THE COVID-19 INFECTION FROM THE PERSPECTIVE OF THE GASTROENTEROLOGIST

  • Marija Branković University Hospital Medical Center Bezanijska kosa, Department of Internal medicine
  • Igor Jovanović KBC Bežanijska Kosa
  • Tijana Radonjić KBC Bežanijska Kosa
  • Olivera Marković KBC Bežanijska Kosa
  • Milica Brajković KBC Bežanijska Kosa
  • Višeslav Popadić KBC Bežanijska Kosa
  • Slobodan Klašnja KBC Bežanijska Kosa
  • Marija Zdravković KBC Bežanijska Kosa
Keywords: SARS-CoV-2, gastrointestinal tract, liver, inflammatory bowel disease, endoscopy

Abstract


The gastrointestinal tract and liver are not spared, when it comes to the coronavirus disease of 2019 (COVID-19), as it doesn’t only affect the respiratory tract, but it is also a systemic disease that causes multiple organ damage. In this review, we have united all information that is clinically significant for physicians dealing with this infection, especially for gastroenterologists. One must bear in mind that gastrointestinal symptoms can be the first and/or only indicators of COVID-19, so this infection needs to be suspected when a patient at risk presents with diarrhea, loss of appetite, abdominal pain, nausea, and/or vomiting. Upper gastrointestinal endoscopy in the COVID-19 pandemic is a major issue, as transmission of this airborne infection happens very easily during this procedure, and it should be performed only in cases of gastrointestinal emergencies. With regard to patients suffering from inflammatory bowel disease (IBD), they are often on immunosuppressive therapy, but recommendations are that no change in therapy should be made, as these patients do not fall under the category of patients who are at increased risk of contracting COVID-19. In addition, liver lesion caused by this infection develops as the result of a multifactorial mechanism and is a
definite cause for concern, especially in patients with pre-existing chronic liver conditions, who should be closely monitored.

