THURSDAY, Oct. 1, 2020 — A higher rate of gastrointestinal complications, including mesenteric ischemia, occurs among critically ill patients with COVID-19 versus matched patients without COVID-19, according to a research letter published online Sept. 24 in the Journal of the American Medical Association.

Mohamad El Moheb, M.D., from Massachusetts General Hospital in Boston, and colleagues compared the incidence of gastrointestinal complications of critically ill patients with COVID-19-induced acute respiratory distress syndrome (ARDS) versus propensity-matched and comparably ill patients with non-COVID-19 ARDS treated between March 13 and May 7, 2020. The final analysis included 92 patients in each group.

The researchers found that patients with COVID-19 were more likely to develop gastrointestinal complications versus those without COVID-19 (74 versus 37 percent; incidence rate ratio, 2.33). This difference in incidence was more pronounced after the third day of critical illness. Patients with COVID-19 developed more transaminitis (55 versus 27 percent), severe ileus (48 versus 22 percent), and bowel ischemia (4 versus 0 percent). Among patients with COVID-19 and bowel ischemia, pathology findings showed fibrin thrombi in the microvasculature underlying areas of necrosis.

These findings suggest “a distinct phenotype for COVID-19 compared with conventional ARDS,” the authors write.

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