Gastrointestinal disorders and of COVID-19

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Farima Kahe M.D. [2]Tayyaba Ali, M.D.[3]Ifrah Fatima, M.B.B.S[4]

Overview

Transmission of COVID-19 through gastrointestinal route

SARS-CoV-2 has been detected in non-respiratory specimens, together with stool, blood, ocular secretions, and semen. However, the role of those sites in the transmission is unsure.[1][2][3][4][5][6] Several reports are evident for the detection of SARS-CoV-2 RNA from a stool sample, even after no viral RNA is detected from the upper respiratory sample.[7][8]According to studies, the SARS-CoV-2 antigen is detected in gastrointestinal epithelial cells of a biopsy sample.[9] Live SARS-CoV-2 is also cultured from stool samples in rare cases.[2][10] In spite of the fact that it is hard to affirm, fecal-oral transmission has not been clinically depicted, and as indicated by a joint WHO-China report, didn't have all the earmarks of being a noteworthy factor in the spread of infection.

Gastrointestinal risk factors of COVID-19

Complications

Diarrhea

  • Diarrhea is an uncommon gastrointestinal symptom in patients with COVID-19, but may be the presenting symptom in a few patients. The frequency of occurrence of diarrhea varies between 1%-35%. [11]It varies widely between different studies probably due to the different criteria used to define diarrhea.
  • Greater percentage of occurrence of diarrhea was noted in patients with severe COVID-19 when compared to non-severe disease. Likewise, patients with gastrointenstinal symptoms were more likely to have severe respiratory disease with ARDS requiring ventilatory support. [12] [13]

Pathophysiology

  • SARS-CoV-2 uses the Angiotensin-converting enzyme 2 (ACE2) and the serine protease TMPRSS2 receptors for cell entry. These receptors are presently abundantly not only in the lungs but also in the enterocytes of the small intestinal.[14][15] Other sites of expression of the receptors in the gastrointestinal tract are-the upper esophagus, liver, and colon. [14]
  • Entry of the virus causes disruption of the enterocytes and may lead to inflammation and alteration of intestinal permeability.
  • COVID- 19 is being treated by atrial of many different antivirals and antibiotics. Diarrhea could also be a result of an alteration of the gut microbiota due to any of these. [16]

Clinical Features of Diarrhea caused by SARS-CoV-2

  • According to Jin et al[12], the definition of diarrhea was the passing of loose stools >3 times per day.
  • According to this study, 8.1% had diarrhea at onset and the symptoms lasted for approximately 4 days.
  • The duration of diarrhea ranged from 2-4 days with 3-8 bowel movements per day, according to various studies. [17][18]

Treatment

  • Supportive management is the mainstay of treatment.
  • Rehydration, fluid repletion, and potassium monitoring are essential.
  • Use of probiotics may have a role if the diarrhea is being caused by alteration of the gut microbiome. This could also be potentially useful in preventing secondary bacterial infections by restoring the gut microbiota. [16]

