Saudi Journal of Gastroenterology
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   Table of Contents - Current issue
Coverpage
September-October 2020
Volume 26 | Issue 5
Page Nos. 223-286

Online since Friday, September 18, 2020

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EDITORIAL  

COVID-19 in gastroenterology and hepatology: Living with the realities of a historic 21st century pandemic p. 223
Eric M Yoshida, Trana Hussaini, Majid Alsahafi
DOI:10.4103/sjg.SJG_248_20  PMID:32567581
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REVIEW ARTICLE Top

Gastrointestinal and liver manifestations of COVID-19 Highly accessed article p. 226
Janice Cheong, Nichoals Bartell, Thoetchai Peeraphatdit, Mahmoud Mosli, Bandar Al-Judaibi
DOI:10.4103/sjg.SJG_147_20  PMID:32367837
The novel coronavirus 2 (SARS-CoV-2) has spread worldwide. While patients typically present with fever and symptoms of a respiratory illness, patients have also presented with gastrointestinal symptoms such as diarrhea, vomiting and abdominal pain. In addition, some patients were reported to have liver injury. In this article, we review gastrointestinal and liver aspects of COVID-19. In addition, we provide general gastroenterologists with guidance on the management of patients with gastrointestinal and liver disorders from COVID-19.
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SPECIAL COMMUNICATION Top

Saudi association for the study of liver diseases and transplantation position statement on liver transplantation during the COVID-19 pandemic p. 233
Bandar Al-Judaibi, Reem Almaghrabi, Mohammed Alghamdi, Waleed K Al-Hamoudi, Mohammed AlQahtani, Faisal Abaalkhail, Mohammed Shagrani, Faisal M Sanai
DOI:10.4103/sjg.SJG_131_20  PMID:32341229
The World Health Organization (WHO), on March 11th 2020, upgraded the status of the novel coronavirus disease (COVID-19) from epidemic to pandemic. Over two million individuals have been infected with SARS-CoV-2, the virus causing COVID-19, and as of April, 14th 2020, there were over 5000 confirmed cases in Saudi Arabia (SA). Many countries, including SA, have imposed major restrictions on travel, and everyday life, and the implications of these necessary changes are being felt in liver transplant (LT) centers in SA. Concerns remain that there is an increased risk for individuals over 65 years of age, with underlying medical conditions, or for those who are immunocompromised. Therefore, the Saudi Association for the Study of Liver Diseases and Transplantation (SASLT) established an urgent task force to launch a statement that can be utilized by LT centers as a guidance in the management of patients with advanced liver disease from the time of LT listing to the post-operative care of transplanted patients.
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COVID-19 and endoscopy services in intermediately affected countries: a position statement from the saudi gastroenterology association p. 240
Majid A Almadi, Abdulrahman M Aljebreen, Nahla Azzam, Nuha Alammar, Emad S Aljahdli, Fahad I Alsohaibani, Resheed Alkhiari, Abdulaziz O Almasoud, Mohammad S Al Beshir, Suliman Alshankiti, Ahmad W Alharbi, Mohammed Alkhathami, Faisal Batwa
DOI:10.4103/sjg.SJG_161_20  PMID:32351243
With the global pandemic due to coronavirus disease 2019 (COVID-19), there has been a significant strain on healthcare facilities. The infectivity rate, as well as the rate of healthcare workers who have fallen ill to the disease, has raised concerns globally on the proper management of patients as well as the role of safe healthcare provision utilizing personal protective equipment (PPE). Furthermore, the limited supply of PPEs has mandated rationing their use to achieve maximum utility and preservation. Multiple gastroenterology associations have issued guidance and statements that would help healthcare providers in navigating these unprecedented and difficult times, and the Saudi Gastroenterology Association has provided this statement in an effort to bring the most up to date information for the management of endoscopy units in terms of resources, manpower planning, scheduling, as well as infection control policies and leadership.
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ORIGINAL ARTICLES Top

