Abstract
ABSTRACTThe new coronavirus disease pandemic is defining 2020, with almost 17.5 million infected individuals and 700 thousand deaths up to beginning of August. It is caused by SARS-CoV-2 and the transmission is through the respiratory tract. Those infected may be asymptomatic, present typical symptoms (fever, dry cough and dyspnea), gastrointestinal symptoms (diarrhea, nausea, vomiting and abdominal pain) and viral RNA in stools. The objective of this work was to review the literature related to the prevalence of gastrointestinal symptoms, and to check the possibility of fecal-oral transmission. We searched PubMed® database on COVID-19 and gastrointestinal tract and selected articles using the PRISMA method. We eliminated articles based on titles and abstracts, small number of patients and the mechanism of infection, leaving 14 studies. Comorbidities and laboratory alterations (elevation of hepatic aminotransferases and bilirubin) were related to worsening of the disease. The prevalence of gastrointestinal symptoms ranged from 6.8% to 61.3%, including diarrhea (8.14% to 33.7%), nausea/vomiting (1.53% to 26.4%), anorexia (12.1% to 40.0%) and abdominal pain (0% to 14.5%). The presence of viral RNA in stools was rarely tested, but positive in 0% to 48.1%. The gastrointestinal tract is affected by COVID-19, causing specific symptoms, laboratory alterations and viral presence in the feces. However, the results of prevalence and possibility of fecal-oral transmission were varied, requiring further studies for more assertive conclusions. It is important that healthcare professionals draw attention to this fact, since these changes can help make diagnosis and initiate early treatment.
Highlights
In December 2019, the first cases of patients infected with the new coronavirus were identified in Wuhan, China.(1) The year 2020 will be remembered by the 2019 coronavirus pandemic (COVID-19), causing a great impact on public health and economy of many countries
The mean age of patients ranged from 45.1 to 58.5 years, but only one article significantly correlated advanced age with gastrointestinal symptoms.(21) In another article, advanced age was related to severity of the disease, but without assessing whether these patients had gastrointestinal symptoms.(25) In general, all articles found more men affected with COVID-19 than women, and only one found a significant difference between non-medical women and more gastrointestinal symptoms.(26) These results suggested that advanced age and male gender are risk factors for infection
A study still under review found that ACE2 expression increases in females and with sex hormones; inflammatory cytokines decrease this expression
Summary
In December 2019, the first cases of patients infected with the new coronavirus were identified in Wuhan, China.(1) The year 2020 will be remembered by the 2019 coronavirus pandemic (COVID-19), causing a great impact on public health and economy of many countries. The virus, called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is the seventh coronavirus known to infect humans. The others are the acute severe respiratory syndrome coronavirus (SARS-CoV), with an epidemic in 2003, and the Middle Eastern respiratory syndrome coronavirus (MERS-CoV), with an epidemic in the Middle East, in 2012, and both cause severe disease; and HKU1, NL63, OC43, and 229E, which cause mild symptoms. SARS-CoV-2 is an encapsulated RNA virus of the order Nidovirales, family Coronaviridae, subfamily Coronavirinae, genus Beta.(3) SARS-CoV-2 probably originated in bats and is transmitted to humans through another animal.(4) The main transmission route is respiratory, through contact with droplets, aerosols, and contaminated surfaces.(5)
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