Epidemiological approximation of the enteric manifestation and possible fecal-oral transmission in COVID-19: A preliminary systematic review

Abstract

Objectives: to conduct a systematic review to describe the epidemiological scientific evidence on gastrointestinal symptoms (GIS), enteric involvement and fecal excretion of SARS-CoV-2 viral RNA and to discuss the possible fecal-oral transmission pathway of COVID-19.Methods: We have reviewed GIS, enteric involvement, and fecal test results of SARS CoV-2 from case reports and retrospective observational studies related to the digestive system published about the outbreak.Results: The prevalence of GIS in patients infected with SARS CoV-2 ranges from 1.7% (1/56)-100% (10/10), GIS included diarrhea 1/99(1%)-8/10(80%), nausea/vomiting 1/28(3.6%)-5/10 (50%), abdominal pain 2/103(1.9%)-1/3(33.3%). A total of 3% of infected patients may experience GIS in the absence of respiratory symptoms. A pooled analysis of the results showed 16.1% GIS, 8.3% diarrhea and 12% nausea-vomiting. A higher percentage of diarrhea in patients with severe disease (5.8%) than in non-severe disease (3.5%), and a more severe course in patients with GIS (22.97%) than in those without GIS (8.12%) was found. Histological studies demonstrated the presence of ACE2 receptors and the nucleocapsid of the virus in gastrointestinal. The RNA of the virus has been detected in 27-53% of patients with COVID-19 in whom respiratory and stool samples have been analyzed, and it may persist in stool for up to an average of 11.2 days after negativization of the respiratory samples.Conclusions: GIS are common in SARS CoV-2 infection at the time of patient admission, sometimes represent the only clinical manifestation. Infection of the GI tract is possible due to the presence of ACE2 receptors, and there may be viral replication with fecal elimination.

Multidisciplinary Approach to the Diagnosis and In-Hospital Management of COVID-19 Infection: A Narrative Review

“…In fact, Huang et al (2020) reported that GI involvement was present in 2–10% of patients with COVID-19. A systematic review evaluating GI involvement reported that the presence of GI symptoms had a great variability between 2 and 100%; in particular, according to a pooled analysis, 16.1% presented GIS, 8.3% diarrhea, 12% nausea-vomiting and 4% abdominal pain ( Pamolona et al, 2020 ). Sometimes, GI symptoms may precede respiratory ones ( Wang et al, 2020a ).…”

“…This protein, in fact, is expressed in gastric, intestinal and colonic cells, promoting virus infection ( Wan et al, 2020a ). Therefore, once the virus infects the human intestinal epithelia, it can potentially propagate via fecal-oral route ( Wang et al, 2020a ; Guan et al, 2020 ; Pamolona et al, 2020 ). Interesting, viral RNA is detected in the stool for a longer time than in the respiratory system ( Pan et al, 2020 ; Wu et al, 2020b ).…”

“…Interesting, viral RNA is detected in the stool for a longer time than in the respiratory system ( Pan et al, 2020 ; Wu et al, 2020b ). Consequently, it has been suggested that its detection in fecal samples should be considered as one of the routine diagnostic tests to guide decision making on hospital discharge and the lifting of isolation measures ( Pamolona et al, 2020 ).…”

Ischemic gastrointestinal complications of COVID-19: a systematic review on imaging presentation

“…Among the common presenting symptoms of the disease, GI-related complaints are seen in up to 38% of patients, among which diarrhea, nausea/vomiting and abdominal pain are the most common complaints. 43 …”

Perspective: the nose and the stomach play a critical role in the NZACE2-Pātari* (modified ACE2) drug treatment project of SARS-CoV-2 infection

“…First, it is possible the active viral burden is increased by a high stomach pH. This would allow intact virus to travel to the small intestine and gain entry through gut epithelial cells [ 52 ]. Diarrhea and abdominal discomfort can be symptoms of COVID-19 [ 53 ].…”