Gastrointestinal Complications of Coronavirus Disease (Covid-19)

Abstract

Background: It is currently understood that severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) directly enters target cells by binding to the angiotensin-converting enzyme 2 (ACE2) receptor. Accordingly, tissues with high expression levels of ACE2 are more susceptible to infection, including pulmonary alveolar epithelial cells, small intestine enterocytes, cholangiocytes, and vascular endothelial cells. Considering the atypical manifestations of COVID-19 and the challenges of early diagnosis, this review addresses the possible gastrointestinal complications of the disease. Method: The phrase “Gastrointestinal complication of COVID” was searched in the PubMed, Medline, and SciELO databases. Due to the heterogeneity of the studies included in the present review, a narrative synthesis of the available qualitative data was performed. Result: The literature search retrieved 28 articles, primarily case reports and case series, for the qualitative analysis of gastrointestinal complications of COVID-19, in addition to two retrospective cohort and one case-control. The studies focused on hemorrhagic, thrombotic, ischemic, and perforation complications, in addition to acute pancreatitis and pneumatosis intestinalis. Conclusion: There is a straight relationship between high expression levels of ACE2 in the gastrointestinal tract and its greater susceptibility to direct infection by SARS-CoV-2. So, it is important to consider the gastrointestinal infection manifestations for early diagnosis and treatment trying to avoid more serious complications and death.

Gastrointestinal bleeding in patients with COVID-19: an integrative review

“…In addition to the important role of ACE-2 receptors, patients with COVID-19 may develop coagulopathy and vasculopathy, as well as resulting endothelial dysfunction and thrombosis 8 , 10 , 11 , 17 , 18 , 24 . COVID-19-associated coagulopathy (CAC) is characterized by increased D-dimer and fibrinogen levels, which can lead to thrombocytopenia.…”

COVID-19: Parosmia pós-infecção e rejeição alimentar

“…É importante ressaltar que os sintomas de febre e falta de ar, conforme demonstrado nos nossos resultados, afetaram a grande maioria dos indivíduos que apresentaram parosmia pós-COVID, parecem ser fortes indicativos e preditivos para ocorrência da doença. Tal constatação se deve ao fato de que o vírus SARS-CoV-2 possui a capacidade de infectar os neurônios humanos de forma direta, o que faz com que os tecidos infectados com altos níveis de ECA2 fiquem suscetíveis, tais como as células epiteliais dos alvéolos pulmonares 4 . O desequilíbrio entre as citocinas, vindo do estado pró-inflamatório e mudança na resposta imune adaptativa e inata, causa importantes alterações na atividade e desenvolvimento leucocitário 15 , o que pode justificar a elevada prevalência de parosmia no presente estudo, cujo IMC médio foi de sobrepeso.…”

“…Estudos revelam que o vírus SARS-CoV-2 pode infectar, de forma direta, as células-alvo, por acoplamento ao receptor da enzima conversora de angiotensina 2 (ECA2), o que ocasiona maior susceptibilidade à infecção pelos tecidos com altos níveis de ECA2, tais como as células epiteliais dos alvéolos pulmonares, os enterócitos do intestino delgado, os colangiócitos e o endotélio vascular. Além disso, a regulação da resposta inflamatória é influenciada pela ECA2, distribuindo-se nos órgãos abdominais, o que pode explicar a ocorrência de sintomas extrapulmonares em alguns pacientes 4 .…”

Results of Surgical Treatment of Colorectal Cancer, Elective and Emergency, in Patients With Covid-19

“…Other gastrointestinal symptoms, such as vomiting, diarrhea, and abdominal pain simulating inflammatory acute abdomen, have been described with COVID-19 and may occur before or even in the absence of respiratory symptoms 9 , 10 , 11 . It was observed that the patient in case 1 presented outputs of up to 4 L daily, which may be related to the diarrhea caused by SARS-COV-2.…”