Extensive mucosal sloughing of the small intestine and colon in a patient with severe COVID‐19

Abstract

Patients with coronavirus disease 2019 (COVID‐19) primarily cause respiratory symptoms. However, gastrointestinal (GI) symptoms can also occur. The endoscopic characteristics of the GI tract in COVID‐19 patients remain unclear. We herein report a 62‐year‐old male with severe COVID‐19 who needed multidisciplinary treatment, including extracorporeal membrane oxygenation (ECMO). Despite the improvement in his respiratory status, GI bleeding developed. Capsule endoscopy and colonoscopy revealed extensive mucosal sloughing in the lower intestinal tract. Additionally, we performed a comprehensive analysis of the mRNA expression levels of various proinflammatory cytokines in the intestinal mucosal tissues. The results suggested a significant elevation of IL‐6 , which could be involved in the pathophysiology of the GI involvement in COVID‐19. Further investigation with more clinical data, including endoscopic findings and molecular analyses, will contribute to a comprehensive understanding of COVID‐19‐associated GI injury.

Impaired tryptophan metabolism in the gastrointestinal tract of patients with critical coronavirus disease 2019

“…Our institution reported that abdominal pain is a risk factor for severe disease outcomes in COVID-19 ( 2 ). We have also reported a rare case of severe gastrointestinal mucosal damage during the treatment of COVID-19 pneumonia ( 3 ).…”

COVID-19: gastrointestinal and hepatobiliary manifestations

“…[ 11 , [24] , [25] , [26] , [27] ] One case report describes diffuse small intestinal mucosal sloughing, reminiscent of graft-versus-host disease, detected by capsule endoscopy. [ 28 ] However, a significant number of upper GI tract examinations are normal (29.9% in one series). [ 24 ] Colonoscopic examination in COVID-19 patients has shown ischemic colopathy, non-specific erythema, non-specific colonic inflammation, and ulcerative inflammatory colitis.…”

“…[ 11 ] In the case mentioned earlier with small intestinal mucosal sloughing by capsule endoscopy, colonic biopsies showed edema, erosions, infiltration by lymphocytes, and epithelial cell apoptosis. [ 28 ] Finally, a report by Westerhoff and colleagues [ 88 ] describes ileal biopsies in a patient with COVID-19 that demonstrated active ileitis, villous lymphocytosis, increased goblet cells in the villi, and crypt hyperplasia. Neither ISH nor NGS was positive for SARS-CoV-2.…”

Membranes for the life sciences and their future roles in medicine

“…The use of artificial organs has become a preferred and safer curing method. Especially in the treatment of COVID-19, ECMO membranes (artificial lungs) have become the most effective method for the treatment of severe cases [9] , [10] .…”

“…Especially for PMP, the raw material and preparation technology are monopolistic. In addition to the above three generations of membrane materials, in the latest research, fluoropolymers have been reported to significantly improve the service life by reducing the surface energy during gas exchange and are expected to become a new research direction for the preparation of ECMO membranes [9] , [10] . In Park’s work, the as-prepared poly(vinylidene-co-hexafluoropropylene) membrane was coated with Hyflon AD60X (which is a typical fluoropolymer with an extremely low surface energy), displaying a repulsion for both water and blood without hemolysis in a long term.…”