Gastrointestinal coronavirus disease 2019: epidemiology, clinical features, pathogenesis, prevention, and management

Abstract

Introduction: The new Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is the etiologic agent of coronavirus disease 2019. Some authors reported pieces of evidence that patients with SARS-CoV-2 infection could have direct involvement of the gastrointestinal tract, and in symptomatic cases, gastrointestinal symptoms (diarrhea, nausea/vomiting, abdominal pain) could be very common. Area covered: In this article, we reviewed current-published data of the gastrointestinal aspects involved in SARS-CoV-2 infection, including prevalence and incidence of specific symptoms, the presumptive biological mechanism of GI infection, prognosis, clinical management, and public healthrelated concerns on the possible risk of oral-fecal transmission. Expert opinion: Different clues point to direct virus infection and replication in mucosal cells of the gastrointestinal tract. In vitro studies showed that SARS-CoV-2 could enter into the gastrointestinal epithelial cells by the Angiotensin-Converting enzyme two membrane receptor. These findings, coupled with the identification of viral RNA found in stools of patients, clearly suggest that direct involvement of the gastrointestinal tract is very likely. This can justify most of the gastrointestinal symptoms but also suggest a risk for an oral-fecal route for transmission, additionally or alternatively to the main respiratory route.

COVID-19 and the digestive system: A comprehensive review

“…Meanwhile, in the era of COVID-19, these prevention strategies should be improved continually to fit their own unique condition, including released guidelines, recommendations, position statements, or published practical experiences by different organizations and societies worldwide. Increasing evidence suggests that fecal-oral transmission and environmental contamination by COVID-19 patients should not be ignored[ 13 , 17 , 114 , 136 , 137 ]. Although additional experiments and clinical studies are required, future prevention and control measures should consider the possibility of fecal-oral transmission and environmental contamination of the SARS-CoV-2 virus.…”

“…Later, numerous studies found that fecal samples of hospitalized patients were positive for SARS-CoV-2, including those with or without GI symptoms[ 10 , 11 ]. Based on the current research, SARS-CoV-2 RNA has been detected in 29%-55% of stool samples from COVID-19 patients[ 12 , 13 ]. More importantly, Xiao et al [ 14 ] isolated infectious SARS-CoV-2 from stool samples, confirming the release of the infectious virus into the GI tract, and showed that the ACE2 protein was abundantly expressed in the glandular cells of gastric, duodenal, and rectal epithelia, supporting the entry of SARS-CoV-2 into the host GI tract cells.…”

Contaminated Toothbrushes and Potential COVID-19 Transmission: Concerns and Recommendations

“…6,7 Previous studies have found proviral DNA on the toothbrush of an HIV-positive patient. 21 In the same way, HCV-RNA was found in toothbrushes of patients with hepatitis C. 22 Authors have suggested a possible oral-fecal route of SARS-CoV-2 transmission, 17,18 indicating that toothbrushes placed near toilet seats could be contaminated. 17 Moreover, it has been reported the presence of Herpes simplex virus type 1 from 48 hours to 7 days on stored toothbrushes, especially in moist environments such as bathrooms.…”

“…Not to mention that experts have suggested that a fecal-oral route of SARS-CoV-2 transmission is possible, with the potential to contaminate toothbrushes stored near the toilet. 17,18 Therefore, the purpose of this review was to answer the following questions:…”

Interactions between the Gut Microbiome, Lung Conditions, and Coronary Heart Disease and How Probiotics Affect These

“…In a number of mild to severe COVID-19 patients, the gut microbiome is severely disturbed, and this disturbance can be sustained over a period of months. As with other respiratory viral infections, COVID-19 can be accompanied by gastrointestinal symptoms and the viral RNA can be detected for prolonged periods following the end of symptoms in the stool of infected individuals [ 7 ]. Disturbance of the gut microbiome as a result of airway infections does not necessarily depend on the virus actively replicating in the gut, as routes of gut influence exist via the immune and nervous systems, which not only react towards the gut microbiome but also regulate its composition.…”