scholarly journals Involvement of digestive system in COVID-19: manifestations, pathology, management and challenges

2020 ◽  
Vol 13 ◽  
pp. 175628482093462 ◽  
Author(s):  
Song Su ◽  
Jun Shen ◽  
Liangru Zhu ◽  
Yun Qiu ◽  
Jin-Shen He ◽  
...  
Keyword(s):  
Respiratory Symptoms ◽  
Gi Tract ◽  
Angiotensin Converting Enzyme 2 ◽  
Oral Transmission ◽  
Faecal Samples ◽  
Gi Symptoms ◽  
Tract Involvement ◽  
Stool Specimens ◽  
Novel Coronavirus ◽  
Loss Of Appetite

The pandemic of novel coronavirus disease (COVID-19) has developed as a tremendous threat to global health. Although most COVID-19 patients present with respiratory symptoms, some present with gastrointestinal (GI) symptoms like diarrhoea, loss of appetite, nausea/vomiting and abdominal pain as the major complaints. These features may be attributable to the following facts: (a) COVID-19 is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and its receptor angiotensin converting enzyme 2 (ACE2) was found to be highly expressed in GI epithelial cells, providing a prerequisite for SARS-CoV-2 infection; (b) SARS-CoV-2 viral RNA has been found in stool specimens of infected patients, and 20% of patients showed prolonged presence of SARS-CoV-2 RNA in faecal samples after the virus converting to negative in the respiratory system. These findings suggest that SARS-CoV-2 may be able to actively infect and replicate in the GI tract. Moreover, GI infection could be the first manifestation antedating respiratory symptoms; patients suffering only digestive symptoms but no respiratory symptoms as clinical manifestation have also been reported. Thus, the implications of digestive symptoms in patients with COVID-19 is of great importance. In this review, we summarise recent findings on the epidemiology of GI tract involvement, potential mechanisms of faecal–oral transmission, GI and liver manifestation, pathological/histological features in patients with COVID-19 and the diagnosis, management of patients with pre-existing GI and liver diseases as well as precautions for preventing SARS-CoV-2 infection during GI endoscopy procedures.

scholarly journals Gastrointestinal symptoms in COVID-19 patients: a case series

2020 ◽  
Vol 9 (9) ◽  
pp. 3866
Author(s):  
Shahida Naghma ◽  
Deepak Kumar
Keyword(s):  
Gastrointestinal Symptoms ◽  
Hospital Setting ◽  
Case Series ◽  
Oral Transmission ◽  
Virus Rna ◽  
Faecal Samples ◽  
Gi Symptoms ◽  
Sample Testing ◽  
Loss Of Appetite ◽  
Global Threat

The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), presents an ongoing global threat. Common clinical features reported in early confirmed infections included fever, cough, and myalgias or fatigue. But as testing capacity and case numbers have increased worldwide, gastrointestinal (GI) symptoms such as diarrhoea, nausea/vomiting, abdominal pain, and loss of appetite have been increasingly recognized. Authors present a case series of gastrointestinal symptoms in COVID-19 patients and how they were managed at the hospital. However, correlations between the presence of fecal virus RNA and severity of digestive symptoms, namely, diarrhoea severity could not be established due to unavailability of the test in the hospital setting. Although knowledge about the viability of SARS-CoV-2 is limited, the virus could remain viable in the environment for days, which could lead to faeco-oral transmission. Various studies conducted on COVID-19 patients recommended routine stool sample testing with real-time RT-PCR after the clearance of viral RNA in a patient’s respiratory samples. Strict precautions to prevent transmission should be taken for patients who are in hospital or self-quarantined if their faecal samples test positive. Optimally, testing for COVID-19 should be performed using both respiratory and stool samples, if available.

