Gastrointestinal, Liver, Pancreas, Oral and Psychological Long-term Symptoms of COVID-19 After Recovery: A Review

Abstract

Abstracts: Due to the importance of control and prevention of COVID-19-correlated long-term symptoms, the present review article has summarized what has been currently known regarding the molecular and cellular mechanisms linking COVID-19 to important long-term complications including psychological complications, liver and gastrointestinal manifestations, oral signs as well as even diabetes. COVID-19 can directly affect the body cells through their Angiotensin-converting enzyme 2 [ACE-2] to induce inflammatory responses and cytokine storm. The cytokines cause the release of reactive oxygen species [ROS] and subsequently initiate and promote cell injuries. Another way, COVID-19-associated dysbiosis may be involved in GI pathogenesis. In addition, SARS-CoV-2 reduces butyrate-secreting bacteria and leads to the induction of hyperinflammation. Moreover, SARS-CoV-2-mediated endoplasmic reticulum stress induces de novo lipogenesis in hepatocytes, which leads to hepatic steatosis and inhibits autophagy via increasing mTOR. In pancreas tissue, the virus damages beta-cells and impairs insulin secretion. SARS-COV-2 may change the ACE2 activity by modifying ANGII levels in taste buds which leads to gustatory dysfunction. SARS-CoV-2 infection and its resulting stress can lead to severe inflammation that can subsequently alter neurotransmitter signals. This, in turn, negatively affects the structure of neurons and leads to mood and anxiety disorders. In conclusion, all the pathways mentioned earlier can play a crucial role in the disease's pathogenesis and related comorbidities. However, more studies are needed to clarify the underlying mechanism of the pathogenesis of the new coming virus.

Long-term gastrointestinal symptoms and sleep quality sequelae in adolescents after COVID-19: a retrospective study

“…Interestingly, we found that GI symptoms were most severe during the acute phase of the infection, and the symptoms began to improve in the first month of follow-up. Liver injuries occur in 14–53% of COVID-19 cases ( 13 ). Cooper S. et al ( 14 ) reported that in children with COVID-19, possible long-term liver complications include acute liver failure and hepatitis with cholestasis, noting that unlike adult cohorts, the pediatric cohort did not exhibit steatosis.…”

Risks of digestive diseases in long COVID: evidence from a population-based cohort study

“…Digestive outcomes were selected mainly based on evidence in prior literature and the data on digestive system disease records in the UK Biobank [ 2 , 8 , 14 , 21 – 24 ]. As shown in Additional file 1 : Table S2, all the outcomes were defined based on the 10th revision of the International Classification of Diseases (ICD-10).…”

How Does Long-COVID Impact Prognosis and the Long-Term Sequelae?

“…It should also be noted that gastrointestinal symptoms such as nausea, vomiting, and diarrhea present during hospitalization for SARS-CoV-2 infection can lead to malnutrition, which has been linked to increased mortality in patients with COVID-19 [ 66 , 67 ]. Nutrition plays a fundamental role not only during hospitalization but also in reducing gastrointestinal sequelae.…”