Gastrointestinal Symptoms and Coronavirus

Podcast Transcript

Dr. Scott Steele:
Butts & Guts, a Cleveland Clinic podcast exploring your digestive and surgical health from end-to-end.

Hi, everyone and welcome to another episode of Butts & Guts, I'm your host, Scott Steele, the Chair of Colorectal Surgery here at the Cleveland Clinic in beautiful Cleveland, Ohio. We are very pleased to have a returning guest back on, Dr. Miguel Regueiro, who is the Chairman of Gastroenterology and Hepatology here in Cleveland Clinic's Digestive Disease and Surgery Institute. Miguel, welcome back to Butts & Guts.

Dr. Miguel Regueiro:
Thank you, Scott, thanks for having me.

Dr. Scott Steele:
So obviously, kind of in the phase of what's going on right now and understanding that Corona virus has disrupted a lot of our listener's daily lives and there's very uncertain and scary times for a lot of people, we wanted to focus in on something that may be not be getting as much publicity and that's the gastrointestinal symptoms associated with the Corona virus.

Before we jump into it, I would really, truly again like to thank all of our listeners who are working, not only in healthcare but in so many different aspects within our community, helping those out in need. I do also want to remind people that as the Covid-19 health crisis has been a rapidly evolving event that's constantly fluid and changing, our top priority here at the Cleveland Clinic has been always remaining to care for our patients in the safest way possible and also protecting our caregivers.

And also to remind people that we remain open here at the Cleveland Clinic. Our emergency departments remain open, our clinics remain open and our goal is to make sure that we have the best possible community health that we can get and that if any of these symptoms that we're going to discuss here today are arising in you, a family or a friend to please seek immediate medical attention for any symptoms and to make sure that you know that we are here for you.

So with that in mind, again back to you, Miguel, and again as you've been on you know I'd like to make sure that all of our listeners out there who maybe have not had a chance to go back and talk about the IBD family home that you came on the last time for, have a little bit of background for you. So give us a little bit about your background and let the listeners know how it came to the point that you're here at the Cleveland Clinic.

Dr. Miguel Regueiro:
Thanks, again, Scott. So I'm the chairman for gastroenterology, hepatology and nutrition. I joined the Cleveland Clinic in May of 2018 and really the two primary reasons that I joined were one, the opportunity to lead an incredible group of gastroenterologists but also to work with surgical colleagues like you and the other department chairs and wonderful surgeons.

But then secondly, the idea of this population health model and this inflammatory bowel disease medical home, which is really a multi-disciplinary care group where we wrap around the patient who has Crohn's or ulcerative colitis, not only serving their needs from a gastroenterologic standpoint, so medications, surgery, as you very well know. But more than that, really whole person care, so stress, psychology, diet, nutrition, social work, all the needs that patients may have, including health maintenance.

So this is probably a brief snippet of why I came here and we've grown the medical home and really are doing some great things now, expanding into a medical neighborhood for IBD, which I think is the first in the country.

Dr. Scott Steele:
So who would have thought since the last time that you were on how much the world has changed and how much some of the different priorities out there have crept into view but there is a lot of different sources out there that can talk about Corona virus itself, droplet spread, other things, but can you talk a little bit about, let's start first with this idea of how it affects the gastroenterologist patient in terms of spread, either upper or lower?

Dr. Miguel Regueiro:
So SARS-Covid 2 obviously is this novel Corona virus, which most people have understood manifests as upper respiratory infection. So shortness of breath, cough, fever, probably the traditional symptoms that people know but it does bind to a receptor, this angiotensin converting enzyme receptor, which lines the gastrointestinal tract, really from the stomach all the way down to the colon.

So patients with Corona virus or Covid-19 may actually present with GI symptoms as their first symptom or may actually have symptoms that continue even once their respiratory symptoms clear and the common symptoms with this include what we would see with another, any viral gastroenteritis, nausea, vomiting, diarrhea, pain. Interestingly, there are a definite cohort of these patients, 25-30%, who will have GI symptoms. Other symptoms include anorexia, not wanting to eat, loss of appetite. And interestingly, bundled into GI we also put dysgeusia, this loss of taste and anosmia, this loss of smell, which sometimes factors into the patients not wanting to eat or even drink anything.

Dr. Scott Steele:
So you went into it a little bit in there but why do you think that these type of symptoms may occur in patients who have Corona virus and why do they so much overlap with just these routine symptoms that patients may experience independent of being infected with the virus?

Dr. Miguel Regueiro:
This has probably been one of the scariest viruses we've ever seen, really in the history of the world or at least modern history, and we're still learning and I guess my honest answer is, we don't really know. What we do think is that the virus does seem to infect cells that are commonly in the respiratory tract but also in the GI tract.

