Guideline Released for Managing Digestive Disorders in COVID-19

The Chinese Gastroenterology Expert Group and the Chinese Society of Gastroenterology published new management consensus for digestive disorders in patients with the coronavirus disease 2019 (COVID-19).

In the article published in the American Journal of Gastroenterology, the experts provide guidelines on managing diarrhea, upper digestive disorders, outpatient treatment, and gastroenterological procedures.

Anorexia is common, especially in patients with critical COVID-19, whereas nausea and vomiting are often mild and transient, the 2 groups wrote. “These symptoms may be caused by a gastrointestinal response to the SARS-CoV-2 infection or to antiviral medication,” they wrote.

Recommended treatments for these disorders include: fever control, management of drug adverse effects, liver support, and psychotherapy. Metoclopramide, domperidone, or 5-hydroxytryptamine receptor antagonists can be used for nausea and vomiting, they wrote.

There are also many risk factors that can cause stress-induced gastric mucosal damage in patients with severe COVID-19, including: disease severity, hypoxia, acute respiratory distress syndrome, mechanical ventilation, multiple organ failure, and psychological stress.

Proton pump inhibitors are the preferred options for the prevention of stress gastritis erosion in patients with COVID-19 who possess more than one of the high-risk factors. “In addition, enteral nutrition and mucosal protective agents will benefit the gastrointestinal mucosa,” they wrote.

Although there is no specific therapy for the diarrhea caused by SARS-CoV-2, dioctahedral montmorillonite and probiotics may be beneficial, the authors noted. Some Lactobacillus probiotics were effective in relieving animal coronavirus-associated diarrhea, but their effectiveness on human coronavirus-associated diarrhea is still unknown.

COVID-19–associated diarrhea is generally mild or moderate and persists for only a short time. Antiviral drug-induced diarrhea often resolves spontaneously without treatment. Frequent diarrhea or drug intolerance should be treated by adjusting the dosage of the antiviral agents.

Antibiotic-associated diarrhea or Clostridium difficile infection (CDI) may occur in patients with critical COVID-19. “Thus, clinicians should be vigilant for both conditions. CDI tests should be performed and probiotics should be given to prevent or control the occurrence of CDI in patients with severe COVID-19,” they wrote.

The organizations also recommend suspending certain gastroenterological procedures to prevent or control the transmission of SARS-CoV-2 in epidemic communities. These include: esophageal pH test, gastrointestinal motility, hydrogen breath test, fecal microbiota transplantation, Helicobacter pylori breath test, and stool antigen detection.

“Digestive endoscopy is regarded as a risky procedure because of the potential contact or air transmission. It is recommended to cancel or postpone all elective procedures in communities with an ongoing transmission,” the organizations wrote. “Emergent endoscopy, whenever indicated for acute gastrointestinal massive hemorrhage, removal of foreign bodies in the gastrointestinal tract, infectious cholangitis, and biliary pancreatitis, should be available.”

Reference:

1. Zhang X, Tang C, Tian D, Hou X, Yang Y. Management of Digestive Disorders and Procedures Associated with COVID-19. American Journal of Gastroenterology. August 2020 - Volume 115 - Issue 8 - p 1153-1155, doi: 10.14309/ajg.0000000000000728