Corona Virus Disease-19 pandemic: The gastroenterologists’ perspective

Abstract

The world is witnessing a serious public health threat in the wake of the third corona virus pandemic, a novel corona virus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]). The Corona Virus Disease-19 (COVID-19) is not limited to the respiratory system but has widespread involvement including the gastrointestinal (GI) tract and liver, with evidence of prolonged fecal shedding and feco-oral transmission. This finding has stirred up a hornet's nest of not only a newer modality of the spread of the virus but also a risk of the unpredictable duration of the infective potential of the shedders. We reviewed the literature on fecal shedding and possible implications on prevention and surveillance strategies. The pandemic is changing the management of underlying chronic diseases such as inflammatory bowel disease (IBD) and other diseases. Moreover, for the gastroenterologist, doing endoscopic procedures in this COVID-19 era poses a high risk of contamination, as it is an aerosol-generating procedure. There is a daily influx of data on this disease, and multiple societies are coming up with various recommendations. We provide a comprehensive review of all the reported GI manifestations of COVID-19 infection and the side effects of confounding drugs. We have summarized the management recommendations for diseases such as IBD with COVID-19 and nutritional recommendations and provided a concise review of the endoscopy guidelines by the various societies. This review provides a comprehensive account and a lucid guide covering various aspects of gastroenterology practice during this COVID-19 pandemic.

Care of inflammatory bowel disease patients during coronavirus disease‐19 pandemic using digital health‐care technology

“…[28][29][30] The virus enters into the host cells, binding the ACE-2 and host cellular transmembrane serine protease 2 (TMPRSS2). 31 However, the low frequency of COVID-19 among patients with IBD possibly relates to greater awareness among these patients (further raised by regular patient education sessions) and adherence to preventive practices. The experience of the IBD center in Wuhan with 318 patients showed the benefit of such an approach.…”

“…Patients with IBD are at higher risk of SARS‐CoV‐2 infection as they are on multiple immunosuppressive medications and need to go to health‐care facilities repeatedly, and chronically inflamed gut mucosa has been shown to have an increased abundance of SARS‐CoV‐2‐binding receptors, such as angiotensin converting enzyme‐2 (ACE‐2) 28–30 . The virus enters into the host cells, binding the ACE‐2 and host cellular transmembrane serine protease 2 (TMPRSS2) 31 . However, the low frequency of COVID‐19 among patients with IBD possibly relates to greater awareness among these patients (further raised by regular patient education sessions) and adherence to preventive practices.…”

Emergency lower gastrointestinal endoscopy performed safely in a COVID-19 patient on extracorporeal membrane oxygenation (ECMO) with hemorrhagic shock

“…ECMO causes acquired von Willebrand syndrome in severely ill COVID-19 patients [ 10 ], and in the future, the number of situations in which emergency endoscopy is unavoidable may increase. Endoscopy for COVID-19 patients has been proposed by various academic societies to be conducted in a negative pressure room [ 7 ]. In the present case, endoscopy was performed under negative pressure and in a restrictive environment.…”

“…In addition, due to the overall condition of the patient, the lower gastrointestinal endoscopy was performed without pre-treatment. As recommended by various gastroenterology societies [ 7 ], the procedure was performed with full personal protection equipment (PPE), including electric-fan facemasks with 99.7% filtration capability, double gloves, a hairnet, a water-resistant disposable gown, and shoe covers (Fig. 2 ).…”

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“…Angiotensin-Converting Enzyme type 2 (ACE2), highly expressed on lung alveolar epithelial cells and small intestinal epithelial cells, may play a crucial role in the pathogenesis of COVID-19 [11]. The viral spike (S) protein of SARS-CoV-2 binds to ACE2 as a cellular receptor, leading to entry of the vírus in the host cell [12], bringing the gastrointestinal tract as a potential route of virus through of the fecaloral transmission and emphasizing the importance of maintaining hygiene [13,14]. The first confirmed case in the USA presented diarrhea and the fecal sample positive on the 7th day.…”