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Abstract
Coronavirus disease-2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The infection is spreading globally and poses a huge threat to human health. Besides common respiratory symptoms, some patients with COVID-19 experience gastrointestinal symptoms, such as diarrhea, nausea, vomiting, and loss of appetite. SARS-CoV-2 might infect the gastrointestinal tract through its viral receptor angiotensin-converting enzyme 2 (ACE2) and there is increasing evidence of a possible fecal–oral transmission route. In addition, there exist multiple abnormalities in liver enzymes. COVID-19-related liver injury may be due to drug-induced liver injury, systemic inflammatory reaction, and hypoxia–ischemia reperfusion injury. The direct toxic attack of SARS-CoV-2 on the liver is still questionable. This review highlights the manifestations and potential mechanisms of gastrointestinal and hepatic injuries in COVID-19 to raise awareness of digestive system injury in COVID-19.
Highlights
Coronavirus disease-2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has evolved into a pandemic
Anal swab specimens from COVID-19 patients tested positive for SARSCoV-2 nucleic acid and SARS-CoV-2 could be isolated from the stool samples of COVID-19 patients,[3,4] indicating the possibility of fecal–oral transmission
An elevated liver function is common in patients with COVID-19, with more significant increases in alanine aminotransferase (ALT) and aspartate aminotransferase (AST) elevations in severe COVID-19 than in mild/moderate COVID19.5 there is a close relationship between digestive system injury and SARS-CoV-2 infection
Summary
COVID-19-associated gastrointestinal and liver injury: clinical features and potential mechanisms. Some patients with COVID-19 experience gastrointestinal symptoms, such as diarrhea, nausea, vomiting, and loss of appetite. SARS-CoV-2 might infect the gastrointestinal tract through its viral receptor angiotensin-converting enzyme 2 (ACE2) and there is increasing evidence of a possible fecal–oral transmission route. Some COVID-19 patients experience gastrointestinal symptoms such as diarrhea, nausea, and vomiting.[2]. In a US study of 318 confirmed COVID-19 cases, 61.3% of patients reported at least one gastrointestinal symptom, with loss of appetite (34.8%), diarrhea (33.7%), and nausea (26.4%) being the most common.[23]. Multiple studies from different countries have reported a variety of gastrointestinal symptoms in COVID-19 patients, diarrhea, nausea, vomiting, and lack of appetite. In a clinical study involving 651 patients with COVID-19, 74 (11.4%) had at least one gastrointestinal symptom (nausea, vomiting, or diarrhea).[30].
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