COVID-19 and Alimentary Tract: Current Evidence and Recent Recommendations

Walid Ibrahim Yousif

doi:10.47723/kcmj.v17i2.311

Abstract

The pandemic of coronavirus disease 2019 (COVID-19), first reported in China, in December 2019 and since then the digestive tract involvement of COVID-19 has been progressively described. In this review, I summed recent studies, which have addressed the pathophysiology of COVID-19-induced gastrointestinal symptoms, their prevalence, and bowel pathological and radiological findings of infected patients. The effects of gut microbiota on SARS-CoV-2 and the challenges of nutritional therapy of the infected patients are depicted. Moreover, I provide a concise summary of the recommendations on the management of inflammatory bowel disease, colorectal cancer, and performing endoscopy in the COVID era. Finally, the COVID pancreatic relation was explored. Conclusions: digestive symptoms in COVID-19 patients can be the only manifestation and they may be correlated with worse clinical outcomes. The likelihood of fecal-oral transmission of COVID-19 has significant consequences and requires further research. A clear link may exist between the gut microbiome and COVID-19 progression and it may have a therapeutic and prognostic value. No evidence for an increased frequency of covid-19 cases in IBD and stopping immunosuppressive medications is not advised. Triage and risk assessment of patients with suspected or confirmed COVID-19 before endoscopy is essential; deferral of elective endoscopies should be considered.

Highlights

The outbreak of COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first identified in Wuhan, in December 2019, and the pandemic spreads worldwide. [1] As of October 8, 2020, nearly 36 million confirmed positive cases of COVID-19, with more than one million deaths, were reported to WHO, and the number continues to rise. [2] Acute respiratory syndrome, manifested by fever, cough, and dyspnea is the most classical presentation of COVID-19
; COVID-19 has impacts on the management of patients with co-and pre-existing digestive diseases. [1,4] In this review, the studies investigating the pathophysiology of COVID-19-related GIT manifestations, pathological, and radiological imaging results in COVID-19 patients presenting with digestive symptoms have been summarized
The SARS-CoV-2 disease can be included in the differential diagnosis of acute diarrhea and/or vomiting, at least for the time of this pandemic

Summary

Introduction

The outbreak of COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first identified in Wuhan, in December 2019, and the pandemic spreads worldwide. [1] As of October 8, 2020, nearly 36 million confirmed positive cases of COVID-19, with more than one million deaths, were reported to WHO, and the number continues to rise. [2] Acute respiratory syndrome, manifested by fever, cough, and dyspnea is the most classical presentation of COVID-19. Diarrhea was reported as one of COVID-19's initial presenting symptoms in two pooled analyses which involve 9717 and 8070 [46] The SARS-CoV2 infection of the ACE2-expressing enterocytes leads to mucosal inflammation [47], which was verified by an increased level of fecal calprotectin, which significantly correlated with serum interleukin-6 concentration.

Results

Conclusion