Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. The infection started as an outbreak of pneumonia-like symptoms in Wuhan, China. Within a few weeks, it spread across the entire globe resulting in millions of cases and thousands of deaths. While respiratory symptoms and complications are well-defined and can be severe, non-respiratory symptoms of COVID-19 are increasingly being recognized. Gastrointestinal manifestations such as nausea, vomiting, diarrhea, and abdominal pain have been added to the list of common COVID-19 symptoms. Their prevalence has been increasing, probably due to increased recognition and experience with the pandemic. Furthermore, diarrhea and stool testing may change prevalence and transmission rates due to suspicion for fecal-oral transmission of the COVID-19. Due to this risk, various countries have started testing wastewater and sewage systems to examine its role in the spread of SARS-CoV-2 among communities. In this review article, we describe the common gastrointestinal manifestations in COVID-19, their prevalence based upon the current literature, and highlight the importance of early recognition and prompt attention. We also note the role of fecal-oral transmission. Furthermore, the mechanisms of these symptoms, the role of medications, and potential contributing factors are also elaborated.

Coronaviruses have caused three global outbreaks in the last 20 years, which include Severe Acute Respiratory Syndrome (SARS) caused by SARS-CoV (SARS-CoV-1), Middle East Respiratory Syndrome (MERS) by MERS-CoV and Coronavirus Disease-2019 (COVID-19) due to SARS-CoV-2. These outbreaks share many similarities, including clinical presentation, transmission, and management. Although respiratory manifestations are responsible for most of the morbidity and mortality in these conditions, extra-pulmonary manifestations such as gastrointestinal symptoms are also increasingly recognized as important symptoms. Important gastrointestinal symptoms include nausea, vomiting, anorexia, diarrhea, and abdominal pain. Hepatic manifestations such as abnormal aminotransferases are also noted in these patients. Early identification of GI symptoms is crucial as some patients can present only with GI manifestations in the absence of pulmonary symptoms. Furthermore, patients with diarrhea have tested positive for viral RNA in the stool. This has been reported even after the resolution of respiratory symptoms and can extend up to many days from the onset of symptoms. Because of this phenomenon, there is a theoretical risk of fecal-oral transmission and the potential spread of the disease. Though GI symptoms are frequently observed, understanding the pathogenesis of these symptoms is crucial, as it can not only of public health importance but could also identify infected patients early in the spread. Understanding the different GI and hepatic manifestations with underlying mechanisms of symptoms can assist in the therapeutic management of these patients. In this article, we summarize various GI and hepatic manifestations with their prevalence, underlying pathophysiology with emphasis on stool positivity.

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The first case of coronavirus disease 2019 was reported in December 2019 in China. World Health Organization declared it a pandemic on March 11, 2020. It has caused significant morbidity and mortality worldwide. Persistent symptoms and serious complications are being reported in patients who survived COVID-19 infection, but long-term sequelae are still unknown. Several vaccines against COVID-19 have been approved for emergency use around the globe. These vaccines have excellent safety profiles with few reported side effects. Drug-induced hepatotoxicity is mainly seen with different drugs or chemicals. There are only a few reported cases of hepatotoxicity with vaccines. We present a case of liver injury after administration of the vaccine against the COVID-19 infection.

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Background: The clinical application of stem cell therapy for myocardial infarction will require the development of methods to monitor treatment and pre-clinical assessment in a large animal model, to determine its effectiveness and the optimum cell population, route of delivery, timing, and flow milieu.