[What do surgeons need to know about the digestive disorders and paraclinical abnormalities induced by COVID-19?]
Identifieur interne : 000078 ( Main/Exploration ); précédent : 000077; suivant : 000079[What do surgeons need to know about the digestive disorders and paraclinical abnormalities induced by COVID-19?]
Auteurs : J-M Gornet [France] ; M L Tran Minh [France] ; F. Leleu [France] ; D. Hassid [France]Source :
- Journal de chirurgie viscerale [ 1878-786X ] ; 2020.
Abstract
The symptoms associated with COVID-19 are mainly characterized by a triad composed of fever, dry cough and dyspnea. However, digestive symptoms have also been reportedAt first considered as infrequent, they in fact seem to affect more than half of patients. The symptoms are mainly manifested by anorexia, diarrhea, nausea and/or vomiting and abdominal pain. Even though prognosis is associated with lung injury, digestive symptoms seem significantly more frequent in patients presenting with severe COVID-19 infection. Digestive forms, which may be isolated or which can precede pulmonary symptoms, have indeed been reported, with diarrhea as a leading clinical sign. The main biological abnormalities that can suggest COVID-19 infection at an early stage are lymphopenia, elevated CRP and heightened ASAT transaminases. Thoraco-abdominal scan seems useful as a means of on the one hand ruling out digestive pathology unrelated to coronavirus and on the other hand searching for pulmonary images suggestive of COVID-19 infection. No data exist on the interest of digestive endoscopy in cases of persistent digestive symptoms. Moreover, the endoscopists may themselves be at significant risk of contamination. Fecal-oral transmission of the infection is possible, especially insofar as viral shedding in stools seems frequent and of longer duration than at the ENT level, including in patients with negative throat swab and without digestive symptoms. In some doubtful cases, virologic assessment of stool samples can yield definitive diagnosis. In the event of prolonged viral shedding in stools, a patient's persistent contagiousness is conceivable but not conclusively established. Upcoming serology should enable identification of the patients having been infected by the COVID-19 epidemic, particularly among previously undetected pauci-symptomatic members of a health care staff. Resumption of medico-surgical activity should be guided by dedicated strategy preceding deconfinement.
DOI: 10.1016/j.jchirv.2020.04.013
PubMed: 32341722
PubMed Central: PMC7184013
Affiliations:
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Hassid</name><affiliation wicri:level="3"><nlm:affiliation>Université de Paris, Service de Gastroenterologie, AP-HP Hôpital Saint Louis, 1, avenue Claude Vellefaux, Paris, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Université de Paris, Service de Gastroenterologie, AP-HP Hôpital Saint Louis, 1, avenue Claude Vellefaux, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author></analytic><series><title level="j">Journal de chirurgie viscerale</title><idno type="ISSN">1878-786X</idno><imprint><date when="2020" type="published">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">The symptoms associated with COVID-19 are mainly characterized by a triad composed of fever, dry cough and dyspnea. However, digestive symptoms have also been reportedAt first considered as infrequent, they in fact seem to affect more than half of patients. The symptoms are mainly manifested by anorexia, diarrhea, nausea and/or vomiting and abdominal pain. Even though prognosis is associated with lung injury, digestive symptoms seem significantly more frequent in patients presenting with severe COVID-19 infection. Digestive forms, which may be isolated or which can precede pulmonary symptoms, have indeed been reported, with diarrhea as a leading clinical sign. The main biological abnormalities that can suggest COVID-19 infection at an early stage are lymphopenia, elevated CRP and heightened ASAT transaminases. Thoraco-abdominal scan seems useful as a means of on the one hand ruling out digestive pathology unrelated to coronavirus and on the other hand searching for pulmonary images suggestive of COVID-19 infection. No data exist on the interest of digestive endoscopy in cases of persistent digestive symptoms. Moreover, the endoscopists may themselves be at significant risk of contamination. Fecal-oral transmission of the infection is possible, especially insofar as viral shedding in stools seems frequent and of longer duration than at the ENT level, including in patients with negative throat swab and without digestive symptoms. In some doubtful cases, virologic assessment of stool samples can yield definitive diagnosis. In the event of prolonged viral shedding in stools, a patient's persistent contagiousness is conceivable but not conclusively established. Upcoming serology should enable identification of the patients having been infected by the COVID-19 epidemic, particularly among previously undetected pauci-symptomatic members of a health care staff. Resumption of medico-surgical activity should be guided by dedicated strategy preceding deconfinement.