COVID-19 in gastroenterology and hepatology: Lessons learned and questions to be answered

Abstract

BACKGROUND Although coronavirus disease 2019 (COVID-19) presents primarily as a lower respiratory tract infection, increasing data suggests multiorgan, including the gastrointestinal (GI) tract and liver, involvement in patients who are infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). AIM To provide a comprehensive overview of COVID-19 in gastroenterology and hepatology. METHODS Relevant studies on COVID-19 related to the study aim were undertaken through a literature search to synthesize the extracted data. RESULTS We found that digestive symptoms and liver injury are not uncommon in patients with COVID-19 and varies in different individuals. The most common GI symptoms reported are diarrhea, nausea, vomiting, and abdominal discomfort. Other atypical GI symptoms, such as loss of smell and taste and GI bleeding, have also been reported along with the evolvement of COVID-19. Liver chemistry abnormalities mainly include elevation of aspartate transferase, alanine transferase, and total bilirubin. It is postulated to be related to the binding of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus to the angiotensin converting enzyme-2 receptor located on several different human cells. CONCLUSION Standardized criteria should be established for diagnosis and grading of the severity of GI symptoms in COVID-19 patients. Gastroenterology and hepatology in special populations, such as children and elderly, should be the focus of further research. Future long-term data regarding GI symptoms should not be overlooked.

Infection of Human Cells by SARS-CoV-2 and Molecular Overview of Gastrointestinal, Neurological, and Hepatic Problems in COVID-19 Patients

“…In patients with acidosis, uncontrolled bleeding of the GI, uncontrolled hypoxemia, or other harmful conditions, delayed enteral feeding is suggested. Enteral feeding has been proposed for the maintenance of normal intestinal mucosal barrier function, as it prevents intestinal microbiome translocation and reduces the occurrence of infectious complications [ 64 , 65 ]. Enteral nutrition usage might alter the gut flora, which plays a significant role in maintaining GI homeostasis [ 31 ].…”

Digestive Disease Mortality Dynamics During New Coronavirus Infection Pandemic in Different Subjects of Russian Federation

“…Было показано, что SARS-CoV-2 [severe acute respiratory syndrome coronavirus 2 (коронавирус 2, вызывающий тяжелый острый респираторный синдром)] способен проникать в цитоплазму гепатоцитов и поражать ткань печени, что проявляется повышением уровня трансаминаз, билирубина, удлинением протромбинового времени, снижением уровня альбумина [6]. Эти неблагоприятные эффекты в комбинации с гепатотоксическим действием лекарственных препаратов, применяющихся для лечения инфекции COVID-19, приводят к ухудшению течения исходно имевшихся у больных хронических заболеваний печени, способствуя развитию декомпенсации цирроза печени, прогрессированию хронической печеночной недостаточности и развитию на ее фоне острой печеночной недостаточности [7][8][9][10][11][12].…”