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Herbal drugs are medicinally and therapeutically active. From ancient times, Tinospora cordifolia belongs to Menispermaceae. This plant generally contains tinosporine, hydroxy ecdysone, furanoid diterpene, tinosponone, terpenoids, sinapic acid, and aliphatic compounds. Major phytopharmacological actions are significantly reported are against Diabetes Mellitus (DM), SARS-CoV-2 syndrome, boost immunity, treat influenza, viral infection, lymphoma, anticancer, antipyretic, effective against several bacteria such as Mycobacterium leprae, Mycobacterium tuberculosis, Neisseria gonorrhoeae and having diverse variety beneficial properties. This review is an endeavor on many isolated chemical components from T. cordifolia, medicinal utilization of this plant against several disorders, ethnopharmacology, phytopharmacological actions.

Benign biliary strictures (BBS) are usually treated with endoscopic retrograde cholangiopancreatography (ERCP) with the placement of multiple plastic stents (MPS) or a covered self-expandable metal stent (CSEMS). In this meta-analysis, we compared the efficacy and safety of MPS and CSEMS in the management of BBS. We reviewed several databases from inception to 28 April 2021 to identify RCTs that compared MPS with CSEMS in the management of BBS. Our outcomes of interest were stricture resolution, stricture recurrence, adverse events, stent migration and mean number of ERCPs to achieve stricture resolution. Data were analyzed using a random-effects model. We included eight RCTs with 524 patients. We found no significant difference in the rate of stricture resolution (risk ratio, 1.02; 95% CI, 0.96-1.10), stricture recurrence (risk ratio, 1.68; 95% CI, 0.72-3.88) or adverse events (risk ratio, 1.17; 95% CI, 0.73-1.87) between groups. Mean number of ERCPs was significantly lower in the CSEMS group (SMD, -1.99; 95% CI, -3.35 to -0.64). The rate of stent migration was significantly higher in the CSEMS group. CSEMS are comparable in efficacy and safety to MPS in the management of BBS but require fewer ERCPs to achieve stricture resolution.

Fecal microbiota transplantation (FMT) is an effective treatment for recurrent/refractory Clostridioides difficile infection (CDI) with a 10% to 20% risk of recurrence after a single FMT. In this meta-analysis, we aimed to evaluate the predictors of FMT failure.A comprehensive search of MEDLINE, Embase, Cochrane, and Web of Science databases through July 2021 was performed. All studies that evaluated risk factors associated with FMT failure in a multivariate model were included. We calculated pooled odds ratios with 95% confidence intervals for risk factors reported in ≥3 studies using a random-effects model.Twenty studies involving 4327 patients (63.6% females) with recurrent/refractory CDI who underwent FMT were included. FMT failed in 705 patients (16.3%) with 2 to 3 months of follow-up in most studies. A total of 12 different risk factors were reported in a multivariate model in ≥3 studies. Meta-analysis showed that advanced age, severe CDI, inflammatory bowel disease, peri-FMT use of non-CDI antibiotics, prior CDI-related hospitalizations, inpatient status, and poor quality of bowel preparation were significant predictors of FMT failure. Charlson Comorbidity Index, female gender, immunosuppressed status, patient-directed donor, and number of CDI recurrences were not associated with FMT failure.Adequate bowel preparation at the time of FMT and optimizing antibiotic stewardship practices in the peri-FMT period can improve the success of FMT. Patients with nonmodifiable risk factors should be counseled about the risk of FMT failure. Our results may help develop a risk stratification model to predict FMT failure in CDI patients.

BACKGROUND Several studies have examined the efficacy of gastric peroral endoscopic myotomy (G-POEM) for gastroparesis. AIM To evaluate the mid-term efficacy of G-POEM by meta-analysis of studies with a minimum 1 year of follow-up. METHODS We reviewed several databases from inception to 10 June 2021 to identify studies that evaluated the efficacy of G-POEM in refractory gastroparesis, and had at least 1 year of follow-up. Our outcomes of interest were clinical success at 1 year, adverse events, difference in mean pre- and 1 year post-procedure Gastroparesis Cardinal Symptom Index (GCSI) score, and difference in mean pre- and post-procedure EndoFLIP measurements. We analysed data using a random-effects model and assessed heterogeneity by I2 statistic. RESULTS We included 10 studies comprising 482 patients. Pooled rates (95% CI) of clinical success at 1 year and adverse events were 61% (49%, 71%) and 8% (6%, 11%), respectively. Mean GCSI at 1 year post-procedure was significantly lower than pre-procedure; mean difference (MD) (95% CI) -1.4 (-1.9, -0.9). Mean post-procedure distensibility index was significantly higher than pre-procedure in the clinical success group at 40 and 50 mL volume distension; standardised mean difference (95% CI) 0.82 (0.07, 1.64) and 0.91 (0.32, 1.49), respectively. In the clinical failure group, there was no significant difference between mean pre- and post-procedure EndoFLIP measurements. CONCLUSIONS G-POEM is associated with modest clinical success at 1 year. Additional studies with longer follow-up are required to evaluate its longer-term efficacy.

