Gastrointestinal disorders in patients with COVID-19: diagnoses and treatment during the pandemic

Main Article Content

I.G. Paliy
S.V. Zaika
I.V. Chernova
I.M. Yevtodii
D.V. Palii

Abstract

Background. The pandemic caused by the coronavirus disease 2019 (COVID-19) is a topic that is currently in the spotlight of the world community. The use of non-steroidal anti-inflammatory drugs (NSAIDs) in combination with new oral anticoagulants (dabigatran, rivaroxaban, apixaban, etc.) and acetylsalicylic acid by the significant number of patients during the pandemic, caused by COVID-19, raises the question about the safety of the influence of each drug on the occurrence of gastrointestinal complications. The development of algorithms to prevent damage to the gastrointestinal mucosa on the background of these drugs is becoming a priority. The purpose was to examine the presence of gastrointestinal disorders using the Gastrointestinal Symptom Rating Scale (GSRS) in convalescents after COVID-19 and to evaluate the effectiveness of esomeprazole for correction of these disorders. Materials and me­thods. We surveyed 92 (48 men and 44 women) convalescents after COVID-19. The mean age of individuals was (49.2 ± 2.0) years. To conduct a survey of patients who had COVID-19, we developed a questionnaire which included patient’s passport data, age, gender. In addition, patients reported how COVID-19 was diagnosed, what drugs they were taking during treatment, and whether they nee­ded oxygen therapy. Subsequently, convalescents after COVID-19 ­answered questions from the GSRS. Information was collected and the questionnaire was completed by telephone survey. Depending on the data of GSRS, esomeprazole (Ezonexa) was prescribed to patients at a dose of 20 mg 1 time per day, 30 minutes before meals, for 30 days. During the follow-up survey on day 30 of esomeprazole intake, patients re-answered the GSRS questions. Results. Thirty days after starting esomeprazole intake at a dose of 20 mg 1 time per day, 92 convalescents after COVID-19 showed a significant reduction (p < 0.001) in the manifestations of reflux, abdominal pain and dyspeptic syndromes compared to the results before treatment ((2.3 ± 0.1), (4.3 ± 0.2), (5.7 ± 0.3) versus (4.3 ± 0.3), (9.3 ± 0.4), (8.6 ± 0.6), respectively). Esomeprazole was equally effective (p > 0.05) in influencing the severity of reflux, abdominal pain, dyspeptic, diarrheal and constipation syndromes in both men and women: (2.3 ± 0.1), (4.3 ± 0.2), (5.7 ± 0.3), (3.9 ± 0.3), (3.0 ± 0.1) versus (2.4 ± 0.1), (4.2 ± 0.2), (6.0 ± 0.4), (4.0 ± 0.4), (3.1 ± 0.1), respectively. Esomeprazole was also equally effective (p > 0.05) in the impact on the severity of reflux, abdominal pain, dyspeptic, diarrheal and constipation syndromes among patients receiving acetylsalicylic acid and those treated with rivaroxaban: (2.5 ± 0.2), (4.2 ± 0.2), (5.6 ± 0.2), (3.9 ± 0.4), (3.1 ± 0.1) versus (2.2 ± 0.1), (4.4 ± 0.3), (6.4 ± 0.6), (4.2 ± 0.4), (3.0 ± 0.1), respectively. Esomeprazole at a dose of 20 mg 1 time per day was equally effective (p > 0.05) in relation to the dynamics of the severi­ty of syndromes in patients receiving paracetamol and one NSAID and in those receiving paracetamol and 2 NSAIDs. In particular, in people receiving paracetamol and one NSAID, on the background of esomeprazole administration, the severity of reflux, abdominal pain, dyspeptic, diarrheal and constipation syndromes were (2.4 ± 0.1), (4.3 ± 0.2), (5.8 ± 0.3), (4.1 ± 0.3), (3.1 ± 0.1) and in patients taking paracetamol and 2 NSAIDs — (2.1 ± 0.2), (4.5 ± 0.4), (6.7 ± 0.7), (4.4 ± 0.7), (3.0 ± 0.1), respectively. Conclusions. Esomeprazole (Ezonexa) effectively reduces (p < 0.001) the severity of reflux, abdominal pain and dyspeptic syndromes in convalescents after COVID-19. The use of Esomeprazole (Ezo­nexa) demonstrates the same efficacy (p > 0.05) in men and women when receiving both ASA and rivaroxaban and during the treatment with both paracetamol and one NSAID and paracetamol and 2 NSAIDs.

Article Details

How to Cite
Paliy, I., Zaika, S., Chernova, I., Yevtodii, I., & Palii, D. (2021). Gastrointestinal disorders in patients with COVID-19: diagnoses and treatment during the pandemic. GASTROENTEROLOGY, 55(2), 81–90. https://doi.org/10.22141/2308-2097.55.2.2021.233628
Section
Original Researches

References

Karateev AE, Nasonov EL, Lila AM. Do NSAIDs cause specific complications in covid-19 coronavirus infection? Rheumatology Science and Practice. 2020;58(3):340-343. doi:10.14412/1995-4484-2020-340-343. (in Russian).

Melville NA, Nainggolan L. Are warnings against NSAIDs in COVID-19 warranted? Available from: https://www.medscape.com/viewarticle/926940. Accessed: March 17, 2020.

Paliy IG, Zaika SV, Yankovetska AG. Gastrointestinal lesions in patients, administrated acetylsalicylic acid for cardiovascular pathology: the syndromic diagnosis and possible methods of correction. Modern Gastroenterology. 2018;(99):29-38. (in Ukrainian).

