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Background & Aims: The prevalence and significance of digestive manifestations in coronavirus disease 2019 (COVID-19) remain uncertain. We aimed to assess the prevalence, spectrum, severity, and significance of digestive manifestations in patients hospitalized with COVID-19., Methods: Consecutive patients hospitalized with COVID-19 were identified across a geographically diverse alliance of medical centers in North America. Data pertaining to baseline characteristics, symptomatology, laboratory assessment, imaging, and endoscopic findings from the time of symptom onset until discharge or death were abstracted manually from electronic health records to characterize the prevalence, spectrum, and severity of digestive manifestations. Regression analyses were performed to evaluate the association between digestive manifestations and severe outcomes related to COVID-19., Results: A total of 1992 patients across 36 centers met eligibility criteria and were included. Overall, 53% of patients experienced at least 1 gastrointestinal symptom at any time during their illness, most commonly diarrhea (34%), nausea (27%), vomiting (16%), and abdominal pain (11%). In 74% of cases, gastrointestinal symptoms were judged to be mild. In total, 35% of patients developed an abnormal alanine aminotransferase or total bilirubin level; these were increased to less than 5 times the upper limit of normal in 77% of cases. After adjusting for potential confounders, the presence of gastrointestinal symptoms at any time (odds ratio, 0.93; 95% CI, 0.76-1.15) or liver test abnormalities on admission (odds ratio, 1.31; 95% CI, 0.80-2.12) were not associated independently with mechanical ventilation or death., Conclusions: Among patients hospitalized with COVID-19, gastrointestinal symptoms and liver test abnormalities were common, but the majority were mild and their presence was not associated with a more severe clinical course., (Copyright © 2021 AGA Institute. Published by Elsevier Inc. All rights reserved.)

The reported increase in the non-medical use of opioid prescription medication in West Africa and Middle East coinciding with the ongoing problems in North America has moved the International Narcotic Control Board and the United Nations Office on Drugs and Crime to talk about a global opioid crisis requiring global solutions. The measures proposed include the strengthening of the global control system by adding the opioid analgesic tramadol to the list of internationally scheduled substances. Yet North America and West Africa have profoundly different health care systems as well as different access pathways to opioid medications and consumer motivation for non-medical use. Further, the substances driving the US opioid crisis are exponentially more powerful and dangerous than the falsified tramadol circulating in West Africa. Across West Africa patients are suffering from untreated pain, whereas one of the main drivers behind the different problems that has come to be known as the North American opioid crisis has been the overprescribing of opioid analgesics. Far from constituting a global opioid crisis, the two regions are facing fundamentally different challenges that need to be treated with specifically tailored policy responses. In particular, the urgent call for reducing opioid prescription levels in North America should not discourage medical professionals and public health agencies from rapidly improving pain management and opioid prescribing in Africa and other low and middle income countries., (Copyright © 2020 Elsevier B.V. All rights reserved.)