A0191 - Upper Gastrointestinal Manifestations of SARS-CoV-2 Infection in the United States: A Population-Based Study

Sunday, October 23, 2022

5:00 PM – 7:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Khaled Alsabbagh Alchirazi, MD

Cleveland Clinic
Cleveland, OH

Khaled Alsabbagh Alchirazi, MD¹, Prabhat Kumar, MD¹, Abdul Mohammed, MD¹, Thabet Qapaja, MD¹, Madhusudhan Sanaka, MD², Prashanthi Thota, MD³
¹Cleveland Clinic, Cleveland, OH; ²Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH; ³Cleveland Clinic, Cleveland, OH

Introduction: Extrapulmonary manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Infection are frequently reported and correlate with disease severity and mortality. Our study aimed to assess the association between upper gastrointestinal (GI) disorders and upper GI symptoms with COVID-19 infection.

Methods: We queried a large multi-center database (Explorys Inc., Cleveland, OH, USA), an aggregate of electronic health records of 26 different healthcare systems with 360 hospitals. In the last two years, we identified patients with a Systemized Nomenclature of Medicine-Clinical Terms (SNOMED-CT) diagnosis of “COVID-19”. We compared Demographic data and clinical characteristics of patients with and without a diagnosis of COVID-19.

Results: Among the 70,039,864 individuals included in this database, 34,720 individuals were diagnosed with a COVID-19 infection, a prevalence rate of 493 per 100,000 in the US population. COVID-19 infection was more commonly associated with patients of age >65 years (OR 1.18, p < 0.0001) and in African American (OR 2.90, p < 0.0001). There was no statistically significant gender-based differences. COVID-19 patients were more likely to be suffer from upper GI disorders such as gastritis (OR 4.38), gastroesophageal reflux disease (GERD) (OR 6.02), esophagitis (OR 3.84), upper GI bleeding (OR 4.91), and duodenitis (OR 4.95), p < 0.0001 to all. COVID-19 patients were also found to be more likely to have upper GI symptoms such as nausea and vomiting (OR 4.12), abdominal pain (OR 3.70), loss of appetite (OR 3.27), weight loss (OR 2.98), and dysphagia (OR 11.84), p< 0.0001 to all (figure 1).

Discussion: In this large population-based study, we found an increased association of upper GI symptoms and upper GI disorders with a diagnosis of COVID-19 infection. It is unclear if patients with a concomitant upper GI etiology have a prolonged or more severe clinical course or prolonged virus shedding in GI specimens. Further prospective studies are required to evaluate this association.

Figure: Figure 1: A comparison of the prevalence of upper gastrointestinal symptoms and conditions in patients with and without COVID-19 infection.

	COVID-19 patients (n, %)	Non-COVID-19 patients (n, %)	OR	CI	p-value
Demographics
Age: 18-65	23,030 (66%)	47,926,050 (68%)	0.92	0.90 to 0.94	< 0.0001
Age: >65	11,730 (34%)	21,254,620 (30%)	1.18	1.15 to 1.21	< 0.0001
Male	15,620 (45%)	31,412,530 (45%)	1.01	0.99 to 1.04	0.1954
Female	19,060 (55%)	38,452,220 (55%)	1.01	0.99 to 1.03	0.3521
Caucasian	16,680 (48%)	37,840,470 (54%)	0.79	0.78 to 0.81	< 0.0001
African American	8,440 (24%)	7,023,300 (10%)	2.9	2.83 to 2.97	< 0.0001
Upper GI Conditions and Symptoms
Gastritis	800 (2%)	376,990 (0.5%)	4.38	4.08-4.70	< 0.0001
GERD	3,140 (9%)	1,142,660 (1.6%)	6.02	5.81-6.25	< 0.0001
Esophagitis	250 (0.7%)	132,790 (0.2%)	3.84	3.39-.35	< 0.0001
Duodenitis	110 (0.3%)	45,130 (0.01%)	4.95	4.11-5.97	< 0.0001
Upper GI bleed	160 (0.5%)	66,230 (0.1%)	4.91	4.21-.74	< 0.0001
Nausea and vomiting	740 (3%)	370,390 (0.5%)	4.12	3.83-4.43	< 0.0001
Abdominal pain	2,240 (7%)	1,286,290 (1.8%)	3.70	3.55-3.87	< 0.0001
Loss appetite	230 (0.7%)	143,250 (0.2%)	3.27	2.87-3.72	< 0.0001
Weight loss	350 (1%)	239,400 (0.3%)	2.98	2.69-3.31	< 0.0001
Dysphagia	760 (2%)	132,790 (0.2%)	11.84	11.01-12.72	< 0.0001

Table: Table 1: A comparison of the baseline characteristics and upper gastrointestinal conditions and symptoms of patients with and without COVID-19 infection. Univariate analysis used to calculate OR. OR; odd ratio. CI; confidence interval.

Disclosures:

Khaled Alsabbagh Alchirazi indicated no relevant financial relationships.

Prabhat Kumar indicated no relevant financial relationships.

Abdul Mohammed indicated no relevant financial relationships.

Thabet Qapaja indicated no relevant financial relationships.

Madhusudhan Sanaka indicated no relevant financial relationships.

Prashanthi Thota indicated no relevant financial relationships.

Khaled Alsabbagh Alchirazi, MD¹, Prabhat Kumar, MD¹, Abdul Mohammed, MD¹, Thabet Qapaja, MD¹, Madhusudhan Sanaka, MD², Prashanthi Thota, MD³. A0191 - Upper Gastrointestinal Manifestations of SARS-CoV-2 Infection in the United States: A Population-Based Study, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.