Corona VIrus Disease 2019 (COVID-19) pandemic has forced important restructuring in health-care attendance. The virus responsible for COVID-19, SARS-Cov2, has its highest load in the nasopharynx. Virus enters into the cells via the angiotensin-converting enzyme 2 (ACE2) receptor, which is expressed in the blood vessels of the lungs, brain, skin, and digestive system. In the digestive tract, ACE2 is widely expressed on esophageal epithelial cells,1 on gastric glandular cells and on enterocytes in small bowel and colon.1 Main transmission is via aerosols and droplets generation although virus can also be spread indirectly via contaminated surfaces.2 The virus is present in feces, but fecal-oral transmission has not been considered as clinically relevant due to denaturation of virus protein capsid in contact with intestinal secretions.3

All diagnostic examinations which imply near contact with potentially infectious biological material, especially those examinations able to generate aerosols like intubation of gastrointestinal tract during a digestive motility examination, had been considered to have a high infection risk. To minimize the risk of infection during motility examinations of the gastrointestinal tract, many scientific societies (ESNM, ASENEM, ANMS, ANMA) have developed guidelines with recommendations on how to perform those examinations during the pandemic.4, 5, 6, 7 All proposed algorithms include recommendations to perform a previous patient selection (evaluating the indication and establishing the priority, and clinical implication of the examination), evaluation of active infection risk (by means of reporting symptoms, identifying clinical signs of infection or performing COVID-19 specific detection tests) and measures that should be taken to perform motility testing with safety for health-care professionals and patients (using PPE (personal protection equipment), sterilizing used material). However, due to the lack of studies evaluating the real efficacy of the different detection and protection measures in different phases of the COVID-19 pandemic, each society has published its own guidelines with its own particularities based mainly on current knowledge of the virus dissemination pathways and common rules to prevent general transmission of infections in general.

The aim of the present study was to evaluate prospectively the independent value of reverse transcription polymerase chain reaction (RT-PCR) test and a symptom-based questionnaire before performing a digestive motility examination during different phases of incidence of the COVID-19 pandemic in an area with high impact of COVID-19 infection in north of Spain.