It Ain’t Over 'Til It's Over: SARS CoV-2 and Post-infectious Gastrointestinal Dysmotility

Abstract

The ongoing pandemic resulting from severe acute respiratory syndrome—caused by coronavirus 2 (SARS-CoV-2)—has posed a multitude of healthcare challenges of unprecedented proportions. Intestinal enterocytes have the highest expression of angiotensin-converting enzyme-2 (ACE2), which functions as the key receptor for SARS-CoV-2 entry into cells. As such, particular interest has been accorded to SARS-CoV-2 and how it manifests within the gastrointestinal system. The acute and chronic alimentary clinical implications of infection are yet to be fully elucidated, however, the gastrointestinal consequences from non-SARS-CoV-2 viral GI tract infections, coupled with the generalized nature of late sequelae following COVID-19 disease, would predict that motility disorders are likely to be seen in these patients. Determination of the chronic effects of COVID-19 disease, herein defined as GI disease which is persistent or recurrent more than 3 months following recovery from the acute respiratory illness, will require comprehensive investigations comprising combined endoscopic- and motility-based evaluation. It will be fascinating to ascertain whether the specific post-COVID-19 phenotype is hypotonic or hypertonic in nature and to identify the most vulnerable target portions of the gut. A specific biological hypothesis is that motility disorders may result from SARS-CoV-2-induced angiotensin-converting enzyme 2 (ACE2) depletion. Since SARS-CoV-2 is known to exhibit direct neuronal tropism, the potential also exists for the development of neurogenic motility disorders. This review aims to explore some of the potential pathophysiologic mechanisms underlying motility dysfunction as it relates to ACE2 and thereby aims to provide the foundation for mechanism-based potential therapeutic options.

Bowel symptoms associated with coronavirus disease 19 in hospitalized patients with moderate to severe illness

“…Nevertheless, determining the chronicity of post-infectious dysmotility is an important topic to consider because the emergence of this condition can directly and permanently affect the patient's quality of life. 38 The findings of this study should be interpreted in the context of certain Our study was limited by the small sample size (109), 55 of whom were evaluated during the post-infection period. In addition, data were obtained from only one medical center.…”

Disorders of gut-brain interaction in post-acute COVID-19 syndrome

“…Further studies are required to analyse the long-term impacts of chronic ACE-2 level deficiency on the enteric nervous system. 67…”

“…Increased angiotensin II levels coupled with reduction in the renin-angiotensin system substrates has been postulated to also increase fluid secretion within the small intestinal lumen promoting rapid transit times as well. Further studies are required to analyse the long-term impacts of chronic ACE-2 level deficiency on the enteric nervous system 67…”

Spike S1 domain interactome in non-pulmonary systems: A role beyond the receptor recognition

“…Besides the lungs and upper airways, which are the main targets of SARS-CoV-2 infection, other tissues and/or organs i.e., heart ( Azevedo et al, 2021 ; Bader et al, 2021 ), brain ( Aghagoli et al, 2021 ), kidney ( Bravi et al, 2022 ; Singh et al, 2022 ), gut ( Villapol, 2020 ; Lei et al, 2021 ; Coles et al, 2022 , etc) are affected by the virus, with even serious clinical manifestations ( Sridhar and Nicholls, 2021 ). The renal cell line HK-2 and the human colorectal adenocarcinoma cell line Caco-2 have been demonstrated to be infected by SARS-CoV-2 ( Yeung et al, 2021 ; Bojkova et al, 2020 ) and used as a model in several COVID-19 researches.…”