Lower gastrointestinal bleeding (LGIB) is one of the most common indications for hospital admission. The current standard of care for patients admitted with LGIB includes colonoscopy. The aims of this study are to define the rate of readmission in patients with LGIB and to determine whether early colonoscopy within the first 24 h after admission impacts the rate of readmission in these patients. We performed a retrospective cohort study on data obtained from the Nationwide Readmission Database and identified patients admitted with lower GI bleed using ICD-10 codes. The primary outcome was 30-day all-cause readmission, and one of our secondary outcomes was the impact of early colonoscopy on 30-day readmission. We analyzed data from 35,790,513 patients who were admitted for LGIB in 2017. A total of 16.4% of these patients were readmitted within 30 days of discharge, with diverticular bleeding most common diagnosis for readmission. Overall, in-hospital mortality was 1.18% for index admission and 4.44% for readmission. Early colonoscopy did not impact the rate of readmission within 30 days of discharge. LGIB remains a commonly encountered in clinical practice with a high readmission rate. Mortality is significantly higher during readmission compared to index admission. Early colonoscopy did not impact the 30-day readmission rate.

Studies evaluating the role of endoscopic submucosal dissection (ESD) in the management of superficial pharyngeal cancers have reported promising results. This meta-analysis evaluates the efficacy and safety of ESD in the management of superficial pharyngeal cancers. We reviewed several databases from inception to September 03, 2020, to identify studies evaluating the efficacy and safety of ESD in the management of superficial pharyngeal cancers. Our outcomes of interest were en bloc resection rate, complete resection rate, adverse events, and rates of local recurrence. Pooled rates with 95% confidence intervals (CI) for all outcomes were calculated using random-effect model. Heterogeneity was assessed by I2 statistic. We assessed publication bias by using funnel plots and Egger’s test. We conducted meta-regression analysis to explore heterogeneity in analyses. Ten studies were included in analyses. All studies were from Asia. Pooled rates (95% CI) for en bloc resection and complete resection were 94% (87%, 97%) and 72% (62%, 80%), respectively. The pooled rates (95% CI) for adverse events and local recurrence were 10% (5%, 17%) and 1.9% (0.9%, 4%), respectively. Most of the analyses were limited by substantial heterogeneity. On meta-regression analysis, the heterogeneity was explained by size of tumor and histology. Funnel plots and Egger’s test showed no evidence of publication bias. This meta-analysis including studies from Asian countries demonstrated that ESD is an efficacious and safe option in the management of superficial pharyngeal cancers. More studies and studies from Western countries are needed to further validate these findings.

Despite being the most common healthcare-related infection in the US, nationwide data on readmission, healthcare consumption, and mortality in Clostridioides difficile infection (CDI) remain limited. We examined these outcomes in a US-based cohort of patients with CDI. We queried the 2017 Nationwide Readmission Database using ICD-10-CM codes to identify all adult patients admitted with a principal diagnosis of CDI. Primary outcomes were 30- and 90-day readmission rates. Secondary outcomes included mortality rates and healthcare consumption. Of the 83,865 patients discharged from an index hospitalization for CDI, 22.37% were readmitted within 30 days, and an additional 15.01% were readmitted within 90 days. Recurrent CDI was responsible for more than 30% of readmissions at both 30 and 90 days. Compared to the index hospitalization, readmissions were characterized by higher mortality (1.41% index vs. 4.86% 30-day vs. 4.40% 90-day) and increased hospital length of stay and charges. Medicaid insurance (HR 1.16), cirrhosis (HR 1.31), Type 1 diabetes mellitus (HR 1.38), and end-stage renal disease (HR 1.36) were independently associated with 30-day readmission (all p

