NIGERIAN JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY

EDITORIAL
Year
: 2020  |  Volume : 12  |  Issue : 1  |  Page : 1--2

Coronavirus and gastroenterology practice


Nwokediuko Sylvester Chuks 
 Department of Medicine, UNTH, Ituku, Ozalla, Nigeria

Correspondence Address:
Prof. Nwokediuko Sylvester Chuks
Department of Medicine, UNTH, Ituku, Ozalla
Nigeria




How to cite this article:
Chuks NS. Coronavirus and gastroenterology practice.Niger J Gastroenterol Hepatol 2020;12:1-2


How to cite this URL:
Chuks NS. Coronavirus and gastroenterology practice. Niger J Gastroenterol Hepatol [serial online] 2020 [cited 2020 Sep 18 ];12:1-2
Available from: http://www.njghonweb.org/text.asp?2020/12/1/1/284720


Full Text



Since December 2019, the global community has been facing a crisis of coronavirus pandemic which has virtually brought the entire world on its knees. The problem started in Wuhan city and rapidly spread throughout China and other parts of the world. The illness has been traced to a new type of virus called SARS-Cov-2 virus. The global economy is fast grinding to a halt as flights from and to high-risk countries are being banned in many countries, including Nigeria. As at today, the 10th day of May 2020, Nigeria has recorded 4,151 confirmed cases, with128 deaths.

The thrust of management currently involves mandatory testing and quarantine of every returnee or visitor from countries with community transmission, early detection of cases, prompt contact tracing, and rapid isolation and treatment of confirmed cases. Hand washing and use of sanitizers remain very effective ways of reducing spread of this infection

In the initial outbreak, patients presented with unexplained pneumonia; the most common symptoms are fever, cough, and breathlessness. A study of the first 2 months of the outbreak put the prevalence of diarrhea at 3%.[1] Initial reports put the prevalence of gastrointestinal manifestations at 5%–50%. Liver enzyme abnormalities were reported in 20%–30% of cases. In fact, the possibility of fecal transmission has been raised. Clinical evidence that the digestive system may serve as an alternative route of transmission of this virus is growing. A recent study from China[2] found that diarrhea was a prominent symptom among up to half of patients with COVID-19 during the outbreak in Wuhan. The study also showed that those with digestive symptoms had a significantly longer time from onset to admission than patients without digestive symptoms. Patients who experienced digestive symptoms had a variety of manifestations, including anorexia (83.8%), diarrhea (29.3%), vomiting (0.08%), and abdominal pain (0.4%). As the severity of the disease increased, digestive symptoms became more pronounced.

From the foregoing, it is imperative that gastroenterologists should exercise the highest degree of caution and nimbleness as they maintain service during this challenging time. Some of the tips considered useful in this effort include:

Detailed history must be obtained from all patients, with attention to fever, cough, dyspnea, and gastrointestinal symptoms. Travel history must not be left outTemperature should be measured in the clinic or endoscopy suitePatients waiting to be attended to should be made to maintain reasonable distance between each otherUpper endoscopy and colonoscopy are potentially hazardous to patients, doctors, nurses and other medical staff. If healthcare workers and healthcare systems, in general, are not adequately prepared for the challenges of COVID-19, they can actually become part of the problem. Strict adherence to all aspects of universal precaution must be ensured. Personal protective equipment must be available for use in confirmed or suspected casesIn line with the global trend in the provision of endoscopy services during this crisis, all elective cases should be postponed to limit exposure of staff, patients and patients' relativesStaff who fall sick should not come to workPatients booked for endoscopy should be contacted on phone or by e-mail and instructed to stay at home if they fall sickCrowd avoidance should be encouragedHand shaking should be discouragedSocial distancing should also be encouragedPatients and staff should cover their mouth when coughing or sneezingSeek up to date information from relevant sources such as WHO, CDC of the USA, NCDC, and FMH.

It is our hope that we would survive the present crisis and live to tell the story and further strengthen our arsenal against these microbes that are ever on the prowl.

References

1Guan W, Ni Z, Hu Yu, Liang W, Ou C, He J, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med 2020;382:1708-20. [doi: 10.1056/NEJMMoa2002032].
2Pan L, Mu M, Yang P, et al. Clinical Characteristics of COVID-19 Patients With Digestive Symptoms in Hubei, China: A Descriptive, Cross-Sectional, Multicenter Study. Am J Gastroenterol 2020;115: 766-73.