COVID‐19 and its effects on the digestive system and endoscopy practice

Abstract

The Coronavirus Disease 2019 (COVID‐19) is a respiratory illness caused by the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) and has been classified as a pandemic by the World Health Organization in March 2020. Several studies have demonstrated that the gastrointestinal (GI) tract is also a potential route. As the pandemic is continuously evolving, and more data are made available, this article highlights the best evidence and practices regarding the effects of the SARS‐CoV‐2 virus relevant to GI practice. Published clinical studies have supported that SARS‐CoV‐2 affects the GI tract and the liver. The largest published dataset comprised of 4243 patients and showed a pooled prevalence of GI symptoms at 17.6%. GI symptoms varied and usually preceded pulmonary symptoms by 1–2 days. These include anorexia (26.8%), nausea and vomiting (10.2%), diarrhea (12.5%), and abdominal pain (9.2%). Incidence of liver injury ranges from 15 to 53%. Evidence shows that the severity of COVID‐19 infection is compounded by its effects on nutrition, most especially for the critically ill. As such, nutrition societies have recommended optimization of oral diets and oral nutritional supplements followed by early enteral nutrition if nutritional targets are not met, and parenteral nutrition in the distal end of the spectrum. In addition to possible fecal–oral transmission, GI endoscopy procedures, which are considered to be aerosol‐generating procedures, contribute to increased risk to GI health‐care professionals. Infection prevention measures and guidelines are essential in protecting both patients and personnel.

Gastrointestinal manifestation as clinical predictor of severe COVID‐19: A retrospective experience and literature review of COVID‐19 in Association of Southeast Asian Nations (ASEAN)

“…2 The majority of patients have respiratory manifestations, and many report gastrointestinal symptoms. [3][4][5] Anorexia, diarrhea, abdominal pain, nausea, and vomiting are reported in 3-79% of patients. 6 There are abundant viral receptor expressions on gastrointestinal epithelial cells, and recent studies have suggested possible fecal-oral transmission.…”

Gastrointestinal Manifestations of COVID‐19: Impact on Nutrition Practices

“…Although the ACE2 receptors are primarily seen in the respiratory lining, these receptors are also abundantly expressed in the digestive system, specifically the enterocytes in the lining of the ileum and colon. 2,3 The attachment of the SARS-CoV-2 virus on the ACE2 receptors of the digestive system is believed to disrupt the normal intestinal flora, leading to different GI symptoms-especially diarrhea. 4 Evidence has also shown the presence of SARS-CoV-2 RNA in feces, supporting its pathologic mechanism in the gut.…”

COVID‐19 and the digestive system: More than just a “flu”

“…In this June issue, JGH Open has published two Leading Articles on the COVID‐19 infection: the first is the “Asian Pacific Association of Gastroenterology (APAGE) Inflammatory Bowel Disease (IBD) Working Party Guidelines on the IBD during the COVID‐19 pandemic 1 and the second an excellent review article by Aguila et al . focusing on gastrointestinal and liver complications of COVID‐19 infection and endoscopy practice.” 2 …”

“…Aguila et al . have provided a succinct review of the complications of GI and liver diseases in collaboration with COVID‐19 infection 2 …”

“…Aguila et al . have also outlined practical steps that must be taken in the endoscopy room 2 . As with other procedures, only urgent or emergency cases should be performed.…”