COVID-19 aus der Sicht der Gastroenterologie

2020 ◽  
Vol 145 (15) ◽  
pp. 1033-1038
Author(s):  
Christian Schulz ◽  
Julia Mayerle ◽  
Hans Christian Stubbe ◽  
Simon Sirtl ◽  
Markus M. Lerch ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Respiratory Symptoms ◽  
Gastrointestinal Symptoms ◽  
Clinical Routine ◽  
Fecal Samples ◽  
Oral Transmission ◽  
Number Of Patients ◽  
New Variant ◽  
Therapeutic Procedures ◽  
Loss Of Appetite

AbstractCOVID 19, caused by SARS-CoV2, a new variant of coronaviruses, typically presents with respiratory symptoms. However, in a significat number of patients different organs are involved in the disease, often including gastrointestinal symptoms. These could include loss of appetite, vomiting, abdominal pain and diarrhea, with diarrhea being associated with a more severe course of COVID-19. Because viral RNA can be detected in fecal samples, some implications for clinical routine in diagnostic and therapeutic procedures are grown. Until yet, no clear evidence is given regarding fecal-oral transmission of SARS-CoV2.

scholarly journals Gastrointestinal and Liver Manifestations of COVID-19

2020 ◽  
Vol 56 (02) ◽  
pp. 091-098
Author(s):  
Sunil Taneja ◽  
Rohit Mehtani ◽  
Yogesh Kumar Chawla
Keyword(s):  
Respiratory Symptoms ◽  
Gastrointestinal Symptoms ◽  
Liver Function Tests ◽  
Atypical Presentation ◽  
Shortness Of Breath ◽  
Gi Tract ◽  
First Case ◽  
The World ◽  
Novel Coronavirus ◽  
Common Manifestation

AbstractA novel Coronavirus, SARS-CoV-2 illness, has spread throughout the world after the first case was reported from Wuhan, China, in December 2019. This illness typically causes respiratory symptoms like fever, cough, and shortness of breath, although atypical presentation with gastrointestinal symptoms like abdominal pain, nausea, vomiting, or diarrhea are being increasingly reported. The viral RNA has been detected in saliva and stool of such patients, which raises concerns regarding the risk of transmission during gastrointestinal (GI) endoscopy. Many patients also have liver involvement, with the most common manifestation being deranged liver function tests. This review highlights the symptomatology, mechanism, and histopathology findings of SARS-CoV-2 in GI tract and liver. This review also focuses on implications of COVID-19 in patients afflicted with chronic liver disease and in patients undergoing liver transplantation.

scholarly journals Gastrointestinal symptoms in the course of COVID-19

2020 ◽  
Vol 74 ◽  
pp. 498-503
Author(s):  
Grzegorz K. Jakubiak ◽  
Józefina Ochab-Jakubiak ◽  
Grzegorz Cieślar ◽  
Agata Stanek
Keyword(s):  
Intestinal Inflammation ◽  
Gastrointestinal Symptoms ◽  
Unknown Etiology ◽  
Wuhan City ◽  
Angiotensin Converting Enzyme 2 ◽  
Current State ◽  
Novel Coronavirus ◽  
Loss Of Appetite ◽  
First Time

COVID-19 is an infectious disease caused by novel coronavirus SARS-CoV-2, a betacoronavirus comprised of single-stranded ribonucleic acid (RNA), the first time reported in December 2019 as pneumonia with unknown etiology in Wuhan City in China. It is a very important current problem for public health worldwide. A typical clinical course includes dyspnoea, dry cough and fever. In the presented paper we conducted the literature review and described the most important facts within the current state of knowledge about symptomatology and pathophysiology of gastrointestinal dysfunction in the course of COVID-19. Data about prevalence of gastrointestinal symptoms in the course of COVID-19 show wide divergence in the cited literature. Generally, the most common reported digestive symptoms were loss of appetite, nausea and vomiting. Liver injury in the course of COVID-19 is also an important and not well understood problem. The virus has high affinity to cells containing angiotensin- -converting enzyme 2 (ACE2) protein. Digestive symptoms of COVID-19 may be associated with ACE2 expression in epithelial cells in upper oesophagus, ileum and colon. Previous scientific reports have elucidated the role of ACE2 in modulating intestinal inflammation and diarrhoea.

