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Prevalence of Clostridioides difficile and Other Gastrointestinal Pathogens in Patients with COVID-19.
Laszkowska, M, Kim, J, Faye, AS, Joelson, AM, Ingram, M, Truong, H, Silver, ER, May, B, Greendyke, WG, Zucker, J, et al
Digestive diseases and sciences. 2021;(12):4398-4405
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Abstract
BACKGROUND Gastrointestinal symptoms are common in patients with COVID-19, but prevalence of co-infection with enteric pathogens is unknown. AIMS This study assessed the prevalence of enteric infections among hospitalized patients with COVID-19. METHODS We evaluated 4973 hospitalized patients ≥ 18 years of age tested for COVID-19 from March 11 through April 28, 2020, at two academic hospitals. The primary exposure was a positive COVID-19 test. The primary outcome was detection of a gastrointestinal pathogen by PCR stool testing. RESULTS Among 4973 hospitalized individuals, 311 were tested for gastrointestinal infections (204 COVID-19 positive, 107 COVID-19 negative). Patients with COVID-19 were less likely to test positive compared to patients without COVID-19 (10% vs 22%, p < 0.01). This trend was driven by lower rates of non-C.difficile infections (11% vs 22% in COVID-19 positive vs. negative, respectively, p = 0.04), but not C. difficile infection (5.1% vs. 8.2%, p = 0.33). On multivariable analysis, infection with COVID-19 remained significantly associated with lower odds of concurrent GI infection (aOR 0.49, 95% CI 0.24-0.97), again driven by reduced non-C.difficile infection. Testing for both C.difficile and non-C.difficile enteric infection decreased dramatically during the pandemic. CONCLUSIONS Pathogens aside from C.difficile do not appear to be a significant contributor to diarrhea in COVID-19 positive patients.
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Characteristics and Maternal-Fetal Outcomes of Pregnant Women Without Celiac Disease Who Avoid Gluten.
Wagner, BA, Zork, N, Blackett, JW, Green, PHR, Lebwohl, B
Digestive diseases and sciences. 2020;(10):2970-2978
Abstract
BACKGROUND Gluten avoidance among patients without celiac disease has become increasingly popular, especially among young and female demographics; however, no research has explored gluten avoidance during pregnancy, when nutrition is particularly important. AIMS To determine whether avoiding gluten in pregnancy is associated with any medical, obstetric, or neonatal characteristics. METHODS In this single-center retrospective cohort study, we identified women with singleton pregnancies who avoid gluten based on antenatal intake questionnaire responses and inpatient dietary orders, excluding those with celiac disease. Certain demographic, medical, obstetric, and neonatal characteristics were compared to matched controls who do not avoid gluten. RESULTS From July 1, 2011 to July 1, 2019, 138 pregnant women who avoid gluten were admitted for delivery of singleton gestations. Compared to controls, gluten-avoidant women had fewer prior pregnancies (p = 0.005), deliveries (p < 0.0005), and living children (p < 0.0005), higher rates of hypothyroidism (OR = 3.22; p = 0.001) and irritable bowel syndrome (OR = 6.00; p = 0.019), higher second trimester hemoglobin (p = 0.018), and lower body mass index at delivery (p = 0.045). Groups did not differ in any obstetric or fetal characteristics. CONCLUSIONS Gluten avoidance in pregnancy is common and, in women without celiac disease, is associated with higher rates of hypothyroidism and irritable bowel syndrome, fewer pregnancies, term births, and living children, and lower peripartum BMI, but is not associated with any obstetric or neonatal comorbidities. Avoiding gluten does not appear to adversely affect maternal or fetal health, but reasons for gluten avoidance, as well as long-term maternal and pediatric outcomes after gluten avoidance in pregnancy, warrant further study.
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Characteristics and comorbidities of inpatients without celiac disease on a gluten-free diet.
Blackett, JW, Shamsunder, M, Reilly, NR, Green, PHR, Lebwohl, B
European journal of gastroenterology & hepatology. 2018;(4):477-483
Abstract
OBJECTIVES Despite the increasing popularity of gluten-free diet (GFD), the demographic characteristics and medical features of patients without celiac disease on this diet have not been extensively investigated.We aimed to characterize the medical conditions and demographic backgrounds of hospitalized patients without celiac disease who adhere to a GFD, to further understand their reasons for gluten avoidance. MATERIALS AND METHODS We performed an observational cohort study on all inpatients at Columbia University Medical Center on a GFD in 2011-2016, excluding those with celiac disease, compared with age-matched and sex-matched inpatients on a regular diet. We determined the odds ratio (OR) of being on a GFD for various comorbidities using conditional logistic regression. RESULTS Of 769 inpatients on a GFD, most (63.6%) did not have celiac disease. Gluten-avoiding patients were more likely to be non-Hispanic Whites [OR: 2.92; 95% confidence interval (CI): 2.31-3.70]. They had a lower prevalence of hypertension (OR: 0.38; 95% CI: 0.27-0.52) and diabetes (OR: 0.58; 95% CI: 0.32-0.75) and higher prevalence of inflammatory bowel disease (OR: 1.56; 95% CI: 1.02-2.41), irritable bowel syndrome (OR: 6.16; 95% CI: 2.11-10.23), hyperthyroidism (OR: 2.73; 95% CI: 1.22-6.10), hypothyroidism (OR: 2.06; 95% CI: 1.39-3.06), lupus (OR: 2.87; 95% CI: 1.13-7.29), and autism spectrum disorder (OR: 23.42; 95% CI: 5.29-103.73). CONCLUSION Nonceliac gluten-avoiding patients have higher prevalences of inflammatory bowel disease, irritable bowel syndrome, thyroid disease, lupus, and autism spectrum disorder, suggesting patients with these disorders have turned to a GFD for perceived benefit, despite a scant evidence basis.