Gastrointestinal implications in COVID-19

Abstract

Believed to have originated from a local Huanan Seafood Wholesale Market in Wuhan, Hubei Province in China, the COVID-19 has had an unprecedented and catastrophic impact on humanity, with the WHO declaring it a global pandemic. Although the first case of COVID-19 was reported in December 2019, the primary source and intermediate host have not been confirmed, but human-to-human transmission has been universally accepted. The main mode of transmission of the virus is through respiratory droplets along with prominent respiratory system involvement. However, fecal-oral transmission due to the shedding of the virus in the gastrointestinal (GI) tract may continue for up to 10 weeks after respiratory clearance and is fast becoming important. SARS-CoV-2 shows a high affinity to ACE2 receptors, making sites of high ACE2 receptor expression, such as lungs, GI tract, brain, kidneys, heart, liver and immune system, a prime target for infection. Through this literature review, we aim to summarize the current knowledge of immunological pathways that contribute to the disease with a focus specifically on the GI tract involvement. We direct attention to the pathophysiological mechanism of involvement of the GI tract leading to symptomatic manifestations, track GI organ-specific viral loads to compare and contrast with other organ systems. We briefly detail specific treatment strategies from a GI disease standpoint and mention special considerations when there is involvement of the GI tract.

Implications of SARS‐CoV‐2 infection for neurogastroenterology

“…7 After internalization, the virus starts its replication using the cellular replication processes, which ends with new viral assemblies, viral secretion, and release of cytokine which contribute to symptom generation. 13 ACE2 receptors have been reported to be highly expressed in several organs of the human body beyond the lungs, such as endothelial cells, renal tubular epithelium, testes, kidneys, brain, heart, and liver. 7 However, the highest expression of ACE2 in the human body occurs in the brush border of intestinal enterocytes.…”

Liver injury in the era of COVID-19

“…Another observation in this study was that a more severe course of COVID-19 was associated with more marked gastrointestinal symptoms[ 7 ]. Recent observations proved that gastrointestinal manifestations of SARS-CoV-2 infection may involve 39.6% to 50% of patients and usually include nausea, diarrhea, anorexia, abdominal pain, belching and emesis[ 8 - 10 ]. A complex presentation of SARS-CoV-2 infection involving skin disorders, impaired taste and smell, kidney dysfunction, acute heart failure and even multiple organ dysfunction syndrome, proves that COVID-19 is a systemic diseases.…”

Coronavirus Disease (COVID-19) Caused by (SARS-CoV-2) Infections: A Real Challenge for Human Gut Microbiota

“…When the viral entity is replicated, it transpasses the cells through secretions. Within the GI tract, the viral secretions are followed by the release of the cytokines, which in turn are responsible for the associated GI manifestations ( Dahiya et al., 2020 ). Still, it remains unknown how SARS-CoV-2 enters the GI tract and survives the extreme pH medium of the stomach ( Ng and Tilg, 2020 ).…”