scholarly journals Fluid and Electrolyte Disturbances in COVID-19 and Their Complications

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Mohammad Pourfridoni ◽  
Seyede Mahsa Abbasnia ◽  
Fateme Shafaei ◽  
Javad Razaviyan ◽  
Reza Heidari-Soureshjani
Keyword(s):  
Kidney Injury ◽  
Respiratory Illness ◽  
The Novel ◽  
Acute Respiratory Illness ◽  
Gi Tract ◽  
Angiotensin Converting Enzyme 2 ◽  
Intensive Care Patients ◽  
Electrolyte Disturbances ◽  
Novel Coronavirus ◽  
Tract Damage

The novel coronavirus disease 2019 (COVID-19) is the cause of an acute respiratory illness which has spread around the world. The virus infects the host by binding to the angiotensin-converting enzyme 2 (ACE2) receptors. Due to the presence of ACE2 receptors in the kidneys and gastrointestinal (GI) tract, kidneys and GI tract damage arising from the virus can be seen in patients and can cause acute conditions such as acute kidney injury (AKI) and digestive problems for the patient. One of the complications of kidneys and GI involvement in COVID-19 is fluid and electrolyte disturbances. The most common ones of these disorders are hyponatremia, hypernatremia, hypokalemia, hypocalcemia, hypochloremia, hypervolemia, and hypovolemia, which if left untreated, cause many problems for patients and even increase mortality. Fluid and electrolyte disturbances are more common in hospitalized and intensive care patients. Children are also at greater risk for fluid and electrolyte disturbances complications. Therefore, clinicians should pay special attention to the fluid and electrolyte status of patients. Changes in fluid and electrolyte levels can be a good indicator of disease progression.

scholarly journals Clinical Case Series of Gastrointestinal Symptoms in Patients With Novel Coronavirus 2019 Infection

2021 ◽  
Author(s):  
Hamideh Abbaspour Kasgari ◽  
Amir Mohammad Shabani ◽  
Hafez Fakheri ◽  
Parnian Mohammadzadeh
Keyword(s):  
Respiratory Symptoms ◽  
Acute Phase Proteins ◽  
Severe Disease ◽  
Gastrointestinal Symptoms ◽  
Case Series ◽  
Stable Condition ◽  
Signs And Symptoms ◽  
Case Series Study ◽  
Gi Symptoms ◽  
Loss Of Appetite

Background: Various digestive symptoms have been frequently reported in a significant portion of patients infected with the virus since the outbreak of Coronavirus Disease 2019 (COVID-19). Most patients with COVID-19 have a fever accompanied by respiratory signs and symptoms, such as cough and dyspnea. We present 36 cases with a chief complaint of Gastrointestinal (GI) symptoms along with respiratory symptoms. In this study, we aimed at investigating the prevalence and outcomes of COVID-19 patients with digestive symptoms. Methods: A variety of observed GI symptoms included nausea and vomiting (72.2%), diarrhea (25%), abdominal pain (19.4%), loss of appetite (14%), and anosmia (14%). The most nonGI symptoms were dyspnea (66.7%), fever (66.7%), dry cough (58.3%), myalgia (52.4%), and others. Six patients (16.6%) were critically ill, 7 (19.4%) were in stable condition, and 23 patients (64%) showed moderate symptoms. Among the patients, 7 (19.5%) needed critical care and were admitted to ICU. Leucopenia, lymphopenia, and elevated acute-phase proteins were other features observed in these patients. The most common antiviral regimen was hydroxychloroquine and oseltamivir. Finally, 32 patients (89%) were discharged, and 4 (11%) died. Conclusion: This case series study highlights that patients with COVID-19 are prone to GI symptoms along with fever and respiratory symptoms. Patients may even present with digestive symptoms and without any respiratory symptoms. Hence, clinicians should pay more attention to these patients and help diagnose COVID-19 earlier to start prompt treatment before the occurrence of severe disease.