Nauesa and vomiting

Abdominal pain

Loss of appetite

References

  1. ↑ Chen, Weilie; Lan, Yun; Yuan, Xiaozhen; Deng, Xilong; Li, Yueping; Cai, Xiaoli; Li, Liya; He, Ruiying; Tan, Yizhou; Deng, Xizi; Gao, Ming; Tang, Guofang; Zhao, Lingzhai; Wang, Jinlin; Fan, Qinghong; Wen, Chunyan; Tong, Yuwei; Tang, Yangbo; Hu, Fengyu; Li, Feng; Tang, Xiaoping (2020). "Detectable 2019-nCoV viral RNA in blood is a strong indicator for the further clinical severity". Emerging Microbes & Infections. 9 (1): 469–473. doi:10.1080/22221751.2020.1732837. ISSN 2222-1751.
  2. ↑ 2.0 2.1 Wang, Wenling; Xu, Yanli; Gao, Ruqin; Lu, Roujian; Han, Kai; Wu, Guizhen; Tan, Wenjie (2020). "Detection of SARS-CoV-2 in Different Types of Clinical Specimens". JAMA. doi:10.1001/jama.2020.3786. ISSN 0098-7484.
  3. ↑ Colavita, Francesca; Lapa, Daniele; Carletti, Fabrizio; Lalle, Eleonora; Bordi, Licia; Marsella, Patrizia; Nicastri, Emanuele; Bevilacqua, Nazario; Giancola, Maria Letizia; Corpolongo, Angela; Ippolito, Giuseppe; Capobianchi, Maria Rosaria; Castilletti, Concetta (2020). "SARS-CoV-2 Isolation From Ocular Secretions of a Patient With COVID-19 in Italy With Prolonged Viral RNA Detection". Annals of Internal Medicine. doi:10.7326/M20-1176. ISSN 0003-4819.
  4. ↑ Cheung, Ka Shing; Hung, Ivan F.N.; Chan, Pierre P.Y.; Lung, K.C.; Tso, Eugene; Liu, Raymond; Ng, Y.Y.; Chu, Man Y.; Chung, Tom W.H.; Tam, Anthony Raymond; Yip, Cyril C.Y.; Leung, Kit-Hang; Fung, Agnes Yim-Fong; Zhang, Ricky R.; Lin, Yansheng; Cheng, Ho Ming; Zhang, Anna J.X.; To, Kelvin K.W.; Chan, Kwok-H.; Yuen, Kwok-Y.; Leung, Wai K. (2020). "Gastrointestinal Manifestations of SARS-CoV-2 Infection and Virus Load in Fecal Samples From a Hong Kong Cohort: Systematic Review and Meta-analysis". Gastroenterology. doi:10.1053/j.gastro.2020.03.065. ISSN 0016-5085.
  5. ↑ Zheng, Shufa; Fan, Jian; Yu, Fei; Feng, Baihuan; Lou, Bin; Zou, Qianda; Xie, Guoliang; Lin, Sha; Wang, Ruonan; Yang, Xianzhi; Chen, Weizhen; Wang, Qi; Zhang, Dan; Liu, Yanchao; Gong, Renjie; Ma, Zhaohui; Lu, Siming; Xiao, Yanyan; Gu, Yaxi; Zhang, Jinming; Yao, Hangping; Xu, Kaijin; Lu, Xiaoyang; Wei, Guoqing; Zhou, Jianying; Fang, Qiang; Cai, Hongliu; Qiu, Yunqing; Sheng, Jifang; Chen, Yu; Liang, Tingbo (2020). "Viral load dynamics and disease severity in patients infected with SARS-CoV-2 in Zhejiang province, China, January-March 2020: retrospective cohort study". BMJ: m1443. doi:10.1136/bmj.m1443. ISSN 1756-1833.
  6. ↑ Li, Diangeng; Jin, Meiling; Bao, Pengtao; Zhao, Weiguo; Zhang, Shixi (2020). "Clinical Characteristics and Results of Semen Tests Among Men With Coronavirus Disease 2019". JAMA Network Open. 3 (5): e208292. doi:10.1001/jamanetworkopen.2020.8292. ISSN 2574-3805.
  7. ↑ Cheung KS, Hung IFN, Chan PPY, Lung KC, Tso E, Liu R; et al. (2020). "Gastrointestinal Manifestations of SARS-CoV-2 Infection and Virus Load in Fecal Samples From a Hong Kong Cohort: Systematic Review and Meta-analysis". Gastroenterology. doi:10.1053/j.gastro.2020.03.065. PMC 7194936 Check |pmc= value (help). PMID 32251668 Check |pmid= value (help).