Background Peroral endoscopic myotomy (POEM) is increasingly used to treat esophageal achalasia, but is associated with a high rate of gastroesophageal reflux disease (GERD). The aim of our meta-analysis was to compare short and standard POEM in terms of clinical success and postoperative GERD. Methods We conducted a systematic review and meta-analysis of studies that compared POEM using short myotomy with standard myotomy. The primary outcome was clinical success. Secondary outcomes were postoperative GERD, perioperative complications, operation time, and length of hospital stay. A random-effects model was used to calculate the risk ratios (RR), mean differences (MD), and confidence intervals (CI). A P-value

No Abstract available.

BACKGROUND AND STUDY AIM Ulcerative colitis (UC) is a chronic relapsing and remitting disease requiring frequent hospitalization. Biologics have become the recommended initial therapy for Biologics in patients with moderate to severe UC. Our aim was to estimate the changes in Nationwide Healthcare utilization and assess predictive factors of 30-day readmission, morbidity and mortality of UC. METHODS This is a retrospective observational study analyzing the Nationwide Readmission database from 2016 to 2017 using ICD-10 codes. The primary outcomes of the study were to assess the predictors of 30-day readmission in patients with UC. RESULTS Of the 54 138 adult patients with a primary diagnosis of UC, 13.2% were readmitted within 30 days of index hospitalization. The mortality rate (1.4 vs. 0.3%, P < 0.01), length of stay (7 vs. 4.9 days, P < 0.01) and hospital cost ($62 552 vs. $46 971, P < 0.01) were higher on readmission as compared to index hospitalization. We identified multiple patient-related factors (age

Variceal upper gastrointestinal bleeding (VUGIB) is a common and potentially lethal complication of cirrhosis. Population-based data regarding hospital readmission and other outcomes in VUGIB are limited. In a large United States database of patients with VUGIB, we evaluated readmission rates, mortality rates, healthcare resource consumption, and identified predictors of readmission. The 2017 Nationwide Readmission Database using ICD-10 codes was used to identify all adult patients admitted for VUGIB. Primary outcomes were 30- and 90-day readmission rates. Secondary outcomes included mortality, healthcare resource consumption, and predictors of readmission. Multivariate regression analysis was used to adjust for potential confounders. In 2017, there were 26,498 patients with VUGIB discharged from their index hospitalization, and 24.7% were readmitted (all-cause) within 30-days and 41.5% within 90-days. Recurrent VUGIB accounted for 26.7% and 28.9% of 30- and 90-day readmissions, respectively. Compared to index admissions, 30-day readmissions were associated with higher mortality (4.3% vs. 6.4%, p

Transient elastography (TE) provides accurate quantification of liver fibrosis. Its usefulness could be significantly amplified in terms of predicting liver-associated clinical events (LACE). Our aim was to create a model that accurately predicts LACE by combining the information provided by TE with other variables in patients with chronic liver disease (CLD). We retrospectively reviewed the electronic medical records of patients who underwent liver elastography, at John H. Stroger Hospital in Cook County, Chicago, IL. The incidences of LACE were documented including decompensation of CLD, new hepatocellular carcinoma, and liver-associated mortality. Significant predicting factors were identified through a forward stepwise Cox regression model. We used the beta-coefficients of these risk factors to construct the Cook Score for prediction of LACE. Receiver-operating characteristic (ROC) curves were plotted for Cook Score to evaluate its efficiency in prediction, in comparison with MELD-Na Score and FIB-4 Score. A total of 3097 patients underwent liver elastography at our institution. Eighty-eight LACE were identified. Age (hazard ratio (HR) 1.04, p = 0.002), aspartate aminotransferase to alanine aminotransferase ratio (HR 2.61, p

