COVID-19: Gut and liver

Abstract

Currently, the world is facing a pandemic induced by novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), termed as coronavirus disease 2019 (COVID-19). Patients typically present with myalgia, fever and respiratory symptoms, but studies have stated the existence of gastrointestinal (GI) symptoms, liver injury and existence of SARS-CoV-2 RNA in the faecal specimen of these individuals. GI symptoms were also common during the previous outbreak of coronavirus family, i.e., severe acute respiratory syndrome and Middle East respiratory syndrome in 2003 and 2012, respectively. Literature reports multiple studies with varied proportions of GI symptoms such as abdominal pain, nausea, vomiting and diarrhoea. Hepatic injury was assessed with abnormal serum levels of aspartate aminotransferase, alanine aminotransferase and total bilirubin. SARS-CoV-2 may enter host cells by the presence of angiotensin-converting enzyme-2 receptor which is present in enterocytes (in small intestine), cholangiocytes (in bile duct) and hepatocytes (in liver) suggesting replication of virus in intestine and liver. This might be the cause of dysregulation of liver and GI functions. Another possible mechanism of dysregulation of the intestinal and hepatic systems might include inflammatory cytokine storm or antibiotic-induced toxicity. This article discusses a possible faecal-oral transmission due to viral shedding in the stool. This review article also emphasises on GI and hepatic aspects of COVID-19 which might become a defining tool in our fight against it.