Gastrointestinal and Liver Manifestations of COVID-19

Abstract

A novel Coronavirus, SARS-CoV-2 illness, has spread throughout the world after the first case was reported from Wuhan, China, in December 2019. This illness typically causes respiratory symptoms like fever, cough, and shortness of breath, although atypical presentation with gastrointestinal symptoms like abdominal pain, nausea, vomiting, or diarrhea are being increasingly reported. The viral RNA has been detected in saliva and stool of such patients, which raises concerns regarding the risk of transmission during gastrointestinal (GI) endoscopy. Many patients also have liver involvement, with the most common manifestation being deranged liver function tests. This review highlights the symptomatology, mechanism, and histopathology findings of SARS-CoV-2 in GI tract and liver. This review also focuses on implications of COVID-19 in patients afflicted with chronic liver disease and in patients undergoing liver transplantation.

Description of Covid-19 Patients with Comorbidity

“…These results align with the research of Surendra et al in Jakarta, Indonesia; Guan et al in China; and Wang et al in China. 28,44 As the most common symptom in this study, fever is a cardinal sign of an infectious process. Following the pathogenesis of COVID-19, pulmonary alveolar epithelial cells infected with SARS-CoV-2 will secrete proinflammatory cytokines to stimulate the immune system.…”

“…Each of these symptoms was suffered by 41 patients (45.1%), 27 patients (29.7%), and ten patients (11.0%). The proportion of nausea was very high compared to the proportion in several other studies by Guan et al in China, Rozaliyani et al in Indonesia, and Wang et al Symptoms of anorexia, nausea, and vomiting in COVID-19 have not been fully elucidated 2,28,…”

“…Impaired hemostasis characterized by elevated levels of fibrinogen, prothrombin time, activated partial thromboplastin time, and fibrin degradation product is associated with higher mortality. 28 According to a meta-analysis of 8697 patients in China, 47.6% of COVID-19 patients had lymphopenia followed by elevated cardiac enzymes in 49.4%, and 20.4% had elevated D-dimer. 29 Several studies support these findings.…”

Manifestaciones gastrointestinales de la COVID-19 en una población colombiana

“…En diciembre de 2019, en Wuham China, surgió un nuevo virus conocido como el SARS-CoV-2 (Severe Acute Respiratory Sindrome Coronavirus), un virus RNA similar al SARS-CoV y el MERS-CoV, el cual es el agente etiológico de la enfermedad COVID-19, denominada así por la OMS y declarada pandemia en 2020 (1)(2)(3)(4). En la mayoría de los casos la enfermedad es leve cursando con síntomas respiratorios altos, malestar general y fiebre generalmente autolimitada (4); sin embargo, en 15% de los casos puede tener un curso severo con neumonía, requerimiento de hospitalización y hasta en 5% un curso severo con disfunción orgánica, falla ventilatoria y necesidad de ingreso a unidad de cuidados intensivos con una mortalidad entre 1.4 y 5% (4)(5)(6).…”

“…En el sistema gastrointestinal hay alta expresión de la ECA2 en células de la mucosa esofágica, enterocitos de íleon, colon e hígado, lo cual permite que el SARS-CoV-2 tenga la capacidad de infectar estas células y causar diversos síntomas gastrointestinales (2,10,12). Se ha descrito anorexia hasta en 98% de los casos, diarrea hasta en 49% con una duración promedio de cuatro días y tres episodios diarios, náuseas y vómito en 10%, dolor abdominal en 9% y sangre oculta positiva o leucocitos en materia fecal en 7% (3,5,10,12,13). En un metaanálisis con más de 4000 pacientes asiáticos con COVID-19, se demostró RT-PCR positiva en materia fecal en 50% de ellos y desarrollo de síntomas gastrointestinales en cerca de 20%; además, los pacientes con COVID-19 severo tuvieron más síntomas gastrointestinales que los casos no severos (17.1 vs 11.8%) (14).…”