Background Patients with gastrointestinal angiodysplasia (GIA)-related bleeding are at high risk for readmissions, resulting in significant morbidity and an economic burden on the healthcare system. Aim The aim of the study was to determine the 30-day readmission rate with reasons, predictors, and costs associated with GIA-related bleeding in the USA. Methods We queried the National Readmission Database to identify patients hospitalized with GIA-related bleeding in the year 2016 using the International Classification of Diseases, Tenth Revision (ICD-10) codes. Primary outcomes included the 30-day readmission rate, and secondary outcomes were in-hospital mortality and resource utilization for index and re-hospitalizations. We also performed univariate and multivariate cox regression analysis to identify predictors of readmissions. Results A total of 25 079 index hospitalizations for GIA-related bleeding were identified in 2016. Out of these, 5047 (20.34%) patients got readmitted within the next 30 days. The most common diagnosis associated with readmissions were related to recurrent gastrointestinal bleeding. Readmissions compared to index hospitalization has significantly higher length of stay (5.38 vs. 5.11 days, P = 0.03), but mean hospitalization charges ($52 114 vs. $49 691, P = 0.11) and mean total hospitalization costs ($12 870 vs. $12 405, P = 0.16) were similar. Patients with multiple co-morbidities, length of stay >5 days, and end-stage renal disease were found to be independent predictors for 30-day readmissions. Conclusion Our study shows that one in five patients hospitalized with GIA-related bleeding was readmitted within 30 days of index hospitalization, placing a heavy economic burden on the healthcare system. Further research identifying strategies to reduce readmissions in these patients is needed.

Esophageal diverticula can cause significant symptoms and affect the quality of life. There has been recent interest in the use of peroral endoscopic myotomy in the management of esophageal diverticula (D-POEM). In this meta-analysis, we have evaluated the efficacy and safety of D-POEM in the management of esophageal diverticula. Several databases were reviewed from inception to 6/19/2020 to identify the studies evaluating the feasibility, efficacy and safety of D-POEM in the management of esophageal diverticula. Our outcomes of interest were technical success, adverse events and difference in mean pre- and post-procedure symptom score. We performed subgroup analysis including patients with Zenker's diverticulum who underwent POEM (Z-POEM). Pooled rates with 95% confidence intervals (CI) for all outcomes were calculated using random effect model. We calculated standard mean difference (SMD) with 95% CI to compare mean pre- and post-procedure symptom score. We included 7 studies with 233 patients. For D-POEM, pooled rates (95% CI) for technical success and adverse events were 95% (91%, 97%) and 6% (3%, 10%) respectively. For Z-POEM, pooled rates (95% CI) for technical success and adverse events were 95% (90%, 97%) and 6% (3%, 10%) respectively. Mean post-procedure symptom score for all patients who underwent D-POEM was significantly lower compared to mean pre-procedure symptom score, SMD (95% CI) 2.17 (1.51, 2.83). This meta-analysis demonstrated that D-POEM is a safe and feasible option for patients with symptomatic esophageal diverticula.

BACKGROUND AND STUDY AIMS The utility of water-aided techniques (WT): water exchange (WE) and water immersion (WI) have been studied extensively in the literature for improving colonoscopy outcome metrics such as adenoma detection rate. Serrated polyps owing to their location and appearance have a high miss rate. The authors performed a systematic review and meta-analysis of studies comparing WT with the standard gas-assisted (GA) method to determine if there was any impact on serrated polyp detection rate (SPDR) and sessile serrated polyp detection rate. METHODS The following databases were queried for this systematic review: Medline, EMBASE, Cochrane Library, CINAHL, and Web of Sciences. The authors only included randomized controlled trials (RCTs). The primary outcome was SPDR and secondary outcomes were sessile serrated polyp detection rate and cecal intubation rate. Risk ratios (RRs) were calculated for each outcome. A P-value

ERCP is the first line of treatment for malignant biliary obstruction and EUS-guided biliary drainage (EUS-BD) is usually used for patients who have failed ERCP. EUS-guided gallbladder drainage (EUS-GBD) has been suggested as a rescue treatment for patients who fail EUS-BD and ERCP. In this meta-analysis, we have evaluated the efficacy and safety of EUS-GBD as a rescue treatment of malignant biliary obstruction after failed ERCP and EUS-BD. We reviewed several databases from inception to August 27, 2021, to identify studies that evaluated the efficacy and/or safety of EUS-GBD as a rescue treatment in the management of malignant biliary obstruction after failed ERCP and EUS-BD. Our outcomes of interest were clinical success, adverse events, technical success, stent dysfunction requiring intervention, and difference in mean pre- and postprocedure bilirubin. We calculated pooled rates with 95% confidence intervals (CI) for categorical variables and standardized mean difference (SMD) with 95% CI for continuous variables. We analyzed data using a random-effects model. We included five studies with 104 patients. Pooled rates (95% CI) of clinical success and adverse events were 85% (76%, 91%) and 13% (7%, 21%). Pooled rate (95% CI) for stent dysfunction requiring intervention was 9% (4%, 21%). The postprocedure mean bilirubin was significantly lower compared to preprocedure bilirubin, SMD (95% CI): -1.12 (-1.62--0.61). EUS-GBD is a safe and effective option to achieve biliary drainage after unsuccessful ERCP and EUS-BD in patients with malignant biliary obstruction.