References

1. Villapol S. Gastrointestinal symptoms associated with COVID-19: impact on the gut microbiome. Transl Res. 2020;226:57–69.
2. Hongzhou Lu, Stratton CW, Tang Y-W. Outbreak of pneumonia of unknown etiology in Wuhan , China : The mystery and the miracle. J Med Virol. 2020;92(4):401–2.
3. Lu R, Zhao X, Li J, Niu P, Yang B, Wu H, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus : implications for virus origins and receptor binding. Lancet. 2020;395(10224):565–74.
4. Yeo C, Kaushal S, Yeo D. Enteric involvement of coronaviruses: is faecal-oral transmission of SARS-CoV-2 possible? Lancet Gastroenterol Hepatol. 2020;5(4):335–7.
5. Galanopoulos M, Gkeros F, Doukatas A, Karianakis G, Pontas C, Tsoukalas N, et al. COVID-19 pandemic: Pathophysiology and manifestations from the gastrointestinal tract. World J Gastroenterol. 2020;26(31):4579–4588.
6. Schmulson M, Dávalos MF, Berumen J. Beware: Gastrointestinal symptoms can be a manifestation of COVID-19 (Spanish). Rev Gastroenterol Mex. 2020;85(3):282–287.
7. Chai X, Hu L, Zhang Y, et al. Specific ACE2 expression in cholangiocytes may cause liver damage after 2019-nCoV infection. bioRxiv. 2020;
8. Zhang H, Kang Z, Gong H, Xu D, Wang J, Li Z, et al. Digestive system is a potential route of COVID-19: an analysis of single- cell coexpression pattern of key proteins in viral entry process. Gut. 2020;69:1010–8.
9. Xiao F, Tang M, Zheng X, Liu Y, Li X, Shan H. Evidence for Gastrointestinal Infection of SARS-CoV-2. Gastroenterology. 2020;158(6):1831–3.
10. Baj J, Karakuła-Juchnowicz H, Teresiński G, Buszewicz G, Ciesielka M, Sitarz E, et al. COVID-19 : Specific and Non-Specific Clinical Manifestations and Symptoms : The Current State of Knowledge. J Clin Med. 2020;9(6):1753.
11. Hajifathalian K, Mahadev S, Schwartz RE, Shah S, Sampath K, Schnoll-sussman F, et al. SARS-COV-2 infection (coronavirus disease 2019) for the gastrointestinal consultant. World J Gastroenterol. 2020;26(14):1546–53.
12. Wu Y, Guo C, Tang L, Hong Z, Zhou J, Dong X, et al. Prolonged presence of SARS-CoV-2 viral RNA in faecal samples. Lancet Gastroenterol Hepatol. 2020;5(5):434–5.
13. Neurath MF. Covid-19 and immunomodulation in IBD. Gut. 2020;69(7):1335–42.
14. Hunt RH, East JE, Lanas A, Malfertheiner P, Satsangi J, Scarpignato C, et al. COVID-19 and Gastrointestinal Disease: Implications for the Gastroenterologist. Dig Dis. 2021;39(2):119–39.
15. Massironi S, Viganò C, Dioscoridi L, Filippi E, Pagliarulo M, Manfredi G, et al. Endoscopic Findings in Patients Infected With 2019 Novel Coronavirus in Lombardy, Italy. Clin Gastroenterol Hepatol. 2020;18(10):2375–2377.
16. Popadic V, Klasnja S, Milic N, et al. Predictors of Mortality in Critically Ill COVID-19 Patients Demanding High Oxygen Flow: A Thin Line between Inflammation, Cytokine Storm, and Coagulopathy. Oxid Med Cell Longev. 2021;2021:6648199.
17. Monteleone G, Ardizzone S. Are Patients with Inflammatory Bowel Disease at Increased Risk for Covid-19 Infection? J Crohns Colitis. 2020;1–3.
18. Xu L, Liu J, Lu M, Yang D, Zheng X. Liver injury during highly pathogenic human coronavirus infections. Liver Int. 2020;40(5):998–1004.
19. Garrido I, Liberal R, Macedo G. Review article: COVID-19 and liver disease—what we know on 1st May 2020. Aliment Pharmacol Ther. 2020;52(2):267–75.
20. Jothimani D, Venugopal R, Abedin MF, Kaliamoorthy I, Rela M. COVID-19 and the liver. J Hepatol. 2020;73(5):1231–40.
21. Banales JM, Huebert RC, Karlsen T, et al. Cholangiocyte pathobiology. Nat Rev Gastroenterol Hepatol. 2019;16:269–281.
22. Bertolini A, van de Peppel IP, Bodewes FAJA, et al. Abnormal Liver Function Tests in Patients With COVID-19: Relevance and Potential Pathogenesis. Hepatology. 2020;72(5):1864–72.
23. Li J, Fan JG. Characteristics and mechanism of liver injury in 2019 coronavirus disease. J Clin Transl Hepatol. 2020;8:13–7.
24. Bangash MN, Patel J, Parekh D. COVID-19 and the liver: little cause for concern. Lancet Gastroenterol Hepatol. 2020;5:529–30.
25. Sun J, Aghemo A, Forner A, Valenti L. COVID-19 and liver disease. Liver Int. 2020;40:1278–81.
26. Hajifathalian K, Krisko T, Mehta A, et al. Gastrointestinal and Hepatic Manifestations of 2019 Novel Coronavirus Disease in a Large Cohort of Infected Patients From New York: Clinical Implications. Gastroenterology. 2020;S0016-5085(20):30602–8.
27. Mohammed A, Paranji N, Chen P-H, Niu B. COVID-19 in Chronic Liver Disease and Liver Transplantation: A Clinical Review. J Clin Gastroenterol. 2021;55(3):187–94.
28. Wang Y, Liu S, Liu H, Li W, Lin F, Jiang L, et al. SARS-CoV-2 infection of the liver directly contributes to hepatic impairment in patients with COVID-19. J Hepatol. 2020;73(4):807–16.
Published
2021/12/28
Section
Reviews