Gastrointestinal Manifestations of COVID‐19: Impact on Nutrition Practices

Abstract

Although Coronavirus disease 2019 (COVID‐19) is primarily a respiratory disease, growing evidence shows that it can affect the digestive system and present with gastrointestinal (GI) symptoms. Various nutrition societies have recently published their guidelines in context of the pandemic, and several points emphasize the impact of these GI manifestations on nutrition therapy. In patients with COVID‐19, the normal intestinal mucosa can be disrupted by the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) virus, and this could result in GI symptoms and a compromise in nutrient absorption. Optimization of oral diet is still recommended. However, given the GI effects of COVID‐19, a fraction of infected patients have poor appetite and would not be able to meet their nutrition goals with oral diet alone. For this at‐risk group, which includes those who are critically ill, enteral nutrition is the preferred route to promote gut integrity and immune function. In carrying this out, nutrition support practices have been revised in such ways to mitigate viral transmission and adapt to the pandemic. All measures in the GI and nutrition care of patients are clustered to limit exposure of healthcare workers. Among patients admitted to intensive care units, a significant barrier is GI intolerance, and it appears to be exacerbated by significant GI involvement specific to the SARS‐CoV‐2 infection. Nevertheless, several countermeasures can be used to ease side effects. At the end of the spectrum in which intolerance persists, the threshold for switching to parenteral nutrition may need to be lowered.

Gastrointestinal manifestations in COVID-19

“…In a meta-analysis of 60 studies, 26.8% had anorexia as the most common symptom 61 and this accounted for difficulties with enteral feeding and maintenance of adequate nutritional status. 64 Furthermore, individuals who later developed refractory pneumonia had a higher incidence of anorexia on admission. 47 …”

“…The outcomes of patients with pancreatitis, celiac disease or irritable bowel syndrome who get COVID-19 have been poorly studied. 64 …”

Nutritional and Behavioral Approaches to Body Composition and Low-Grade Chronic Inflammation Management for Older Adults in the Ordinary and COVID-19 Times

“…As we know so far, SARS-CoV-2 is an enveloped RNA coronavirus that attaches to the ACE-2 receptors primarily seen in the lungs, although also present in other tissues, including the enterocytes of the digestive tract and thus may disrupt normal intestinal flora, leading to different gastrointestinal symptoms and treatment challenges. Evidence has also shown the presence of SARS-CoV-2 RNA remnants in feces, indicating its presence in the gut [ 86 ]. Moreover, a pilot study in COVID-19 patients of various degrees of severity showed that all of them had significant alterations in the fecal microbiome compared to healthy controls [ 87 ].…”

Nutritional and metabolic management of COVID-19 intensive care patients

“…From the beginning of the SARS CoV2 pandemic, pathophysiology of the disease is better understoodithe ( 1 , 2 ). Gastrointestinal disturbances such as occurrence of diarrhea, vomiting, abdominal distension and pain, alterations in taste and dysphagia, may all impair oral intake ( 3 ) and worsen the nutritional status. These changes have strong metabolic and nutritional consequences on body composition and ability of the patients to overcome the disease or to efficiently recover from it.…”