Abstract
ABSTRACT Background: It is currently understood that severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) directly enters target cells by binding to the angiotensin-converting enzyme 2 (ACE2) receptor. Accordingly, tissues with high expression levels of ACE2 are more susceptible to infection, including pulmonary alveolar epithelial cells, small intestine enterocytes, cholangiocytes, and vascular endothelial cells. Considering the atypical manifestations of COVID-19 and the challenges of early diagnosis, this review addresses the possible gastrointestinal complications of the disease. Method: The phrase “Gastrointestinal complication of COVID” was searched in the PubMed, Medline, and SciELO databases. Due to the heterogeneity of the studies included in the present review, a narrative synthesis of the available qualitative data was performed. Result: The literature search retrieved 28 articles, primarily case reports and case series, for the qualitative analysis of gastrointestinal complications of COVID-19, in addition to two retrospective cohort and one case-control. The studies focused on hemorrhagic, thrombotic, ischemic, and perforation complications, in addition to acute pancreatitis and pneumatosis intestinalis. Conclusion: There is a straight relationship between high expression levels of ACE2 in the gastrointestinal tract and its greater susceptibility to direct infection by SARS-CoV-2. So, it is important to consider the gastrointestinal infection manifestations for early diagnosis and treatment trying to avoid more serious complications and death.
Highlights
Cases of viral pneumonia associated with a severe acute respiratory syndrome were reported in December 2019 in the city of Wuhan, China
Background: It is currently understood that severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) directly enters target cells by binding to the angiotensin-converting enzyme 2 (ACE2) receptor
Considering the atypical manifestations of COVID19 and the challenges of early diagnosis, this review addresses the possible gastrointestinal complications of the disease
Summary
Cases of viral pneumonia associated with a severe acute respiratory syndrome were reported in December 2019 in the city of Wuhan, China. A novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]), the causative agent of coronavirus disease 2019 (COVID-19), was identified in January 202039,43,48. Organization declared a public health emergency of international concern, described as a pandemic, on March 11, 202047. Since September 2020, the world has witnessed a “second wave” of COVID-19, associated with an increase in the number of cases, and with the emergence of new SARS-CoV-2 variants[12,15]. Some patients experience gastrointestinal manifestations in the early stages of the disease, including nausea, vomiting, diarrhea, abdominal pain, and anorexia[8,28,31,37,45]. While others progress without exhibiting any respiratory symptoms[16,20,41]
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