Impact of COVID-19 on the Gastrointestinal Tract: A Clinical Review

Ghazanfar, Haider; Kandhi, Sameer; Shin, Dongmin; Muthumanickam, Aruna; Gurjar, Hitesh; Qureshi, Zaheer A; Shaban, Mohammed Samer; Farag, Mohamed; Haider, Asim; Budhathoki, Pravash; Bhatt, Tanushree; Ali, Ghazanfar; Jyala, Abhilasha; Patel, Harish

doi:10.7759/cureus.23333

Cited by 26 publications

(27 citation statements)

References 103 publications

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“…COVID-19 has been associated with many diseases affecting the immune system including Hashimoto's thyroiditis, GBS, and Systemic lupus erythematosus (SLE)-like disease [20][21]. COVID-19 affects multiple organs including but not limited to the gastrointestinal tract, and cardiovascular and neurological systems [22][23][24]. Further research is necessary to evaluate for long-term effects of the novel coronavirus on thyroid function.…”

Section: Discussionmentioning

confidence: 99%

Hashimoto's Thyroiditis Encephalopathy Induced by COVID-19 Infection

Khaja¹,

Qureshi²,

Samsuddoha³

et al. 2022

Cureus

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Various factors can lead to thyroiditis, including any acute inflammatory process, especially viral illness. While coronavirus disease 2019 (COVID-19) has been linked to disorders of various systems, there is a lack of literature showing an association of coronavirus with the cause of Hashimoto's thyroiditis. Several possible mechanisms for this outcome have been proposed; chief among them is molecular mimicry. Here, we are reporting a case of Hashimoto's thyroiditis incited by COVID-19 in a 34-year-old obese female who presented with anxiety, behavioral changes, and repeated head movements. The patient had an elevated thyroid stimulating hormone (TSH) level, a low thyroxine (T4) level, and a positive anti-microsomal antibody screen. The patient also tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA. Ultrasound of the patient's neck showed an enlarged heterogeneous thyroid gland. Thyroid replacement therapy with intravenous levothyroxine was started with the subsequent oral transition. Concurrently, she received antibiotics, steroids, and low-molecular-weight heparin for COVID-19. The patient exhibited significant improvement in her mental status, with an eventual return to baseline. The results of the thyroid panel obtained at the outpatient follow-up were normal. Although there is a paucity of data to show COVID-19 as a cause of this painless thyroiditis, this case demonstrates such causality between these two.

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Section: Discussionmentioning

confidence: 99%

Hashimoto's Thyroiditis Encephalopathy Induced by COVID-19 Infection

Khaja¹,

Qureshi²,

Samsuddoha³

et al. 2022

Cureus

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“…Gastrointestinal symptoms are recognized to be associated with the presentation of MIS-C ( 74 ). GI signs and symptoms and US alterations also appear prominently as presenting features of MIS-C in our patients, mimicking GI infection or even inflammatory bowel disease and surgical conditions.…”

Section: Discussionmentioning

confidence: 99%

“…The GI tract is known to have high expression of ACE2 receptors in the human body, leading to viral entry into the cell. Additional mechanisms are proposed to explain the gastrointestinal involvement, such as indirect immune-mediated injury triggered by a systemic inflammatory response and disruption of the intestinal microecological balance, leading to excessive inflammation of the gut ( 74 ). During follow-up, complete intestinal recovery was detected, supporting that indirect injury, more so than cell damage, could be a crucial player in the GI symptoms that occur in MIS-C presentation.…”

Section: Discussionmentioning

confidence: 99%

Six-month multidisciplinary follow-up in multisystem inflammatory syndrome in children: An Italian single-center experience

et al. 2023

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BackgroundA severe multisystem inflammatory syndrome in children (MIS-C) related to SARS-CoV-2 has been described after infection. A limited number of reports have analyzed the long-term complications related to pro-inflammatory status in MIS-C. We evaluated multiorgan impairment at the 6-month follow-up in MIS-C.MethodsWe enrolled 33 pediatric patients consecutively hospitalized for MIS-C and monitored for almost 6 months. The inter-relationship of patient's features and disease severity at admission with long term complications was studied by multivariate analysis.ResultsEndo-metabolic derangement, cardiac injury, respiratory, renal and gastrointestinal manifestations and neurological involvement are part of the initial presentation. The most abnormalities appear to resolve within the first few weeks, without significant long term dysfunction at the 6-months follow-up, except for endocrine (non-thyroidal illness syndrome in 12.1%, insulin resistance in 21.2%) and neurological system (27.3% cognitive or psychological, behavioral, adaptive difficulties). Endocrine and heart involvement at admission represent a significant factor on the long term sequelae; however no association between severity score and long-term outcome was noted.ConclusionsThe severity of initial clinical presentation may be associated to organ domain, however it is not related to long term sequelae. The prevalent organ restoration supports a predominant indirect immune-mediated injury triggered by a systemic inflammatory response; however a direct damage due to the viral entry could be not excluded. Eventhought our preliminary results seem to suggest that MIS-C is not a long-term risk condition for children health, a longer follow-up is mandatory to confirm this hypothesis.

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“…Among other factors, the hypermetabolic and prolonged catabolic state of COVID-19 patients make personalized and accurate nutrition treatment essential [38 ▪▪ ,39]. Furthermore, SARS-CoV-2 can attack the mucosal epithelium and cause gastrointestinal symptoms, increasing FI and malnutrition risk [40].…”

Section: Nutrition In Coronavirus Disease 2019mentioning

confidence: 99%

Current insights in ICU nutrition: tailored nutrition

Hermans

Laarhuis²,

Kouw

et al. 2023

Current Opinion in Critical Care

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Purpose of reviewTo summarize recent research on critical care nutrition focusing on the optimal composition, timing, and monitoring of enteral feeding strategies for (post)-ICU patients. We provide new insights on energy and protein recommendations, feeding intolerance, and describe nutritional practices for coronavirus disease 2019 ICU patients.Recent findingsThe use of indirect calorimetry to establish individual energy requirements for ICU patients is considered the gold standard. The limited research on optimal feeding targets in the early phase of critical illness suggests avoiding overfeeding. Protein provision based upon the absolute lean body mass is rational. Therefore, body composition measurements should be considered. Body impedance analysis and muscle ultrasound seem reliable, affordable, and accessible methods to assess body composition at the bedside. There is inadequate evidence to change our practice of continuous enteral feeding into intermittent feeding. Finally, severe acute respiratory syndrome coronavirus 2 patients are prone to underfeeding due to hypermetabolism and should be closely monitored.SummaryNutritional therapy should be adapted to the patient's characteristics, diagnosis, and state of metabolism during ICU stay and convalescence. A personalized nutrition plan may prevent harmful over- or underfeeding and attenuate muscle loss. Despite novel insights, more research is warranted into tailored nutrition strategies during critical illness and convalescence.

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Impact of COVID-19 on the Gastrointestinal Tract: A Clinical Review

Cited by 26 publications

References 103 publications

Hashimoto's Thyroiditis Encephalopathy Induced by COVID-19 Infection

Hashimoto's Thyroiditis Encephalopathy Induced by COVID-19 Infection

Six-month multidisciplinary follow-up in multisystem inflammatory syndrome in children: An Italian single-center experience

Current insights in ICU nutrition: tailored nutrition

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