Despite being the most common healthcare-related infection in the US, nationwide data on readmission, healthcare consumption, and mortality in Clostridioides difficile infection (CDI) remain limited. We examined these outcomes in a US-based cohort of patients with CDI.We queried the 2017 Nationwide Readmission Database using ICD-10-CM codes to identify all adult patients admitted with a principal diagnosis of CDI. Primary outcomes were 30- and 90-day readmission rates. Secondary outcomes included mortality rates and healthcare consumption.Of the 83,865 patients discharged from an index hospitalization for CDI, 22.37% were readmitted within 30 days, and an additional 15.01% were readmitted within 90 days. Recurrent CDI was responsible for more than 30% of readmissions at both 30 and 90 days. Compared to the index hospitalization, readmissions were characterized by higher mortality (1.41% index vs. 4.86% 30-day vs. 4.40% 90-day) and increased hospital length of stay and charges. Medicaid insurance (HR 1.16), cirrhosis (HR 1.31), Type 1 diabetes mellitus (HR 1.38), and end-stage renal disease (HR 1.36) were independently associated with 30-day readmission (all p 0.01), with similar findings in 90-day readmissions.In a large cohort of patients hospitalized for CDI, we found that approximately 1 in 5 were readmitted within 30-days, and more than 1 in 3 within 90-days. Readmission was characterized by increased mortality and greater healthcare consumption. Additionally, we found independent associations for readmission that may help identify patients at high-risk. Prospective investigation is needed to identify means to reduce the healthcare consumption and mortality in CDI.

The incidence of fungal infection in intensive care units have been increasing over the years and Aspergillosis is one of the common fungal infections in the ICUs. It is a challenge for critical care experts to diagnose fungal infections on time and initiate appropriate management strategy to prevent adverse outcomes. Fungal infections may be notorious in not being diagnosed with a chest X ray alone as fungal infections related cavitary lesions may not always be seen in a chest X ray, necessitating the need of a CT Scan early on in the course of the illness. A chest CT scan may further be justified if the patient is not responding to a protracted course of higher antibiotics. Any delay in diagnosis may lead to poor outcome. Here we present a case who underwent subtotal gastrectomy for adenocarcinoma of stomach and presented one month later with fever, cough and shortness of breath. The patient was subsequently managed in the ICU but later expired following pneumothorax due to rupture of lung cavity associated with aspergillosis. Bangladesh Crit Care J September 2020; 8(2): 131-133

Background and aims: Anti-neoplastic immunotherapy has revolutionized cancer management; however, its safety profile with respect to liver-related injury remains largely unexplored. Herein, we analyzed a United States national database to determine the incidence, mortality, and predictors of hepatotoxicity in the setting of anti-neoplastic immunotherapy. Methods: This was a nationwide retrospective study of hospital encounters from 2011 to 2014 using the National Inpatient Sample (NIS) database. We utilized the International Classification of Diseases, Ninth Revision (ICD-9) coding system to identify all adult patients who underwent anti-neoplastic immunotherapy during hospitalization. The primary outcome was the incidence of hepatotoxicity during the same hospitalization. Secondary outcomes included in-hospital mortality as well as socioeconomic and ethno-racial predictors of hepatotoxicity. Analyses were performed using IBM SPSS Statistics 23.0. Results: The sample included 3002 patients who underwent inpatient anti-neoplastic immunotherapy. The incidence of hepatotoxicity was 10.1%, which was significantly higher as compared to a matched inpatient population (adjusted odds ratio (aOR) 4.93, 95% confidence interval (CI): 3.80–6.40, P = 0.001). No significant mortality difference was seen in those that developed hepatotoxicity compared to those who did not (aOR 0.47, 95% CI: 0.03–8.03, P = 0.612). Age under 60 (aOR 1.56, 95% CI: 1.23–1.78, P = 0.050) and white race (aOR 1.85, 95% CI: 1.35–2.04, P

