Gastrointestinal manifestations in COVID-19

Abstract

Coronavirus disease 2019 (COVID-19), a respiratory viral infection, has affected more than 78 million individuals worldwide as of the end of December 2020. Previous studies reported that severe acute respiratory syndrome coronavirus 1 and Middle East respiratory syndrome–related coronavirus infections may affect the gastrointestinal (GI) system. In this review we outline the important GI manifestations of COVID-19 and discuss the possible underlying pathophysiological mechanisms and their diagnosis and management. GI manifestations are reported in 11.4–61.1% of individuals with COVID-19, with variable onset and severity. The majority of COVID-19-associated GI symptoms are mild and self-limiting and include anorexia, diarrhoea, nausea, vomiting and abdominal pain/discomfort. A minority of patients present with an acute abdomen with aetiologies such as acute pancreatitis, acute appendicitis, intestinal obstruction, bowel ischaemia, haemoperitoneum or abdominal compartment syndrome. Severe acute respiratory syndrome coronavirus 2 RNA has been found in biopsies from all parts of the alimentary canal. Involvement of the GI tract may be due to direct viral injury and/or an inflammatory immune response and may lead to malabsorption, an imbalance in intestinal secretions and gut mucosal integrity and activation of the enteric nervous system. Supportive and symptomatic care is the mainstay of therapy. However, a minority may require surgical or endoscopic treatment for acute abdomen and GI bleeding.

The gut in COVID-19

“…Evidence suggests a cytotoxic effect of SARS-CoV-2 on enterocytes. Indeed, enterocytes express both the ACE2 receptor and TMPRSS2, required for intracellular entry of SARS-CoV-2, and cells were rapidly infected in a human small intestinal organoid model, producing infectious virion [1]. SARS-CoV-2 RNA and intracytoplasmatic viral proteins have been observed in biopsies from different parts of the GI tract, supporting viral intrusion in vivo [6,7].…”

“…The reported prevalence of GI symptoms in COVID-19 patients is highly variable and ranges from 11-95%, potentially related to differences in study design, population and definition of GI symptoms (Table 1) [1]. In general, symptoms were mild and non-specific, and included nausea, vomiting, diarrhea, and abdominal pain [1]. Patients with initial GI symptoms more frequently had fever, constitutional symptoms, shortness of breath and body aches [2].…”

“…In one study in patients with acute respiratory distress syndrome (ARDS), COVID-19 ARDS compared to non-COVID ARDS was more commonly associated with potentially severe GI complications, and these complications included, among others, ileus and mesenteric ischemia [4]. Additionally, acute pancreatitis and severe intra-abdominal hypertension have been described in COVID-19 patients [1]. Importantly, GI symptoms may persist in a considerable number of patients.…”

“…Author details 1 Department of Anaesthesiology and Intensive Care, University of Tartu, Puusepa 8, 51014 Tartu, Estonia. 2 Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland.…”

Risk, Course, and Effect of SARS-CoV-2 Infection in Children and Adults with Chronic Inflammatory Bowel Diseases

“…ACE2 and TMPRSS2 are expressed in different cell types, as alveolar pneumocytes type 2 [ 51 ] and in the gastrointestinal tract, where, according to some studies, they would have a greater expression than in the lung [ 52 ]. ACE2 is particularly expressed by epithelial cells of the gut, thus leading to the virus entering in these cells and to the consequent infection and damage [ 53 ].…”