Volume 83 - 2020 - Fasc.4 - Case series
Prevalence of gastrointestinal symptoms in coronavirus disease 2019: a meta-analysis
Background and study aims : The coronavirus disease 2019 (COVID-19) is a pandemic infection spreading worldwide at an unprecedented rate. Our aim was to assess the frequency of gastrointestinal (GI) involvement in COVID-19.
Patients and methods : We performed a systematic review and meta-analysis of all studies reporting clinical data about COVID-19 patients, published until 25th March 2020. The primary endpoint was the pooled prevalence of COVID-19 patients complaining of GI symptoms. Secondary endpoints were the pooled prevalence of cases with COVID-19 positive stool samples, and of asymptomatic COVID-19 patients. We used random-effects model for meta- analysis.
Results: Thirty-three studies were included in the meta- analysis. Out of 4434 COVID-19 patients, the pooled prevalence of GI manifestations was 11.51% (95% CI : 8.16 to 15.35). The most frequent GI symptom was diarrhea (7.78% of cases ; 95% CI : 5.05 to 11.04), followed by nausea/vomiting (3.57% ; 95% CI : 1.87 to 5.80), poor appetite (2.39% ; 95%CI : 0.55 ; 5.46) and abdominal pain (0.78% ; 95% CI : 0.26 to 1.57). Positivity for COVID-19 in stool samples was observed in 41.50% (95% CI : 17.70 to 67.65) of cases. 11.85% (95% CI : 3.53 to 24.17) of COVID-19 patients remained asymptomatic.
Conclusions : The present meta-analysis shows that a significant proportion of COVID-19 patients suffer from GI manifestations, as well as COVID-19 positivity in stool samples. Asymptomatic patients need to be considered a further potential route of viral transmission. (Acta gastroenterol. belg., 2020, 83, 603-615).
Targeting the gut microbiota to treat alcoholic liver diseases: evidence and promises
The human intestine is colonized by a variety of microbes that influence the metabolic responses, the immune system and the nervous system. Dietary patterns are important factors that shape the composition of the gut microbiota. Many animal models of alcohol exposure have highlighted the key role of the alcohol- induced gut microbiota alterations, leaky gut and translocation of microbial products in the development of alcoholic liver disease (ALD). However, in humans, there is no clear picture defining an “alcoholic microbiome”, and the link between intestinal dysbiosis and ALD development is far from being understood. Although we do not comprehend all the mechanistic insights, clinical studies aiming at modulating the gut microbiota of alcoholic patients have shown some beneficial effects. Here we review the potential therapeutic effects of probiotics in ALD and give some clinical perspectives on the role of prebiotics and the use of fecal microbiota transplantation. (Acta gastroenterol. belg., 2020, 83, 616-621).
Proteins involved in lipid metabolism as possible biomarkers or predisposing factors for non-alcoholic fatty liver disease
Non-alcoholic fatty liver disease (NAFLD) is caused by the accumulation of lipids inside hepatocytes ; it can be simple or it can be inflammatory. Its prevalence has been increasing in recent years and is predicted to become the most common indication for liver transplantation by 2030. NAFLD is a multifactorial disease, although patients with metabolic disorders are at higher risk of developing it, and in more severe forms. Liver fat originates from the increase of free fatty acids (FFA), from de novo lipogenesis and from diet. This review compile evidence of the involvement of unregulated enzymes in the synthesis of fatty acids (FA), the alteration of FA transport proteins, and the presence of diverse polymorphisms, which may be associated with an increased risk of NAFLD. (Acta gastroenterol. belg., 2020, 83, 622-630).
Challenges in measuring renal function in liver cirrhosis : are there implications in clinical practice?
Renal dysfunction is frequent in liver cirrhosis, and it is associated with poor prognosis. Currently, there are major limitations when assessing renal function in cirrhotic patients. Available methods are biased and have a tendency to overestimate glomerular filtration rates (GFR) consistently. A subset of new creatinine-based formulas derived specifically from these populations may provide a more accurate estimation of renal function. In this article, we will explore the estimation methods of GFR in cirrhosis available to date and discuss possible implications in clinical practice. (Acta gastroenterol. belg., 2020, 83, 633-638).
Bifurcation of the main pancreatic duct in the body of the pancreas. Two case reports and literature study of a rare anatomical variant of the pancreatic duct
Introduction : Bifurcation of the pancreatic duct is a very rare anomaly and clinical significance is not known. Literature on this topic is scarce. We present two similar case reports with bifurcation of the main pancreatic duct from the body to the tail of the pancreas. Both cases were symptomatic, one had acute pancreatitis and the other recurrent pancreatitis. In both cases the most ventral duct was aberrant as a consequence of pancreatitis.
Discussion : We performed a literature study and found 22 relevant articles containing 26 case reports, of these cases, 12 were considered asymptomatic and were found incidentally, the other 14 cases were symptomatic with signs of acute, chronic or recurrent pancreatitis. To our knowledge this is the first article with a summary of previous published data on the subject.
Conclusion: Bifurcation of the pancreatic duct seems to be a possible cause of pancreatitis, but a large group remains asymptomatic. Since diagnosis is often difficult, the incidence is probably underestimated. More attention to this anomaly is recommended. Further reports are needed to draw conclusion. (Acta gastroenterol. belg., 2020, 83, 639-642).