Variceal upper gastrointestinal bleeding (VUGIB) is a common and potentially lethal complication of cirrhosis. Population-based data regarding hospital readmission and other outcomes in VUGIB are limited.In a large United States database of patients with VUGIB, we evaluated readmission rates, mortality rates, healthcare resource consumption, and identified predictors of readmission.The 2017 Nationwide Readmission Database using ICD-10 codes was used to identify all adult patients admitted for VUGIB. Primary outcomes were 30- and 90-day readmission rates. Secondary outcomes included mortality, healthcare resource consumption, and predictors of readmission. Multivariate regression analysis was used to adjust for potential confounders.In 2017, there were 26,498 patients with VUGIB discharged from their index hospitalization, and 24.7% were readmitted (all-cause) within 30-days and 41.5% within 90-days. Recurrent VUGIB accounted for 26.7% and 28.9% of 30- and 90-day readmissions, respectively. Compared to index admissions, 30-day readmissions were associated with higher mortality (4.3% vs. 6.4%, p 0.01), increased mean hospital length of stay (5.6 days vs. 4.5 days, p 0.01), and charges ($65,984 vs. $53,784, p 0.01), with similar findings in 90-day readmissions. Factors associated with 30-day readmission included end-stage renal disease (HR 1.2, p 0.05), chronic kidney disease (HR 1.31, p 0.01), and acute kidney injury (HR 1.14, p 0.05).Based on a nationwide cohort of hospitalized VUGIB patients, 25% were readmitted within 30-days and 42% within 90-days. Readmission was associated with increased mortality and healthcare consumption compared to the index admission. Additionally, acute and chronic renal injury were predictors of patients at high-risk for readmission.

BACKGROUND AND AIMS Empiric esophageal dilation is frequently performed for non-obstructive dysphagia. Studies evaluating its efficacy have reported conflicting results. In this meta-analysis, we have evaluated the efficacy of esophageal dilation in the management of non-obstructive dysphagia. METHODS We reviewed several databases from inception to 26 May 2021 to identify randomized controlled trials (RCTs) and observational studies that evaluated the role of empiric esophageal dilation for non-obstructive dysphagia. Our outcomes of interest were clinical success (improvement in dysphagia after dilation) and difference in post-operative dysphagia score between groups. For categorical variables, we calculated pooled odds ratios (OR) with 95% confidence intervals (CI); for continuous variables, we calculated standardized mean difference (SMD) with 95% CI. Data were analyzed using a random effects model. We used GRADE framework to ascertain the quality of evidence. RESULTS We included 4 studies (3 RCTs and one observational) with 243 patients; there were 133 treated with empiric dilation and 110 controls. We found no significant difference in clinical success (OR (95% CI) 1.91 (0.89, 4.08)) or post-procedure dysphagia score between groups (SMD (95% CI) 0.38 (-0.37, 1.14)). Our findings remained consistent on subgroup analysis including RCTs only. Quality of evidence ranged from low to very low based on GRADE framework. CONCLUSIONS Our meta-analysis does not support the use of empiric esophageal dilation in patients with non-obstructive dysphagia. More studies are required to confirm these findings.

COVID-19 has become a pandemic since its emergence in Wuhan, China. The disease process was initially defined by presence of respiratory symptoms; however, it is now well studied and shown in evidence that this is a multisystem process. Involvement of gastrointestinal (GI) system has been identified, and GI symptoms can be the only presenting symptoms in some patients. Hence, it is important to identify and understand the GI symptoms associated with COVID-19 for appropriate care of patient. We conducted a systematic review and metaanalysis to identify the GI symptoms of COVID-19 and identify association of diarrhea with severity of COVID-19. We performed extensive search of Medline and Embase from December 2019 to May 2020 to identify articles reporting GI symptoms in COVID-19 patients. The primary outcome was prevalence of GI symptoms in COVID-19 patients, and secondary outcome was the association of diarrhea with disease severity. A total of 38 studies with 8407 patients were included. Of the total patients, 15.47% patients had at least one GI symptom. The pooled prevalence of nausea/vomiting was 7.53% and diarrhea was 11.52%. On metaanalysis, patients with diarrhea as one of the presenting symptoms were more likely to have severe disease (OR 1.63, 95% CI: 1.11–3.38, p = 0.01). Our systematic review and metaanalysis demonstrated that GI symptoms are common in COVID-19. Presence of diarrhea as a presenting symptom is associated with increased disease severity and likely worse prognosis. Early recognition of patients is needed for prompt management of this at-risk population. Supplementary Information The online version contains supplementary material available at 10.1007/s42399-020-00662-w.

