrospective studies,online survey,as well as cohort-studies,while articles not published as full reports,such as conference abstracts,case reports and editorials were excluded.We tried to summarize and pool all the data if available.RESULTS A total of 9 studies were found that described the use of PPIs,of which only 5 clearly reported the severity and mortality data in SARS-CoV-2 patients.Our pooled incidence analysis of severe events did not differ between patients with and without PPIs(odds ratio 1.65,95%confidence interval:0.62-4.35)(P=0.314),or for mortality(odds ratio 1.77,95%confidence interval:0.62-5.03)(P=0.286).CONCLUSION Detailed and larger case studies are needed to accurately understand the role of PPIs in this viral infection.

New device to implement the adenoma detection rate

It is well-known that colonoscopy is considered the gold standard for colon cancer prevention.Although performed by experienced endoscopists,the matter remains of polyps missed during this examination.The reasons may include the size,shape and location of the lesions.Many colorectal cancer screening programs have been proposed to increase the adenoma detection rate.The substantial difference between these methods is whether the improvement in vision,particularly the detection of irregularities of the mucosa,is inside the endoscope electronic components(magnification,wideangle vision,narrow band imaging,flexible spectral imaging colour enhancement,i-Scan) or outside the same,by the use of specific caps(EndoC uff,EndoV ision,Endo Rings).Endocuff is a plastic device mounted at the end of the scope with a constant vision field of the entire colon.The aim of this study is to explore the potential clinical and technical benefits of Endocuff.

Evaluation of the risk factors for severe complications and surgery of intestinal foreign bodies in adults:a single-center experience with 180 cases

Background Foreign bodies(FBs)lodged in the intestine or causing intestinal complications are uncommon in clinical practice but may pose diagnostic difficulties and prove life-threatening.This study aimed to evaluate the risk factors for severe complications and surgery to aid clinicians in the diagnosis and management of intestinal FBs.Methods We performed a retrospective analysis of patients in whom FBs were lodged in the intestine or caused complications from 2010 to 2020 in the First Affiliated Hospital of Wenzhou Medical University(Zhejiang,China).The characteristics of the patients and FBs,symptoms,imaging findings,diagnostics,treatment strategies,and clinical outcomes were analysed.Furthermore,the risk factors for complications and surgery were investigated.Results In total,180 patients were included in our study.Most patients(76.1%)were unable to provide a history of ingestion.Bezoars were the most common FBs(35.6%).The FBs were mainly located in the duodenum(32.8%)and the ileum(27.8%).Surgical removal of FBs was successful in 89(49.4%)patients and endoscopic removal in 54(30.0%)patients.Eleven with perforations were treated conservatively.FBs located in the jejunum or ileum were more likely to cause severe complications than those located in the duodenum.FBs located in the jejunum,ileum,or sigmoid colon were more likely to undergo surgery,and severe complications were an independent risk factor for surgery.Conclusion Intestinal FBs,often localized in angulation,are likely to be misdiagnosed because most patients do not provide a history of FB ingestion.Surgery and endoscopic therapy are the most commonly used treatment modalities.Surgery is not mandatory in clinically stable patients with small and contained perforations.FBs located in the jejunum or ileum are risk factors for both complications and surgery.