COVID-19: Gastrointestinal manifestations, liver injury and recommendations

Abstract

Coronavirus disease 2019 (COVID-19) has caused a pandemic that affected all countries with nearly 270 million patients and 5 million deaths, as of as of December, 2021. The severe acute respiratory syndrome coronavirus 2 virus targets the receptor, angiotensin-converting enzyme 2, which is frequently found in human intestinal epithelial cells, bile duct epithelial cells, and liver cells, and all gastrointestinal system organs are affected by COVID-19 infection. The aim of this study is to review the gastrointestinal manifestations and liver damage of COVID-19 infection and investigate the severe COVID-19 infection risk in patients that have chronic gastrointestinal disease, along with current treatment guidelines. A literature search was conducted on electronic databases of PubMed, Scopus, and Cochran Library, consisting of COVID-19, liver injury, gastrointestinal system findings, and treatment. Liver and intestinal involvements are the most common manifestations. Diarrhea, anorexia, nausea/vomiting, abdominal pain are the most frequent symptoms seen in intestinal involvement. Mild hepatitis occurs with elevated levels of transaminases. Gastrointestinal involvement is associated with long hospital stay, severity of the disease, and intensive care unit necessity. Treatments and follow-up of patients with inflammatory bowel diseases, cirrhosis, hepatocellular carcinoma, or liver transplant have been negatively affected during the pandemic. Patients with cirrhosis, hepatocellular carcinoma, auto-immune diseases, or liver transplantation may have a greater risk for severe COVID-19. Diagnostic or therapeutic procedures should be restricted with specific conditions. Telemedicine should be used in non-urgent periodic patient follow up. COVID-19 treatment should not be delayed in patients at the risk group. COVID-19 vaccination should be prioritized in this group.

Prognostic Value of Transaminases and Bilirubin Levels at Admission to Hospital on Disease Progression and Mortality in Patients with COVID-19—An Observational Retrospective Study

“…In addition, the increase in bilirubin levels at time of hospital admission is significantly related to hospital mortality; however, also considering the minor association, further research is required to validate the data shown. Considering the need for tools and prognostic examinations that can help to predict the clinical progression of disease in COVID-19 patients, our study, with others recently published [8][9][10][11][12][13][14][15][16][17][18][19], could be a useful guide, using liver damage and liver function tests to highlight patients at risk of COVID-19 progression or to predict the severity of disease progression.…”

“…Liver damage is likely multifactorial: it may be due not only to direct viral damage, but also due to a systemic cytokine storm, pro-thrombotic state, drug use and abuse during COVID-19, and hypoxic injury [8]. Finally, several studies have investigated the role of liver enzymes on disease progression and mortality [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22], showing a relation between the elevation of liver enzymes, considered as a manifestation of liver damage, and the severity of COVID-19 disease. In addition, the impact that the SARS-CoV-2 pandemic has determined on patients with liver disease has been considerable for both outpatient and inpatient management [23][24][25].…”

A COVID–19-hez kapcsolódó májenzim-emelkedés valószínűleg multifaktoriális eredetű

“…A tocilizumab alkalmazása mellett a leggyakrabban átmeneti szérum-GPT-aktivitás-emelkedés fordul elő a betegek pár százalékában [17]. További következménye lehet a HBV-reaktiváció, mely a májsejtek pusztulása révén idézhet elő magas májenzim-aktivitást [18]. A baricitinib kis molekula súlyú JAK-inhibitor.…”

“…A májenzim-emelkedés >10%-ban előforduló mellékhatás a gyógyszer leirata szerint [19]. Baricitinib szedése mellett is tisztázni kell a beteg HBV-statusát az esetleges reaktiváció elkerülése, illetve obszervációja és felismerése céljából [18]. A favipiravir RNS-dependens RNS-polimeráz-gátló antivirális készítmény [20].…”

Efficacy of <i>Saccharomyces boulardii</i> CNCM I-745 probiotic drug in the prevention and treatment of diarrhea in hospitalized patients with new coronavirus infection COVID-19

“…Среди множества гастроэнтерологических проявлений у пациентов с COVID-19 наиболее часто регистрируется диарея [12]. В некоторых выборках частота данного симптома достигала 49,5% [12,13]. В крупнейшей российской когорте пациентов с COVID-19 (n=3764) распространенность диареи у госпитализированных больных составила 15,04% (95% ДИ 13,90-16,19) [10].…”