The psychological impact of COVID-19 pandemic on physicians in Saudi Arabia: A cross-sectional study p. 249
Eman Al Sulais, Mahmoud Mosli, Turki AlAmeel
DOI:10.4103/sjg.SJG_174_20  PMID:32496223
Background/Aim: COVID-19 pandemic exposed physicians to extraordinary stress and made them vulnerable to various types of psychological illnesses. The aim of this study was to evaluate the impact that the COVID-19 pandemic had on the psychological well-being of physicians. Materials and Methods: We performed a cross-sectional, survey-based study, targeting physicians in Saudi Arabia during the COVID-19 pandemic. The primary outcome was to assess the psychological impact that the pandemic had on physicians by using a questionnaire that was previously designed and used by Reynold's et al. to survey Canadians during the SARS outbreak in 2003. The questionnaire assessed respondents' understanding of the rationale for quarantine, quarantine behaviors (including difficulties and compliance), as well as socio-economic and psychological impacts through answers that are based on a Likert scale. We also assessed the possible risk factors for psychological disorders related to the pandemic. Results: The study included 529 physicians from various regions in Saudi Arabia. The enrolled physicians were practicing different specialties and branches in medicine. We classified them based on their workplace in relation to COVID-19 exposure to: COVID-19 designated center vs. non-COVID-19 designated centers. Furthermore, we subdivided the physicians who work in COVID-19 designated centers to those who work in high-risk areas such as ER, ICU and COVID-19 isolation wards and other areas as low-risk areas. The most common feelings reported by the physicians during the pandemic were: worry (357, 67.5%), isolation (301, 56.9%) and fear (263, 49.7%). According to logistic regression analysis, physicians older than age 60 were less likely to feel isolated (OR = 0.08, 95% CI = 0.01-0.96, P = 0.05), female physicians were more likely to experience fear (OR = 2.96, 95% CI = 1.20 – 7.27, P = 0.02) and worry (OR = 2.87,95% CI = 1.23 – 6.69, P = 0.02), while physicians with a previous exposure to similar traumatic events were less likely to experience fear (OR = 0.24, 0.10 – 0.64, P = 0.004) during the COVID-19 pandemic. Conclusions: The COVID-19 pandemic had a negative psychological effect on physicians in Saudi Arabia. Gender, age, and previous exposure to similar traumatic events were predictive of psychological reactions to the pandemic in this population.
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Disability and quality of life before and during the COVID-19 outbreak: A cross-sectional study in inflammatory bowel disease patients p. 256
Nahla A Azzam, Abdulrahman Aljebreen, Arwa Almuhareb, Majid A Almadi
DOI:10.4103/sjg.SJG_175_20  PMID:32415045
Background/Aim: Inflammatory bowel disease (IBD) is a chronic disorder affecting patients' health-related quality of life (HRQoL) which adds to their disability. Little is known about the impact of the COVID-19 pandemic on HRQoL of IBD patients. We aimed to evaluate HRQoL in IBD patient's pre- and post-COVID-19 pandemic using the IBD-disk questionnaire and explore associations between socio demographic factors, disease types, severity and impaired HRQoL in patients with IBD. Patients and Methods: A cross-sectional study was conducted at a tertiary care centre in Saudi Arabia between November 2019 and March 2020 at the outpatient IBD clinics. The HRQoL of patients was assessed using the 10-item IBD-disk questionnaire. Results: A total of 59 IBD patients (40 Crohn's disease, 19 Ulcerative colitis) with a mean disease duration of 3.5 years were included. Most of the patients (77.97%) were on biologics while 35.59% were on immune modulators, 16.94% on 5-ASA, and 3.38% were on corticosteroids. There was no difference between any of the 10 IBD-disk variables pre and post-COVID-19 pandemic apart from the perception of body image, where there was a slightly more negative perception with an increase from 2.53 to 3.39 (P = 0.05) There was no significant difference in HRQoL between patients with ulcerative colitis and Crohn's disease in any of domains. Conclusion: The current study showed that disability and HRQoL appears to be unaffected by the COVID-19 pandemic among our cohort, however further studies with longer follow up and larger sample size is needed.
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A cross-sectional survey on the psychological impact of the COVID-19 pandemic on inflammatory bowel disease patients in Saudi Arabia p. 263
