Gastrointestinal mucosal damage in patients with COVID-19 undergoing endoscopy: An international multicentre study

Giuseppe Vanella, Gabriele Capurso, Cesare Burti, Lorella Fanti, Luigi Ricciardiello, Andre Souza Lino, Ivo Boskoski, Michiel Bronswijk, Amy Tyberg, Govind Krishna Kumar Nair, Stefano Angeleti, Aurelio Mauro, Fabiana Zingone, Kofi W. Oppong, Daniel De La Iglesia-Garcia, Lieven Pouillon, Ioannis S. Papanikolaou, Pierluigi Fracasso, Fabio Ciceri, Patrizia Rovere-QueriniCarolina Tomba, Edi Viale, Leonardo Henry Eusebi, Maria Elena Riccioni, Schalk Van Der Merwe, Haroon Shahid, Avik Sarkar, Jin Woo Gene Yoo, Emanuele Dilaghi, R. Alexander Speight, Francesco Azzolini, Francesco Buttitta, Serena Porcari, Maria Chiara Petrone, Julio Iglesias-Garcia, Edoardo V. Savarino, Antonio Di Sabatino, Emilio Di Giulio, James J. Farrell, Michel Kahaleh, Philip Roelandt, Guido Costamagna, Everson Luiz De Almeida Artifon, Franco Bazzoli, Per Alberto Testoni, Salvatore Greco, Paolo Giorgio Arcidiacono

Research output: Contribution to journalArticlepeer-review


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, χ 2 or Fisher'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 (58-74); 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 (1.69-86.87)) and presence of GI symptoms (OR=6.17 (1.13-33.67)) 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 (ID: NCT04318366).

Original languageEnglish
Article numbere000578
JournalBMJ Open Gastroenterology
Issue number1
Publication statusPublished - Feb 24 2021


  • covid-19
  • endoscopy
  • gastrointestinal tract
  • mucosal infection

ASJC Scopus subject areas

  • Gastroenterology


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