Breaking data: Today we released a new study of 53K Americans revealing that use of proton pump inhibitors (eg. Prilosec, Prevacid, Nexium) is associated w/ a 2-4x risk of #COVID19. In this thread I explain why we did this study, what we found, what it may mean, & key limitations 2. Here is a link to the full peer-reviewed study published online in #AmJGastro: journals.lww.com/ajg/Documents/…. Also, the @AmCollegeGastro released this fact sheet with answers to FAQs: webfiles.gi.org/links/media/AC…. Both documents are more effective than tweets to convey the full results.

When should a negative #COVID19 test be ignored? Let's say a doctor sees a patient w/ possible #COVID19. She highly suspects infection because patient has cough, chest pain, abnormal chest x-ray, fever, diarrhea & known exposure. Doc puts the chance at 90%. Next... (1/5) ... a throat swab is checked but comes back negative. Let's assume that throat swab is 90% sensitive & specific (in reality, it's lower than that, but let's assume a best case scenario). What is the chance this patient still has #COVID19? Read on... (2/5)

The equation below has never been more important. It's Bayes' theorem; I teach it to all my students. I'm not hearing much discussion about how to use this equation to diagnose #COVID19. As a result, I'm concerned we are missing cases. In a nutshell, here's how it works... (1/5) When clinicians see a patient w/ possible #COVID19, they should look at the whole picture (all symptoms, lab data, imaging, exposures, etc) & estimate a "pre-test probability" of disease. If it's high enough, they should test. Test comes back either +ive or negative. Next...(2/5)

*Please share*: Top ten facts about #COVID19 and the gut: C19 is #NotJustCough. In the past 3 wks we've learned a lot about how C19 infects the gastrointestinal tract. In this tweetorial, I summarize what's known and provide relevant research links in one place. Here goes...(1/6) 1. 50.5% of hospitalized patients report one or more digestive symptom (including diarrhea, nausea, vomiting, abdominal pain, or low appetite). Here's the link: journals.lww.com/ajg/Documents/…

2. 18.6% of hospitalized patients report diarrhea, in particular (same link as above) (2/6)

Breaking #COVID19 Data – Please Share: #COVID19 is #NotJustCough. For the past 2 weeks I've worked with colleagues in Wuhan to analyze data on digestive symptoms of #COVID19. We just published the pre-print here: journals.lww.com/ajg/Documents/… This paper focuses on people with...(1/8) ...less severe disease reflective of those in the community who do not need critical care but wonder about their symptoms. In this study, we focused on #COVID19 patients w/ digestive symptoms like diarrhea, nausea, vomiting. We found that compared to people w/ only...(2/8)

Evolving #COVID19 data, please share: Could COVID19 spread through stool? In this thread, I will summarize what our editorial team at #AmJGastro knows about the risk of fecal spread. I will start by emphasizing that we do *not* yet know, for sure, if it spreads though... (1/10) ...stool. But we do know the following: (1) #COVID19 genetic material is frequently found in stool. This study found 53% of stool samples were positive: gastrojournal.org/article/S0016-…. (2) The virus sheds into the stool for weeks, even after respiratory symptoms subside. This... (2/10)

Breaking #COVID19 Data – Please Share (1/10): On behalf of @AmCollegeGastro, our editorial team at #AmJGastro just released a study from Wuhan, China reporting 48.5% of patients presented to hospital with a digestive symptom as their chief complaint. Coronavirus is #NotJustCough. (2/10) One in 5 presented with either diarrhea, nausea, vomiting or belly pain as the presenting complaint. “Clinicians must bear in mind,” write the authors, “that digestive symptoms, such as diarrhea, may be a presenting feature of #COVID-19, & that the index of suspicion may…

1/7 Important #COVID19 Updates (please share): We know that Covid19 is principally a respiratory illness. But people are starting to wonder if it presents in other ways, namely as a gastrointestinal (GI) illness. If so, that’s critical to know, because current testing requires… 2/7 …respiratory symptoms. Moreover, absence of diarrhea is being used by some doctors to distinguish #COVID19 from flu. However, several reports now indicate that COVID19 is detected in stool. A forthcoming report, available here (gastrojournal.org/article/S0016-…), shows that 53.4%...