Mahmoud Mosli, Mansour Alourfi, Amani Alamoudi, Almoutaz Hashim, Omar Saadah, Eman Al Sulais, Turki AlAmeel, Othman Alharbi, Shakir Bakari, Yaser Meeralam, Seigha Alshobai, Majid Alsahafi, Hani Jawa, Yousif Qari
DOI:10.4103/sjg.SJG_220_20  PMID:32567580
Background/Aims: The coronavirus (COVID-19) pandemic has caused significant disruption to patients with chronic illnesses. We explored the emotional state, perception, and concerns of Saudi patients with inflammatory bowel disease (IBD) during the crisis. Materials and Methods: We conducted a cross-sectional survey from 30 March to 5 April, 2020 using a pre-designed questionnaire distributed through social media platforms to IBD patients. The five-part questionnaire included an assessment of psychological wellbeing using a previously validated Arabic version of the Hospital Anxiety and Depression Scale (HADS), which includes domains for anxiety (HADS-A) and depression (HADS-D). A logistic regression analysis was used to uncover possible associations between patient characteristics and anxiety and depression. Results: The data from 1156 IBD patients were analyzed. Normal, borderline, and HADS-A scores consistent with a diagnosis of anxiety were reported by 423 (36.6%), 174 (15.1%), and 559 (48.4%) patients, respectively. However, 635 (69%) patients had normal scores and 273 (30.1%) had borderline HADS-D scores; no patients reported scores consistent with depression. Based on a multiple logistic regression analysis, patients educated till a high school diploma (OR = 2.57, 95% CI: 0.09–6.05, P = 0.03) and that had indeterminate colitis (OR = 2.23, 95% CI: 1.27–3.89, P = 0.005) were more likely to express anxiety. Conclusions: Many patients expressed symptoms of anxiety, although not depression. Female patients, patients educated till a high school diploma, and those with indeterminate colitis were more likely to have anxiety. IBD patients require greater attention during a pandemic to avoid adverse disease-related outcomes.
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Abnormal liver-related biomarkers in COVID-19 patients and the role of prealbumin p. 272
Tao Li, Ying Guo, Xianghua Zhuang, Laigang Huang, Xingqian Zhang, Fengtao Wei, Baohua Yang
DOI:10.4103/sjg.SJG_239_20  PMID:32769260
Background/Aims: We aimed to evaluate the distribution of abnormal liver-related biomarkers in patients with coronavirus disease (COVID-19) and explore the prognostic value of elevated liver enzymes and abnormal liver synthetic capacity with regards to patient mortality. Patients and Methods: This retrospective observational study included 80 laboratory-confirmed COVID-19 cases. Data were collected from the electronic medical record system by a trained team of physicians. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TB), albumin, and prealbumin levels at admission and on day 7 after admission were collected. The primary outcome of the current study was patient mortality. Results: Abnormal ALT, AST, TB, albumin, and prealbumin levels were observed in 11 (13.8%), 15 (18.8%), 5 (6.3%), 22 (27.5%), and 31 (38.8%) patients, respectively. Male gender correlated with elevated ALT and AST levels (p = 0.027 and 0.036, respectively). Higher levels of AST and lower levels of albumin and prealbumin were associated with patient mortality (p = 0.009, 0.002, and 0.003, respectively). Multivariate Cox regression analysis identified patient age (p = 0.013, HR 1.108) and prealbumin levels (p = 0.015, HR 0.986) as independent predictors for patient mortality. However, changes in liver-related biomarkers were not associated with poor outcome in multivariate analysis (p > 0.05). Conclusions: Abnormalities in albumin and prealbumin levels are common among COVID-19 patients and hypoprealbuminemia independently predicts adverse outcome and should be carefully considered in clinical practice. Moreover, changes in liver-related biomarkers is not a salient feature of COVID-19.
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LETTERS TO THE EDITOR Top

Guidance and workflow of endoscopy reopening during COVID-19 pandemic p. 279
Nahla Azzam, Nora Alotaibi, Majid Almadi, Abdulrahman Aljebreen
DOI:10.4103/sjg.SJG_425_20  PMID:32830791
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A call for structured re-opening of endoscopy services during the COVID-19 pandemic p. 283
Ahmad S Almalki, Mohammed Khan, Turki AlAmeel
DOI:10.4103/sjg.SJG_450_20  PMID:32883893
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Response to Almalki et al.: Resuming endoscopy services during the COVID-19 pandemic p. 285
Majid A Almadi, Abdulrahman M Aljebreen, Nahla Azzam, Faisal Batwa
DOI:10.4103/sjg.SJG_455_20  PMID:32893842
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