</div></front></TEI><pubmed><MedlineCitation Status="PubMed-not-MEDLINE" Owner="NLM"><PMID Version="1">32341722</PMID><DateRevised><Year>2020</Year><Month>08</Month><Day>25</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Print">1878-786X</ISSN><JournalIssue CitedMedium="Print"><Volume>157</Volume><Issue>3</Issue><PubDate><Year>2020</Year><Month>Jun</Month></PubDate></JournalIssue><Title>Journal de chirurgie viscerale</Title><ISOAbbreviation>J Chir Visc</ISOAbbreviation></Journal><ArticleTitle>[What do surgeons need to know about the digestive disorders and paraclinical abnormalities induced by COVID-19?]</ArticleTitle><Pagination><MedlinePgn>S52-S59</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1016/j.jchirv.2020.04.013</ELocationID><Abstract><AbstractText>The symptoms associated with COVID-19 are mainly characterized by a triad composed of fever, dry cough and dyspnea. However, digestive symptoms have also been reportedAt first considered as infrequent, they in fact seem to affect more than half of patients. The symptoms are mainly manifested by anorexia, diarrhea, nausea and/or vomiting and abdominal pain. Even though prognosis is associated with lung injury, digestive symptoms seem significantly more frequent in patients presenting with severe COVID-19 infection. Digestive forms, which may be isolated or which can precede pulmonary symptoms, have indeed been reported, with diarrhea as a leading clinical sign. The main biological abnormalities that can suggest COVID-19 infection at an early stage are lymphopenia, elevated CRP and heightened ASAT transaminases. Thoraco-abdominal scan seems useful as a means of on the one hand ruling out digestive pathology unrelated to coronavirus and on the other hand searching for pulmonary images suggestive of COVID-19 infection. No data exist on the interest of digestive endoscopy in cases of persistent digestive symptoms. Moreover, the endoscopists may themselves be at significant risk of contamination. Fecal-oral transmission of the infection is possible, especially insofar as viral shedding in stools seems frequent and of longer duration than at the ENT level, including in patients with negative throat swab and without digestive symptoms. In some doubtful cases, virologic assessment of stool samples can yield definitive diagnosis. In the event of prolonged viral shedding in stools, a patient's persistent contagiousness is conceivable but not conclusively established. Upcoming serology should enable identification of the patients having been infected by the COVID-19 epidemic, particularly among previously undetected pauci-symptomatic members of a health care staff. Resumption of medico-surgical activity should be guided by dedicated strategy preceding deconfinement.</AbstractText><CopyrightInformation>© 2020 Elsevier Masson SAS. All rights reserved.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Gornet</LastName><ForeName>J-M</ForeName><Initials>JM</Initials><AffiliationInfo><Affiliation>Université de Paris, Service de Gastroenterologie, AP-HP Hôpital Saint Louis, 1, avenue Claude Vellefaux, Paris, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Tran Minh</LastName><ForeName>M L</ForeName><Initials>ML</Initials><AffiliationInfo><Affiliation>Université de Paris, Service de Gastroenterologie, AP-HP Hôpital Saint Louis, 1, avenue Claude Vellefaux, Paris, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Leleu</LastName><ForeName>F</ForeName><Initials>F</Initials><AffiliationInfo><Affiliation>Université de Paris, Service de Radiologie, AP-HP Hôpital Saint Louis, Paris, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Hassid</LastName><ForeName>D</ForeName><Initials>D</Initials><AffiliationInfo><Affiliation>Université de Paris, Service de Gastroenterologie, AP-HP Hôpital Saint Louis, 1, avenue Claude Vellefaux, Paris, France.</Affiliation></AffiliationInfo></Author></AuthorList><Language>fre</Language><PublicationTypeList><PublicationType UI="D004740">English Abstract</PublicationType><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D016454">Review</PublicationType></PublicationTypeList><VernacularTitle>Que doivent savoir les chirurgiens à propos des troubles digestifs et des anomalies paracliniques induits par le COVID 19 ?</VernacularTitle><ArticleDate DateType="Electronic"><Year>2020</Year><Month>04</Month><Day>27</Day></ArticleDate></Article><MedlineJournalInfo><Country>France</Country><MedlineTA>J Chir Visc</MedlineTA><NlmUniqueID>101530148</NlmUniqueID><ISSNLinking>1878-786X</ISSNLinking></MedlineJournalInfo><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">COVID-19</Keyword><Keyword MajorTopicYN="N">Diarrhea</Keyword><Keyword MajorTopicYN="N">Digestive disorders</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="pubmed"><Year>2020</Year><Month>4</Month><Day>29</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2020</Year><Month>4</Month><Day>29</Day><Hour>6</Hour><Minute>1</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2020</Year><Month>4</Month><Day>29</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">32341722</ArticleId><ArticleId IdType="doi">10.1016/j.jchirv.2020.04.013</ArticleId><ArticleId IdType="pii">S1878-786X(20)30101-7</ArticleId><ArticleId IdType="pmc">PMC7184013</ArticleId></ArticleIdList><pmc-dir>pmcsd</pmc-dir>
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