So the virus seems to shed in the gastrointestinal tract, both upper and lower. It does seem to impact in terms of diarrhea, vomiting, nausea, pain. It is found in stool samples, although we don't think that this has what we would consider a fecal/oral spread to the virus. So we think it's more respiratory spread. But at the same time we've looked at this and I guess it's a long way of saying, we're still learning about it. We're still learning about its manifestations and how this acts.

Dr. Scott Steele:
So for our long time listeners here at Butts & Guts they know I like to play truth or myth so let's delve into that real quick. If I'm a listener out there I may be thinking, "God, I have had abdominal pain" or "I've been feeling a little bit full or a little bit diarrhea on the side, maybe I got the Corona virus." If I have one of these symptoms, truth or myth, I should get tested for Corona virus?

Dr. Miguel Regueiro:
No, I still think that's myth. I think most of the GI symptoms are still rare into themselves. Now, if you combine GI symptoms with upper respiratory symptoms and certainly fever, that's when I would probably get a better heightened awareness.

Dr. Scott Steele:
Truth or myth, I should avoid public restrooms because I may have transmission through, as you talked, through fecal spread?

Dr. Miguel Regueiro:
Myth, so far we do not think the virus is infective through fecal spread so don't hesitate to use public bathrooms because of Corona virus.

Dr. Scott Steele:
Truth or myth, I'm experiencing some GI symptoms that are occurring for a while but I'm scared to go into the doctor and so I'm going to put this on hold for a while?

Dr. Miguel Regueiro:
Myth and I would strongly recommend for patients who are out there who have symptoms that are getting worse, do not hesitate to contact your doctor. In fact, we want to catch things early so please seek medical attention if something is getting worse.

Dr. Scott Steele:
And Miguel, along those lines, can you talk to the listeners a little bit about your incorporation into telehealth or virtual visits. I know a lot of people, when they think, "Well, I've got a GI symptom I have to go into the doctor. There's no way that I can do that through the computer."

Dr. Miguel Regueiro:
Most of what we do now has actually been virtual visits or telehealth, telemedicine, essentially this virtual platform, which we see the patient on our computer or they're on their phone and I think this has really revolutionized care. In fact, most gastrointestinal diseases outside of the endoscopic procedure, are what we would consider cognitive, meaning talking to the patient, hearing symptoms. I've actually had patients show me with their phone if they have a rash or a mouth sore, something they're worried about. They can actually show that. That's a visual sign. So I would say 90% of what we do in the office we can do virtually and that's separate from, obviously, endoscopic procedure.

Dr. Scott Steele:
So let's talk a little bit about that endoscopic procedure, as well. What precautions have you been taking, both for the patient and for the caregiver and is endoscopy safe, whether it be upper or lower, during this time of the Corona virus?

Dr. Miguel Regueiro:
Endoscopy is definitely safe in the time of Corona virus. The measures that our society and many of our national and even international societies in gastroenterology have recommended that we wear an N-95 mask because of the potential for aerosolization, especially during endoscopic procedures. So at Cleveland Clinic and many other places, we've been doing that, really for the last six to eight weeks. So that has not changed and we do ask our patients before they come in if they have any respiratory symptoms or fever. Those are the patients that we would be cautious in bringing in if they're sick.

Dr. Scott Steele:
So, Miguel, just some final take home messages for our listeners, with regards to gastroenterology symptoms, the care for the gastroenterology patient in this time of Covid-19.

Dr. Miguel Regueiro:
I guess I would say in the time of Covid-19 if you have a GI symptom alone that doesn't mean you have Corona virus but if you have a GI symptom with upper respiratory symptoms and a fever, that is something that can go hand-in-hand, especially if you lose your sense of taste and smell and please don't hesitate to seek medical attention. A lot of what we're doing now is virtual. It is safe. We take extra precautions, especially at places like Cleveland Clinic, to make sure we insure the safety of you and your family coming in for a visit.

Dr. Scott Steele:
Absolutely and so for more information on Butts & Guts, on the Corona virus, we recommend our listeners to go to the podcast recently released with Dr. Conor Delaney, Patient Care During and After this Pandemic. And for the most up-to-date information on Covid-19, including appointment and visitor policies please visit, clevelandclinic.org/coronavirus. That's clevelandclinic.org/coronavirus.

And to speak with a specialist in the Digestive Disease and Surgery Institute please call 216-444-7000. That's 216-444-7000. In times like these it's important to keep up with your medical care and rest assured here at the Cleveland Clinic we're taking all the necessary precautions to sterilize our facilities, protect our caregivers and most importantly our patients.

Miguel, thank you so much for joining us here on Butts & Guts.

Dr. Miguel Regueiro:
Thank you, Scott.

Dr. Scott Steele:
That wraps things up here at Cleveland Clinic. Until next time, thanks for listening to Butts & Guts.