Background Patients with cirrhosis are at increased risk of Clostridioides difficile infection (CDI). We analyzed outcomes and healthcare utilization in hospitalized cirrhotic patients with CDI. Methods The Nationwide Inpatient Sample from 2016-2017 identified 8245 hospitalized patients with a concurrent diagnosis of cirrhosis and CDI. Our primary outcome was in-hospital all-cause mortality. Secondary outcomes were length of stay (LOS), hospitalization charges and costs, shock, sepsis, acute kidney injury (AKI), intensive care unit (ICU) admission, and home discharge. Results There was no significant difference in all-cause in-hospital mortality between patients with cirrhosis compared to patients without cirrhosis (adjusted odds ratio [aOR] 1.31, 95% confidence interval [CI] 0.89-1.93; P=0.16). Patients with cirrhosis had a slightly but statistically significantly longer mean LOS (+0.57 days, P=0.001). The adjusted difference in mean hospitalization charges was greater in patients with cirrhosis ($+4094, 95%CI $1080-7108; P=0.008), as was the mean hospitalization cost ($+1349, 95%CI $600-2098; P

Studies evaluating the role of tranexamic acid in acute upper GI bleeding (UGIB) have reported conflicting results. In this systematic review, we have evaluated the efficacy and safety of tranexamic acid in UGIB.We searched several databases from inception to June 6, 2020 to identify randomised controlled trials (RCTs) that compared tranexamic acid and placebo in UGIB. Our outcomes of interest were mortality, rebleeding, all thromboembolic events, venous thromboembolic events, need for transfusion, endoscopic intervention and surgery. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using fixed effect model. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework to assess the certainty of evidence.We included 12 RCTs comprising 14,100 patients. We found no significant difference in mortality, pooled RR (95% CI) 0.87 (0.74-1.01), rebleeding, pooled RR (95% CI) 0.90 (0.79-1.02), need for surgery, pooled RR (95% CI) 0.86 (0.73-1.02), need for transfusion, pooled RR (95% CI) 1.00 (0.99-1.01) or thromboembolic events, RR (95% CI) 1.16 (0.87-1.56) between treatments. We found an increased risk of venous thromboembolic events with tranexamic acid, pooled RR (95% CI) 1.94 (1.23-3.05). Certainty of evidence based on the GRADE framework for the different outcomes ranged from low to very low.Tranexamic acid does not improve outcomes in UGIB and may increase the risk of venous thromboembolic events.

Background and aims Some studies have shown that intravenous (IV) lidocaine reduces the dose requirement of propofol in GI endoscopic procedures. We conducted this study to evaluate the efficacy and safety of the combination of IV lidocaine and propofol compared with propofol alone in GI endoscopic procedures. Methods We reviewed several databases from inception to October 13, 2020, to identify randomized controlled trials (RCTs) that compared the role of IV propofol and lidocaine with IV propofol plus placebo for sedation in endoscopic procedures. Our outcomes of interest were the differences in total dose of propofol administered, procedure time, and intraoperative adverse events. For categorical variables, we calculated pooled risk ratios with 95% confidence intervals (CI); for continuous variables, we calculated standardized mean difference (SMD) with 95% CI. Data were analyzed using a random effect model. We used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework to ascertain the quality of evidence. Results We included 5 randomized controlled trials with 318 patients. We found that the total dose of propofol administered was significantly lower in the lidocaine group than the control group (SMD, −0.76; 95% CI, −1.09 to −0.42). We found no significant difference in procedure time (SMD, 0.16; 95% CI, −0.26 to 0.57) or adverse events (risk ratio, 0.60; 95% CI, 0.35-1.03) between the groups. There was moderate to substantial heterogeneity in the data. Quality of evidence based on the GRADE framework ranged from low to moderate. Conclusions Moderate quality of evidence suggests that IV lidocaine decreases the dose of propofol administered for GI endoscopic procedures.