scholarly journals Acute Pancreatitis in a Patient With COVID-19 After the Resolution of Respiratory Symptoms

2021 ◽  
Vol 9 ◽  
pp. 232470962110247
Author(s):  
Hafiz Muhammad Abrar Jeelani ◽  
Muhammad Mubbashir Sheikh ◽  
Shirly Susan Samuel ◽  
Yetunde Bernice Omotosho ◽  
Artem Sharko ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Angiotensin Converting Enzyme ◽  
Respiratory Symptoms ◽  
Epigastric Pain ◽  
The Novel ◽  
Converting Enzyme ◽  
Angiotensin Converting Enzyme 2 ◽  
Novel Coronavirus

The gastrointestinal (GI) involvement, including acute pancreatitis (AP) from the novel coronavirus disease-2019 (COVID-19), is increasingly being reported. Recent evidence suggests that the pathogenesis of COVID-19 is mediated by the angiotensin-converting enzyme 2 (ACE-2) receptors and transmembrane protease serine 2 (TMPRSS2) for “priming,” which is highly expressed in the pancreas. To our knowledge, there is no other reported case of AP associated with COVID-19 after the respiratory symptoms are resolved. In this article, we present a patient with COVID-19, who came with intractable epigastric pain and resolved respiratory symptoms. A diagnosis of AP complicated with COVID-19 was made after laboratory and imaging workup, which was successfully managed conservatively.

scholarly journals Newly Reported Studies on the Increase in Gastrointestinal Symptom Prevalence with COVID-19 Infection: A Comprehensive Systematic Review and Meta-Analysis

Diseases ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 41
Author(s):  
Hakan Akin ◽  
Ramazan Kurt ◽  
Fatih Tufan ◽  
Ahmed Swi ◽  
Resat Ozaras ◽  
...  
Keyword(s):  
Systematic Review ◽  
Abdominal Pain ◽  
Respiratory Symptoms ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Significant Heterogeneity ◽  
Gi Tract ◽  
Chinese Studies ◽  
Gi Symptoms

Background and Aim: Although constitutional and respiratory symptoms such as cough and fever are the most common symptoms in patients infected with COVID-19, gastrointestinal (GI) tract involvement has been observed by endoscopic biopsies. Multiple GI symptoms, including diarrhea, nausea or vomiting and abdominal pain, have also been reported. This review aims to present the currently available data regarding the GI symptoms of COVID-19 patients, and to compare the frequency of GI symptoms in early stage (Eastern) mostly Chinese data to the current stage (Western) non-Chinese data. Methods: We performed a systematic literature search to identify both published studies by using PubMed, Google Scholar, and CNKI (Chinese medical search engine), and yet unpublished studies through medRxiv and bioRxiv. We also reviewed the cross references of the detected articles. We conducted a Medical Subject Headings (MeSH) search up until 20 September 2020. We pooled the prevalence of symptoms of diarrhea, anorexia, nausea, vomiting, and abdominal pain by using the Freeman–Tukey’s transforming random effect model. Results: A total of 118 studies were included in the systematic review and 44 of them were included in the meta-analysis. There was a significant heterogeneity between the studies; therefore, the random effects model was used. The pooled prevalence estimate of any GI symptoms reported was found to be 0.21 (95%CI, 0.16–0.27). Anorexia was the most commonly reported GI symptom at 18% (95%CI, 0.10–0.27) followed by diarrhea at 15% (95%CI, 0.12–0.19). Diarrhea, abdominal pain, nausea/vomiting, and respiratory symptoms were more common in non-Chinese studies. The prevalence of abdominal pain was lower in the “inpatient-only” studies when compared with studies that included outpatients only and those including both inpatients and outpatients. Conclusions: In this comprehensive systematic review and meta-analysis study, we observed higher rates of diarrhea, nausea/vomiting, and abdominal pain in COVID-19 infected patients among non-Chinese studies compared to Chinese studies. We also observed a higher prevalence of GI symptoms in Chinese studies than was reported previously. Non-respiratory symptoms, including GI tract symptoms, should be more thoroughly and carefully evaluated and reported in future studies.

