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Objective To study the GI symptoms in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected patients. Design We analysed epidemiological, demographic, clinical and laboratory data of 95 cases with SARS-CoV-2 caused coronavirus disease 2019. Real-time reverse transcriptase PCR was used to detect the presence of SARS-CoV-2 in faeces and GI tissues. Results Among the 95 patients, 58 cases exhibited GI symptoms of which 11 (11.6%) occurred on admission and 47 (49.5%) developed during hospitalisation. Diarrhoea (24.2%), anorexia (17.9%) and nausea (17.9%) were the main symptoms with five (5.3%), five (5.3%) and three (3.2%) cases occurred on the illness onset, respectively. A substantial proportion of patients developed diarrhoea during hospitalisation, potentially aggravated by various drugs including antibiotics. Faecal samples of 65 hospitalised patients were tested for the presence of SARS-CoV-2, including 42 with and 23 without GI symptoms, of which 22 (52.4%) and 9 (39.1%) were positive, respectively. Six patients with GI symptoms were subjected to endoscopy, revealing oesophageal bleeding with erosions and ulcers in one severe patient. SARS-CoV-2 RNA was detected in oesophagus, stomach, duodenum and rectum specimens for both two severe patients. In contrast, only duodenum was positive in one of the four non-severe patients. Conclusions GI tract may be a potential transmission route and target organ of SARS-CoV-2.

We read with interest the study by Higuchi et al , which identified mechanisms of increased satiation in Cyp8b1−/− mice via slowed gastric empting.1 Following data showing that deleting Cyp8b1, which is required to produce 12α-hydroxylated bile acids, impaired intestinal lipid absorption in mice, the authors convincingly demonstrated that lowering 12α-hydroxylated bile acids slowed gastric emptying in Cyp8b1−/− mice.1 Duodenal lipid infusion affects gastric function, and duodenal hypersensitivity to lipids has been studied in GI disorders with gastric dysmotility, such as functional dyspepsia (FD).2 FD is defined by upper GI symptoms originating from the gastroduodenal region with no structural disease on routine investigation.3 Although studies showed that lipids are a major trigger of dyspeptic symptoms, the effect was only partially explained by duodenal release of cholecystokinin.4 Interestingly, the release of bile salts has been linked to the generation of dyspeptic symptoms, possibly via duodenal luminal or mucosal changes including hyperpermeability.5 6 However, duodenal alterations have not …

Dear Sir, In their letter,1 Dr Cui and colleagues include two interesting thoughts. Primarily, they argue, illustrated by one case, that gastrointestinal (GI) involvement may be more common in systemic lupus erythematosus (SLE) than usually thought. This thought is to some degree supported by the patient survey performed within the European League Against Rheumatism (EULAR)/ American College of Rheumatology (ACR) classification criteria project, in which we noted that more than 5% of the patients reported GI symptoms at the time of their SLE diagnosis,2 even though …

Gastrointestinal (GI) symptoms1 2 and positive stool severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection3 have been reported in COVID-19 infected patients. However, these studies mainly focused on the adult population, and it is still not known whether children with COVID-19 have similar GI involvement. We here report the clinical characteristics of 244 consecutive COVID-19 positive children from Wuhan, during the period 21 January to 20 March 2020. All were confirmed to have SARS-CoV-2 by reverse transcription-polymerase chain reaction (RT-PCR) on nasopharyngeal swabs. We specifically compared the differences between patients with and without GI symptoms (having at least one of the following: diarrhoea; nausea and vomiting; abdominal pain; and decreased feeding). In our cohort, 34 of 244 (13.9%) presented with GI symptoms on admission. These patients were much younger (14 vs 86 months; p

Cow's milk protein (CMP) is usually one of the first complementary foods to be introduced into the infant's diet and is commonly consumed throughout childhood as part of a balanced diet. CMP is capable of inducing a multitude of adverse reactions in children, which may involve organs like the skin, gastrointestinal (GI) tract or respiratory system. The diagnosis of CMP-induced adverse reactions requires an understanding of their classification and immunological basis as well as the strengths and limitations of diagnostic modalities. In addition to the well-recognised, immediate-onset IgE-mediated allergies, there is increasing evidence to support the role of CMP-induced allergy in a spectrum of delayed-onset disorders ranging from GI symptoms to chronic eczema. The mainstay of treatment is avoidance of CMP; this requires dietetic input to ensure that this does not lead to any nutritional compromise. This review is intended to highlight the broad spectrum of manifestations of CMP allergy and to offer an approach to the diagnosis and treatment thereof.

