Gastrointestinal symptoms, pathophysiology, and treatment in COVID-19

Abstract

The novel coronavirus Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has emerged and is responsible for the Coronavirus Disease 2019 global pandemic. Coronaviruses, including SARS-CoV-2, are strongly associated with respiratory symptoms during infection, but gastrointestinal symptoms, such as diarrhea, vomiting, nausea, and abdominal pain, have been identified in subsets of COVID-19 patients. This article focuses on gastrointestinal symptoms and pathophysiology in COVID-19 disease. Evidence suggests that the gastrointestinal tract could be a viral target for SARS-CoV-2 infection. Not only is the SARS-CoV-2 receptor ACE2 highly expressed in the GI tract and is associated with digestive symptoms, but bleeding and inflammation are observed in the intestine of COVID-19 patients. We further systemically summarize the correlation between COVID-19 disease, gastrointestinal symptoms and intestinal microbiota. The potential oral-fecal transmission of COVID-19 was supported by viral RNA and live virus detection in the feces of COVID-19 patients. Additionally, the viral balance in the GI tract could be disordered during SARS-CoV-2 infection which could further impact the homeostasis of the gut microbial flora. Finally, we discuss the clinical and ongoing trials of treatments/therapies, including antiviral drugs, plasma transfusion and immunoglobulins, and diet supplementations for COVID-19. By reviewing the pathogenesis of SARS-CoV-2 virus, and understanding the correlation among COVID-19, inflammation, intestinal microbiota, and lung microbiota, we provide perspective in prevention and control, as well as diagnosis and treatment of the COVID-19 disease.

Imbalance of the intestinal virome caused by a conditional deletion of the vitamin D receptor from epithelial cells, Paneth cells, or myeloid cells in murine models

“…Vitamin D metabolites have long been known to support innate antiviral effector mechanisms, including induction of antimicrobial peptides and autophagy. Laboratory data relating to effects of vitamin D on host responses to SARS-CoV-2 speci cally are scarce [1,2].…”

“…During the pandemic, the status of vitamin D and risk of coronavirus disease 2019 (COVID19) are of great interests for prevention and treatment [1,2]. Vitamin D acts through the VDR, an ancient nuclear receptor and a transcription factor highly conserved in mammals [3,4].…”

Coronavirus Disease and Abdominal Pain: Mechanism, Diagnostic, and Treatment

“…However, various authors suggest that GI symptoms may be underestimated and indicate that abdominal pain, diarrhea, nausea, vomiting, and lack of appetite, in some cases are presented before [5] or together with mild respiratory symptoms. Zang et al [6] suggested that patients with GI symptoms had longer duration between symptom onset and viral clearance.…”

Center-Based Experiences Implementing Strategies to Reduce Risk of Horizontal Transmission of SARS-Cov-2: Potential for Compromise of Neonatal Microbiome Assemblage

“…(1,2) While initially associated with fever, cough and shortness of breath, presentation of this virus has progressed to include gastrointestinal (GI) symptoms either in isolation or in conjunction with respiratory symptoms in 10-15% of COVID-19 positive patients. (3,4) GI symptoms may Twenty-one patients born to COVID-19 positive mothers were admitted to the NICU per University of Illinois at Chicago (UIC) guidelines. In this paper, we review NICU courses, including the incidence viral transmission.…”

“…(1, 2) While initially associated with fever, cough and shortness of breath, presentation of this virus has progressed to include gastrointestinal (GI) symptoms either in isolation or in conjunction with respiratory symptoms in 10-15% of COVID-19 positive patients. (3, 4) GI symptoms may herald COVID-19 by up to 5 days before admission and these patients may have more complicated courses with longer hospital stays. (5, 6)…”