@article {Vanellae000578, author = {Giuseppe Vanella and Gabriele Capurso and Cesare Burti and Lorella Fanti and Luigi Ricciardiello and Andre Souza Lino and Ivo Boskoski and Michiel Bronswijk and Amy Tyberg and Govind Krishna Kumar Nair and Stefano Angeletti and Aurelio Mauro and Fabiana Zingone and Kofi W. Oppong and Daniel de la Iglesia-Garcia and Lieven Pouillon and Ioannis S. Papanikolaou and Pierluigi Fracasso and Fabio Ciceri and Patrizia Rovere-Querini and Carolina Tomba and Edi Viale and Leonardo Henry Eusebi and Maria Elena Riccioni and Schalk van der Merwe and Haroon Shahid and Avik Sarkar and Jin Woo (Gene) Yoo and Emanuele Dilaghi and R. Alexander Speight and Francesco Azzolini and Francesco Buttitta and Serena Porcari and Maria Chiara Petrone and Julio Iglesias-Garcia and Edoardo V. Savarino and Antonio Di Sabatino and Emilio Di Giulio and James J. Farrell and Michel Kahaleh and Philip Roelandt and Guido Costamagna and Everson Luiz de Almeida Artifon and Franco Bazzoli and Per Alberto Testoni and Salvatore Greco and Paolo Giorgio Arcidiacono}, title = {Gastrointestinal mucosal damage in patients with COVID-19 undergoing endoscopy: an international multicentre study}, volume = {8}, number = {1}, elocation-id = {e000578}, year = {2021}, doi = {10.1136/bmjgast-2020-000578}, publisher = {BMJ Specialist Journals}, abstract = {Background Although evidence suggests frequent gastrointestinal (GI) involvement during coronavirus disease 2019 (COVID-19), endoscopic findings are scarcely reported.Aims We aimed at registering endoscopic abnormalities and potentially associated risk factors among patients with COVID-19.Methods All consecutive patients with COVID-19 undergoing endoscopy in 16 institutions from high-prevalence regions were enrolled. Mann-Whitney U, χ2 or Fisher{\textquoteright}s exact test were used to compare patients with major abnormalities to those with negative procedures, and multivariate logistic regression to identify independent predictors.Results Between February and May 2020, during the first pandemic outbreak with severely restricted endoscopy activity, 114 endoscopies on 106 patients with COVID-19 were performed in 16 institutions (men=70.8\%, median age=68 (58{\textendash}74); 33\% admitted in intensive care unit; 44.4\% reporting GI symptoms). 66.7\% endoscopies were urgent, mainly for overt GI bleeding. 52 (45.6\%) patients had major abnormalities, whereas 13 bled from previous conditions. The most prevalent upper GI abnormalities were ulcers (25.3\%), erosive/ulcerative gastro-duodenopathy (16.1\%) and petechial/haemorrhagic gastropathy (9.2\%). Among lower GI endoscopies, 33.3\% showed an ischaemic-like colitis.Receiver operating curve analysis identified D-dimers \>1850 ng/mL as predicting major abnormalities. Only D-dimers \>1850 ng/mL (OR=12.12 (1.69{\textendash}86.87)) and presence of GI symptoms (OR=6.17 (1.13{\textendash}33.67)) were independently associated with major abnormalities at multivariate analysis.Conclusion In this highly selected cohort of hospitalised patients with COVID-19 requiring endoscopy, almost half showed acute mucosal injuries and more than one-third of lower GI endoscopies had features of ischaemic colitis. Among the hospitalisation-related and patient-related variables evaluated in this study, D-dimers above 1850 ng/mL was the most useful at predicting major mucosal abnormalities at endoscopy.Trial registration number ClinicalTrial.gov (ID: NCT04318366).}, URL = {https://bmjopengastro.bmj.com/content/8/1/e000578}, eprint = {https://bmjopengastro.bmj.com/content/8/1/e000578.full.pdf}, journal = {BMJ Open Gastroenterology} }