COVID-19 and Gastrointestinal Disease: Implications for the Gastroenterologist

Abstract

COVID-19 was initially considered to be a respiratory disease but soon after the pandemic established it became clear that the SARS-CoV-2 virus which caused the disease could lead to serious systemic consequences affecting most of the major organs including the digestive tract, liver and pancreas. This review brings together the new information which is clinically relevant to the gastroenterologist including the origins of the disease, mechanisms of tissue damage and how this affects specific patient groups, including those with inflammatory bowel disease, comorbidities and the role of immunosuppression, chronic liver disease and the risk of decompensation for those with cirrhosis. The impact of COVID-19 for gastrointestinal emergencies is addressed together with the implications for the conduct of endoscopic and other interventional and diagnostic procedures. The importance of fully understanding the pharmacology and therapeutic implications of drugs commonly used by the gastroenterologist and their relationship with COVID-19 are also highlighted. The risk for drug-drug interactions is considerable in patients seriously ill with COVID-19 who are often requiring mechanical ventilation and life-support. Some re-purposed drugs used against SARS-CoV-2 can cause or aggravate some of the COVID-19 GI symptoms and also can induce iatrogenic liver injury. Ongoing clinical studies will hopefully identify effective drugs with a risk-benefit ratio which will be more favorable than many recently tried treatments.

Opportunities, Challenges and Pitfalls of Using Cannabidiol as an Adjuvant Drug in COVID-19

“…However, the negative consequences of COVID-19 are also connected with other disorders of the respiratory system [ 1 , 16 , 26 , 27 ], with the cardiovascular system (for review, see [ 1 , 16 , 22 , 26 , 28 , 29 , 30 ]) and with dangerous hematological complications, particularly thromboembolism [ 1 , 16 , 31 , 32 , 33 , 34 , 35 , 36 ]. In addition, pathological changes in the renal [ 1 , 16 , 27 , 33 , 37 , 38 ], gastrointestinal, hepatic, pancreatic [ 1 , 16 , 27 , 31 , 39 , 40 ] and nervous systems [ 1 , 27 , 41 , 42 , 43 ] have been described. Disturbances of the eyes [ 1 , 44 ], endocrine [ 45 , 46 ] and reproductive functions [ 31 , 45 , 46 , 47 ], skeletal muscles [ 1 , 33 , 48 ] and skin [ 1 , 49 , 50 ] occur as well (for details, see Figure 2 ).…”

SARS-CoV-2 Virus Manifestations in the Gastrointestinal Tract: Therapeutic Implications

“…There seems to be a fecal-oral route for SARS-CoV-2, even though it is unproven [ 14 ]. It is also imaginable that SARS-CoV-2 enters the gut when the patient swallows their sputum.…”

“…Vice vera, COVID-19 can lead to decompensation of a pre-existing liver damage, so some guidelines recommend testing for COVID-19 in decompensating liver cirrhosis without any other signs of COVID-19-like respiratory symptoms. Beyond that, distinguishing whether the higher rate of death in liver patients with COVID-19 is because of the underlying liver disease or different relevant comorbidities is challenging [ 14 , 48 , 49 , 50 ].…”

“…Still, we have to take into account that these patients are highly immunosuppressed. There are recommendations to reduce immunosuppressive medications in LTX patients with COVID-19, especially when they show lymphopenia or disease worsening, yet there is a lack of evidence to support this [ 14 ]. Colmenero et al [ 53 ] propose that a withdrawal of immunosuppressant agents may not be necessary.…”

“…Even though the ACE2 receptor and TMPRSS2 are expressed on pancreatic ductular cells, the pancreas itself is rarely affected by COVID-19 [ 14 ]. Inamdar et al [ 54 ] performed a retrospective study and found that only 0.27% of patients presenting with COVID-19 had an acute pancreatitis.…”