Abstract
Objectives: This work aims to study the gastrointestinal (GI) symptoms in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected patients and the susceptibility factors of the stomach for SARS-CoV-2.Materials and Methods: We investigated the SARS-CoV-2 susceptibility by analyzing the expression distribution of viral entry-associated genes, ACE2 and TMPRSS2, in single-cell RNA sequencing data derived from 12 gastric mucosa samples. We also analyzed the epidemiological, demographic, clinical, and laboratory data of 420 cases with SARS-CoV-2-caused coronavirus disease 2019 (COVID-19).Results: ACE2 and TMPRSS2 are specifically expressed in enterocytes which are mainly from gastric mucosa samples with Helicobacter pylori (H. pylori) infection history and intestinal metaplasia (IM). A total of 420 patients were surveyed, of which 62 were with and 358 were without GI symptoms. There is a significant difference in average hospital stay (p < 0.001) and cost (p < 0.001) between the two groups. Among 23 hospitalized patients including seven with upper GI symptoms and 16 with lower GI symptoms, six (85.7%) and five (31.3%) had H. pylori infection history, respectively (p = 0.03). Of 18 hospitalized patients with initial upper GI symptoms, none of the eight patients with mucosal protective agent therapy (e.g., sucralfate suspension gel, hydrotalcite tablets) had diarrhea subsequently, whereas six out of 10 patients without mucosal protective agent therapy had diarrhea subsequently (p = 0.01).Conclusion: IM and H. pylori infection history may be susceptibility factors of SARS-CoV-2, and the mucosal protective agent may be useful for the blockade of SARS-CoV-2 transmission from the stomach to the intestine.
Highlights
The current SARS-CoV-2-caused coronavirus disease 2019 (COVID-19) pandemic is an ongoing global health crisis [1, 2]
We speculate that SARS-Cov-2 can infect the stomach with H. pylori infection history and IM, thereby resulting in upper GI symptoms. These results revealed that H. pylori infection history and IM might be susceptibility factors of SARS-Cov-2
We explored the association of H. pylori infection with GI symptoms for 23 hospitalized patients, including seven with upper GI symptoms (UGIS) and 16 with lower GI symptom (LGIS), of which six (85.7%) and five (31.3%) had H. pylori infection, respectively (p = 0.03, Table 2)
Summary
The current SARS-CoV-2-caused coronavirus disease 2019 (COVID-19) pandemic is an ongoing global health crisis [1, 2]. The distribution of SARS-CoV-2 entry receptor may be highly associated with the route of infection, which is essential for understanding the pathogenesis mechanism [7,8,9]. Recent studies [10, 11] reported that the viral host receptor ACE2 and the viral nucleocapsid were mainly in the cytoplasm of gastrointestinal epithelial cells. The scRNA-seq findings uncovered that the SARS-CoV-2 entry receptor ACE2 and TMPRSS2 were expressed in gastrointestinal epithelial cells such as enterocytes [7, 12]. As stomach is the upstream target organ in the fecal–oral route, a systematic survey of the distribution of SARS-CoV-2 entry receptor in the stomach and its susceptibility factors for SARS-CoV-2 infection will benefit our understanding of the mechanism of non-diarrhea GI symptoms and further guide effective prevention and treatment
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