scholarly journals Respiratory cryptosporidiosis in Malawian children with diarrheal disease

2021 ◽  
Author(s):  
Pui-Ying Iroh Tam ◽  
Mphatso Chisala ◽  
Wongani Nyangulu ◽  
Herbert Thole ◽  
James Nyirenda
Keyword(s):  
Longitudinal Study ◽  
Diarrheal Disease ◽  
Induced Sputum ◽  
Gi Tract ◽  
Respiratory Involvement ◽  
Gi Symptoms ◽  
Stool Specimens ◽  
Moderate Malnutrition ◽  
Mean Cycle

Background: Respiratory cryptosporidiosis has been documented in children with diarrhea. We sought to describe the dynamics of respiratory involvement in children hospitalized with gastrointestinal (GI) diarrheal disease. Methods: We conducted a prospective, observational longitudinal study of Malawian children 2-24 months hospitalized with diarrhea. Nasopharyngeal (NP) swabs, induced sputum and stool specimens were collected. Participants that were positive by cryptosporidium PCR in any of the three compartments were followed up with fortnightly visits up to 8 weeks post-enrollment. Results: Of the 162 children recruited, participants had mild-moderate malnutrition, 36 (22%) were PCR-positive for cryptosporidium at enrollment (34 stool, 11 sputum, and 4 NP) and 27 completed the majority of follow-up visits (75%). Cryptosporidium was detected in all compartments over the 4 post-enrollment visits, most commonly in stool (94% at enrollment with mean cycle thresholds (Ct) of 28.8+/-4.3 to 44% at 8 weeks with Ct 29.9+/-4.1), followed by sputum (31% at enrollment with mean Ct 31.1+/-4.4 to 20% at 8 weeks with Ct 35.7+/-2.6), then NP (11% with mean Ct 33.5+/-1.0 to 8% with Ct 36.6+/-0.7). Participants with cryptosporidium detection in both the respiratory and GI tract over the study period reported respiratory and GI symptoms in 81% and 62% of study visits, respectively, compared to 68% and 27%, respectively, for those with only GI detection, and had longer GI shedding (17.5+/-6.6 v. 15.9+/-2.9 days). Conclusion: Cryptosporidium was detected in both respiratory and GI tracts throughout the 8 weeks post-enrollment. The development of therapeutics for cryptosporidium in children should target the respiratory as well as GI tract.

scholarly journals Gastrointestinal Aspects of COVID-19: A Review

2020 ◽  
Vol 8 (T1) ◽  
pp. 52-54
Author(s):  
Gontar Alamsyah Siregar ◽  
Ginanda Putra Siregar ◽  
Darmadi Darmadi
Keyword(s):  
Small Intestine ◽  
Gastrointestinal Tract ◽  
Respiratory Symptoms ◽  
Protective Equipment ◽  
Converting Enzyme ◽  
Fecal Examination ◽  
Angiotensin Converting Enzyme 2 ◽  
Oral Transmission ◽  
Gastrointestinal Manifestation ◽  
Disease Spreading

Coronaviruses commonly cause mild infections, but recently severe acute respiratory syndrome-coronavirus (SARS-CoV)-2 caused a pandemic of coronavirus disease 2019 (COVID-19). A total of 3,181,642 cases were confirmed globally. Gastrointestinal tract may be involved in COVID-19 due to the presence of angiotensin converting enzyme-2 (ACE2) and transmembrane protease serine 2 (TMPRSS2) in small intestine and colon which are mandatory for SARS-CoV-2 invasion. A proportion of patients with COVID-19 had gastrointestinal manifestation without respiratory symptoms. Viable virus can also be isolated from feces of patients. Fecal-oral transmission should be considered in controlling disease spreading. Fecal examination may also be considered to diagnose COVID-19, especially in areas with limited personal protective equipment.

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