Introduction Chronic gastrointestinal (GI) symptoms after pelvic radiotherapy are common. Most affected patients never see a GI specialist. We developed a comprehensive algorithm to direct management of new GI symptoms after pelvic radiotherapy. A 3 arm randomised controlled trial was performed to test 2 hypotheses: (1) Algorithm directed intervention is beneficial compared to no intervention (2) outcomes are not worse when patients are managed by a nurse rather than a gastroenterologist. Methods Patients treated with pelvic radiotherapy > 6 months earlier with persisting GI symptoms were randomised to management according to the algorithm by 1. a GI nurse or 2. gastroenterologist or 3. the self help Macmillan booklet “Pelvic Radiotherapy: Possible Late Effects”. After 6 months, booklet arm patients with persisting symptoms could ask to see the gastroenterologist. Patients in the nurse arm were transferred to the gastroenterologist if they had problems beyond the algorithm’s scope. The primary end point was change in the modified Inflammatory Bowel Disease Questionnaire – bowel sub score (IBDQ-B) at 6 months. Follow up continued until 12 months. The trial had 80% power to answer the 1st hypothesis after randomising 196 patients and the 2ndafter closing the booklet arm, and randomising 22 more patients to gastroenterologist or nurse. Results 168 men, median age 70 (range 34 – 83), 50 women median age 61 (29 – 87), 28 treated for GI, 34 gynaecological & 156 urological cancer were randomised to booklet (n = 68), nurse (n = 80) or gastroenterologist (n = 70). 30 (44%) from the booklet and 4 (5%) from the nurse arm crossed to the gastroenterologist. Groups were well balanced for baseline scores and patient characteristics. 66.5% of patients had a baseline IBDQ-B score indicating moderate/severe symptoms. Intention to treat analysis showed a mean improvement in IBDQ-B score in the booklet arm of 4.9 (95% CIs 1.4–8.4), in the nurse arm 8.8 (6.9–11.2) and 10.3 (7.7–13.1) in the gastroenterologist arm. Improvement in IBDQ-B score was both clinically and statistically significant (compared to booklet) in the nurse (p = 0.04), gastroenterologist (p = 0.014) and combined treatment arms (p = 0.006). Outcomes in the nurse treated arm were not worse than those treated by the gastroenterologist (p = 0.428). Improvements were sustained over time. Conclusion Targeted intervention following a detailed clinical algorithm can significantly ameliorate radiotherapy-induced GI symptoms. Most patients can be managed by a suitably trained and supported nurse. (Funding RfPB, NIHR) Disclosure of Interest None Declared

Introduction The Bowel Cancer Screening Programme (BCSP) commenced in England in 2006 using the Hemoccult guaiac faecal occult blood test (FOBt). The study aimed to evaluate if significant numbers of upper GI cancers were being diagnosed in patients with a positive FOBt in the absence of colonic pathology. Methods A quantitative data analysis of all BCSP patients with a negative colonoscopy cross referenced with all patients within screening age (60yrs > ) diagnosed with upper GI cancer in the North East of England, comprising of South of Tyne, North of Tyne, Teesside, Durham and Darlington. Results Collectively the North East Bowel Cancer Screening centres carried out 5176 colonoscopies from 2008–2011, resulting in 1108 (21.4%) normal investigations. In the same time period 589 patients were diagnosed with upper GI cancer. 243 were invited to participate in BCSP and 109 (45%) took part. 33/109 (30%) patients were diagnosed with upper GI cancer prior to submitting FOBt, leaving 76 (70%) presumably undiagnosed. 72/76 (94.8%) returned a negative FOBt, 2 (2.6%) returned an unclear subsequently followed by 2 negative FOBt kits according to BCSP practise, leaving 2 (2.6%) patients with a positive FOBt who subsequently had a normal colonoscopy. At the time of screening both patients were symptomatic with upper GI symptoms, and diagnosed with upper GI cancer within 3 months of screening. Conclusion These data suggest that carrying out an upper GI investigation in FOBt positive and colonoscopy negative patients is not justified. Consideration to investigate maybe given in the presence of upper GI symptoms; however, further work is needed to evaluate the prevalence of upper GI symptoms in this population. Disclosure of Interest None Declared.

Introduction 17 000 patients are treated with radical pelvic radiotherapy per year in the UK. 50% will develop chronic gastrointestinal (GI) symptoms that adversely affect quality-of-life, which have been shown to persist at the same level of severity for at least 3 years following treatment. Despite this, fewer than 20% are referred to a gastroenterologist. We aimed to determine if structured gastroenterological evaluation improves symptoms this patient group. Methods 60 patients with GI symptoms ≥6 months after radical pelvic radiotherapy were identified from oncology clinics. Those requiring urgent investigation via the 2-week wait pathway were excluded. They were assessed at baseline using patient-reported symptom-based questionnaires: inflammatory bowel disease questionnaire (IBDQ); Vaizey incontinence questionnaire (VIQ); and the Common Terminology Criteria for Adverse Events (CTCAE) pelvis questionnaire. Participants were then referred to and managed by gastroenterologists using an algorithmic approach, which involves the identification of all GI symptoms and investigation for all potential causes for these symptoms. Further assessments were made at 3 and 6 months using the questionnaires. Results 20 men and 36 women were included, with a median age of 58.5 years (range 26.9–81.8). Median time from radiotherapy to baseline gastroenterological assessment was 3.0 years (range 0.6–18.7). Median IBDQ score improved from 168 at baseline to 195 at 6 months (p=0.014). Median IBDQ bowel subset score improved from 41 at baseline to 50 at 6 months (p Conclusion GI symptom questionnaire scores significantly improved from baseline to 6 months. This suggests that structured gastroenterological evaluation using an algorithmic approach may improve GI symptoms in this patient group, although a controlled study is necessary to confirm this. Competing interests None declared.