Coronavirus disease 2019 and the pancreas

Abstract

Coronavirus disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has led to a world-wide pandemic since its onset in December of 2019. Although, a primary respiratory pathogen, over the ensuing period, its extra-pulmonary effects have come to the forefront. The virus, having multi-organ tropism, has been shown to affect a host of other organs beyond the lung, including the pancreas. The data on pancreatic involvement by COVID-19, however, have been limited. Moreover, whether the effects on the pancreas are due to the direct effects of the virus or is just an epi-phenomenon is debatable. The prevalence of pancreatic injury and degree of injury are the other issues that need to be addressed. Pancreatic cancer has a dismal prognosis and the management of the same in the COVID era needs to be tailored assessing the risk-benefit ratio for the same. Additionally, pancreatic surgery increases not only the morbidity of the patient, but also the risk of the operator and burden on the health care system. Hence, the decision for such major procedures needs to be rationalized for optimum benefit during this pandemic. Similarly, for the endoscopist, pancreatic endoscopy needs to be carefully regulated to reduce risk to both the patient and the physician and yet deliver optimum patient care. This review gives a concise summary of various aspects of pancreatic involvement and pancreatic disease management during this pandemic.

Association between acute pancreatitis and COVID-19 infection: What do we know?

“…In December 2020, Samanta et al [ 15 ] published an interesting article in which the authors explained precisely the multiorgan tropism of SARS-CoV-2. It attaches to the ACE2 receptor on lung type 2 alveolar cells, which leads to lung injury.…”

“…It attaches to the ACE2 receptor on lung type 2 alveolar cells, which leads to lung injury. Once the spike (S) protein attaches to alveolar cells, it leads to a cytokine storm that deteriorates the alveolar epithelium, hindering oxygen exchange and manifesting as acute respiratory distress syndrome (ARDS)[ 15 , 16 ]. Crucially, ACE2 receptor expression is present not only in the lungs but also in esophageal epithelial cells, ileal and colonic enterocytes, and cardiovascular, renal, and pancreatic tissues.…”

COVID-19 Associated Pancreatitis: A Review of 66 Cases

“…Investigations have reported several mechanisms that explain pancreatic involvement during this disease. One of these mechanisms is based on Angiotensin-converting enzyme 2 (ACE2) receptor expression on the pancreatic cells (21). The pathogenicity of SARS-CoV-2 is through binding to the ACE2 receptor on alveolar cells in the lung (22).…”

Changes in the Levels of Biochemical Markers Following Coronavirus Infection in Patients with Liver Disease, Renal Disease and Diabetes Mellitus as Compared to Control Participants: A Cross Sectional Study

“…This can lead to cellular hypoxia and the generation of reactive oxygen types leading to blanket damage and insulin resistance. Besides, an oxidic pancreatic infection can cause collateral damage to beta cells via inflammatory cytokines, thus, the damage to the pancreas, whether from secretions or endocrine, is multifactorial include: direct injury to the pancreatic tissue, the systemic inflammation and pancreatic injury due to the viral infection, the release of high levels of proinflammatory mediators, and immune plasticity [16].…”