COVID‐19 and the digestive system: More than just a “flu”

Goh, Khean Lee; Chuah, Kee Huat

doi:10.1002/jgh3.12364

Cited by 2 publications

(3 citation statements)

References 11 publications

(17 reference statements)

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“…The significance of GI involvement in COVID-19 patients requires attention in clinical practices, such as incorporation of rectal swab testing before discharging patients, as well as the importance of personal protective equipment in the endoscopy setting. These precautions will be imperative in our battle against COVID-19[ 63 ].…”

Section: Discussionmentioning

confidence: 99%

Pathophysiological mechanisms underlying gastrointestinal symptoms in patients with COVID-19

Jin

Singh

et al. 2021

WJG

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Gastrointestinal (GI) symptoms, such as diarrhea, abdominal pain, vomiting, and anorexia, are frequently observed in patients with coronavirus disease 2019 (COVID-19). However, the pathophysiological mechanisms connecting these GI symptoms to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections remain elusive. Previous studies indicate that the entry of SARS-CoV-2 into intestinal cells leads to downregulation of angiotensin converting enzyme 2 (ACE2) receptors resulting in impaired barrier function. While intestinal ACE2 functions as a chaperone for the amino acid transporter B0AT1, the B0AT1/ACE2 complex within the intestinal epithelium acts as a regulator of gut microbiota composition and function. Alternations to the B0AT1/ACE2 complex lead to microbial dysbiosis through increased local and systemic immune responses. Previous studies have also suggested that altered serotonin metabolism may be the underlying cause of GI disorders involving diarrhea. The findings of elevated plasma serotonin levels and high fecal calprotectin in COVID-19 patients with diarrhea indicate that the viral infection evokes a systemic inflammatory response that specifically involves the GI. Interestingly, the elevated proinflammatory cytokines correlate with elevated serotonin and fecal calprotectin levels further supporting the evidence of GI inflammation, a hallmark of functional GI disorders. Moreover, the finding that rectal swabs of COVID-19 patients remain positive for SARS-CoV-2 even after the nasopharynx clears the virus, suggests that viral replication and shedding from the GI tract may be more robust than that of the respiratory tract, further indicating fecal-oral transmission as another important route of viral spread. This review summarized the evidence for pathophysiological mechanisms (impaired barrier function, gut inflammation, altered serotonin metabolism and gut microbiota dysbiosis) underlying the GI symptoms in patients with COVID-19.

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Section: Discussionmentioning

confidence: 99%

Pathophysiological mechanisms underlying gastrointestinal symptoms in patients with COVID-19

Jin

Singh

et al. 2021

WJG

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“…6 There are abundant viral receptor expressions on gastrointestinal epithelial cells, and recent studies have suggested possible fecal-oral transmission. [7][8][9] It has been suggested that preventive measures against fecal contamination should be implemented owing to prolonged duration of viral shedding in stool up to 16 days from symptom onset. 10 The Association of Southeast Asian Nations (ASEAN) is composed of 11 countries with a total population of more than 655 million people, ranking third among all subregions in the world.…”

Section: Introductionmentioning

confidence: 99%

“…Anorexia, diarrhea, abdominal pain, nausea, and vomiting are reported in 3–79% of patients 6 . There are abundant viral receptor expressions on gastrointestinal epithelial cells, and recent studies have suggested possible fecal–oral transmission 7–9 . It has been suggested that preventive measures against fecal contamination should be implemented owing to prolonged duration of viral shedding in stool up to 16 days from symptom onset 10 …”

Section: Introductionmentioning

confidence: 99%

Gastrointestinal manifestation as clinical predictor of severe COVID‐19: A retrospective experience and literature review of COVID‐19 in Association of Southeast Asian Nations (ASEAN)

2020

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Background and Aim Coronavirus disease 19 (COVID‐19) has caused over 200 000 deaths worldwide. Thailand announced the first confirmed case outside mainland China in January 2020. The disease also spread widely across Association of Southeast Asian Nations (ASEAN). Gastrointestinal manifestations could be presenting symptoms of COVID‐19. This study aimed to determine the prevalence of gastrointestinal manifestations of COVID‐19 patients in Thailand and review important aspects of this disease in ASEAN. Methods Thai patients diagnosed with COVID‐19 at Thammasat University Hospital, Thailand, were evaluated between 1 January 2020 and 30 April 2020. Patients' data, clinical presentation, exposure risk, past medical history, laboratory results, and treatment outcomes were extensively reviewed. Results A total of 352 COVID‐19 tests were performed, and 40 patients with positive tests were studied. The mean age was 30.5 years, and 55% were female. Most (82.5%) had no underlying diseases. Comorbidities were associated with severe COVID‐19 (odds ratio [OR] 29.93; 95% confidence interval [CI] 2.31–388.40, P = 0.009). Gastrointestinal symptoms were present in 12 patients (30%). The most common presenting symptoms were anorexia (17.5%) and diarrhea (15%). Gastrointestinal symptoms developed before (9.1%), concurrent with (63.6%), and after (27.3%) respiratory symptoms. Diarrhea was significantly associated with severe COVID‐19 (OR 38.52; 95% CI 3.11–476.70, P = 0.004). Twenty‐four patients (60%) received antiviral drugs; 40% had only supportive care. Only one patient required intensive care. No patient died. Conclusions Gastrointestinal manifestations in COVID‐19 patients are common symptoms and can occur anytime during the disease course. Patients presenting with only gastrointestinal symptoms should raise clinical suspicion for COVID‐19 in areas with high disease incidence. Clinically severe COVID‐19 was associated with comorbidities and diarrhea.

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COVID‐19 and the digestive system: More than just a “flu”

Cited by 2 publications

References 11 publications

Pathophysiological mechanisms underlying gastrointestinal symptoms in patients with COVID-19

Pathophysiological mechanisms underlying gastrointestinal symptoms in patients with COVID-19

Gastrointestinal manifestation as clinical predictor of severe COVID‐19: A retrospective experience and literature review of COVID‐19 in Association of Southeast Asian Nations (ASEAN)

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