Bentsa TM. Damage to the digestive system by non-steroidal anti-inflammatory drugs. Ratsionalnaya farmakoterapiya. 2007;(5):39-45. (in Russian).

Lanas A. A review of the gastrointestinal safety data--a gastroenterologist's perspective. Rheumatology (Oxford). 2010 May;49 Suppl 2(Suppl 2):ii3-10. doi:10.1093/rheumatology/keq058.

Ivashkin VT, Sheptulin AA, Mayev IV, Baranskaya YeK, Trukhmanov AS, Lapina TL. Russian gastroenterological association clinical guidelines on diagnostics and treatment of NSAIDs-associated erosive and ulcerative lesions of the stomach and duodenum. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2014;(6):89-94. (in Russian). 

Nasonov EL, Karateev AE. Lesions of the stomach associated with the use of non-steroidal anti-inflammatory drugs. Part 1. Klinicheskaya Meditsina. 2003;(3):4-10. (in Russian).

García Rodríguez LA, Hernández-Díaz S. Risk of uncomplicated peptic ulcer among users of aspirin and nonaspirin nonsteroidal antiinflammatory drugs. Am J Epidemiol. 2004 Jan 1;159(1):23-31. doi:10.1093/aje/kwh005.

Peters RJ, Mehta SR, Fox KA, et al. Effects of aspirin dose when used alone or in combination with clopidogrel in patients with acute coronary syndromes: observations from the Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) study. Circulation. 2003 Oct 7;108(14):1682-1687. doi:10.1161/01.CIR.0000091201.39590.CB.

Hallas J, Dall M, Andries A, et al. Use of single and combined antithrombotic therapy and risk of serious upper gastrointestinal bleeding: population based case-control study. BMJ. 2006 Oct 7;333(7571):726. doi:10.1136/bmj.38947.697558.AE.

Delaney JA, Opatrny L, Brophy JM, Suissa S. Drug drug interactions between antithrombotic medications and the risk of gastrointestinal bleeding. CMAJ. 2007 Aug 14;177(4):347-351. doi:10.1503/cmaj.070186.

Eikelboom JW, Wallentin L, Connolly SJ, et al. Risk of bleeding with 2 doses of dabigatran compared with warfarin in older and younger patients with atrial fibrillation: an analysis of the randomized evaluation of long-term anticoagulant therapy (RE-LY) trial. Circulation. 2011 May 31;123(21):2363-2372. doi:10.1161/CIRCULATIONAHA.110.004747.

Schulman S, Kearon C, Kakkar AK, et al. Dabigatran versus warfarin in the treatment of acute venous thromboembolism. N Engl J Med. 2009 Dec 10;361(24):2342-2352. doi:10.1056/NEJMoa0906598.

Patel MR, Mahaffey KW, Garg J, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011 Sep 8;365(10):883-891. doi:10.1056/NEJMoa1009638.

Giugliano RP, Ruff CT, Braunwald E, et al. Edoxaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2013 Nov 28;369(22):2093-2104. doi:10.1056/NEJMoa1310907.

Granger CB, Alexander JH, McMurray JJ, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011 Sep 15;365(11):981-992. doi:10.1056/NEJMoa1107039.

Miller CS, Dorreen A, Martel M, Huynh T, Barkun AN. Risk of Gastrointestinal Bleeding in Patients Taking Non-Vitamin K Antagonist Oral Anticoagulants: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol. 2017 Nov;15(11):1674-1683.e3. doi:10.1016/j.cgh.2017.04.031.

Karasyova GA. NSAID-gastropathy: from understanding to prevention and treatment strategy development. Meditsinskie novosti. 2012;(8):21-26. (in Russian).

Zhou J, Wang X, Lee S, et al. Proton pump inhibitor or famotidine use and severe COVID-19 disease: a propensity score-matched territory-wide study. Gut. 2020 Dec 4:gutjnl-2020-323668. doi:10.1136/gutjnl-2020-323668.

Almario CV, Chey WD, Spiegel BMR. Increased Risk of COVID-19 Among Users of Proton Pump Inhibitors. Am J Gastroenterol. 2020 Oct;115(10):1707-1715. doi:10.14309/ajg.0000000000000798.

Grinevich VB, Gubonina IV, Doshchitsin VL, et al. Management of patients with comorbidity during novel coronavirus (COVID-19) pandemic. National Consensus Statement 2020. Cardiovascular Therapy and Prevention. 2020;19(4):2630. doi:10.15829/1728-8800-2020-2630. (in Russian).

Drapkina OM, Maev IV, Bakulin IG, et al. Interim guidelines: Diseases of the digestive organs in the context of a new coronavirus infection pandemic (COVID-19). Profilakticheskaya Meditsina. 2020;23(3):2120-2152. doi:10.17116/profmed202023032120. (in Russian).

Novik AA, Ionova TI, Shevchenko IuL, authors; Shevchenko IuL, editor. Rukovodstvo po issledovaniiu kachestva zhizni v meditsine [Guidelines for the study of quality of life in medicine]. 2nd ed. Moscow: OLMA Media Grupp; 2007. 320 p. (in Russian).

Redkin AN, Chukardin AV, Brykalina JV, Fontes-Carvalho R. Validation questionnaire GSRS for studying quality of a life at the patients who have transferred abdominal surgical interventions. Rev Port Cardiol. 2010;29(10):1555-1567.

Kolde IaK. Praktikum po teorii veroiatnostei i matematicheskoi statistike [Workshop on probability theory and mathematical statistics]. Moscow: Meditsina; 1991. 157 p. (in Russian).