  8. ↑ Zheng S, Fan J, Yu F, Feng B, Lou B, Zou Q; et al. (2020). "Viral load dynamics and disease severity in patients infected with SARS-CoV-2 in Zhejiang province, China, January-March 2020: retrospective cohort study". BMJ. 369: m1443. doi:10.1136/bmj.m1443. PMC 7190077 Check |pmc= value (help). PMID 32317267 Check |pmid= value (help).
  9. ↑ Xiao, Fei; Tang, Meiwen; Zheng, Xiaobin; Liu, Ye; Li, Xiaofeng; Shan, Hong (2020). "Evidence for Gastrointestinal Infection of SARS-CoV-2". Gastroenterology. 158 (6): 1831–1833.e3. doi:10.1053/j.gastro.2020.02.055. ISSN 0016-5085.
  10. ↑ Xiao F, Sun J, Xu Y, Li F, Huang X, Li H; et al. (2020). "Infectious SARS-CoV-2 in Feces of Patient with Severe COVID-19". Emerg Infect Dis. 26 (8). doi:10.3201/eid2608.200681. PMID 32421494 Check |pmid= value (help).
  11. ↑ Li XY, Dai WJ, Wu SN, Yang XZ, Wang HG (2020). "The occurrence of diarrhea in COVID-19 patients". Clin Res Hepatol Gastroenterol. doi:10.1016/j.clinre.2020.03.017. PMC 7270575 Check |pmc= value (help). PMID 32253163 Check |pmid= value (help).
  12. ↑ 12.0 12.1 Jin X, Lian JS, Hu JH, Gao J, Zheng L, Zhang YM; et al. (2020). "Epidemiological, clinical and virological characteristics of 74 cases of coronavirus-infected disease 2019 (COVID-19) with gastrointestinal symptoms". Gut. 69 (6): 1002–1009. doi:10.1136/gutjnl-2020-320926. PMC 7133387 Check |pmc= value (help). PMID 32213556 Check |pmid= value (help).
  13. ↑ Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX; et al. (2020). "Clinical Characteristics of Coronavirus Disease 2019 in China". N Engl J Med. 382 (18): 1708–1720. doi:10.1056/NEJMoa2002032. PMC 7092819 Check |pmc= value (help). PMID 32109013 Check |pmid= value (help).
  14. ↑ 14.0 14.1 D'Amico F, Baumgart DC, Danese S, Peyrin-Biroulet L (2020). "Diarrhea During COVID-19 Infection: Pathogenesis, Epidemiology, Prevention, and Management". Clin Gastroenterol Hepatol. doi:10.1016/j.cgh.2020.04.001. PMC 7141637 Check |pmc= value (help). PMID 32278065 Check |pmid= value (help).
  15. ↑ Liang W, Feng Z, Rao S, Xiao C, Xue X, Lin Z; et al. (2020). "Diarrhoea may be underestimated: a missing link in 2019 novel coronavirus". Gut. 69 (6): 1141–1143. doi:10.1136/gutjnl-2020-320832. PMID 32102928 Check |pmid= value (help).
  16. ↑ 16.0 16.1 Gao QY, Chen YX, Fang JY (2020). "2019 Novel coronavirus infection and gastrointestinal tract". J Dig Dis. 21 (3): 125–126. doi:10.1111/1751-2980.12851. PMC 7162053 Check |pmc= value (help). PMID 32096611 Check |pmid= value (help).
  17. ↑ Song Y, Liu P, Shi XL, Chu YL, Zhang J, Xia J; et al. (2020). "SARS-CoV-2 induced diarrhoea as onset symptom in patient with COVID-19". Gut. 69 (6): 1143–1144. doi:10.1136/gutjnl-2020-320891. PMID 32139552 Check |pmid= value (help).
  18. ↑ Chan JF, Yuan S, Kok KH, To KK, Chu H, Yang J; et al. (2020). "A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster". Lancet. 395 (10223): 514–523. doi:10.1016/S0140-6736(20)30154-9. PMC 7159286 Check |pmc= value (help). PMID 31986261.
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