What GI Physicians Need to Know During COVID-19 Pandemic
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REVIEW
What GI Physicians Need to Know During COVID‑19 Pandemic Paul J. Thuluvath1,2 · Joseph J. Alukal3 · Nishal Ravindran3 · Sanjaya K. Satapathy3 Received: 10 July 2020 / Accepted: 16 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract The worldwide pandemic of COVID-19, caused by the virus SARS-CoV-2, continues to cause significant morbidity and mortality in both low- and high-income countries. Although COVID-19 is predominantly a respiratory illness, other systems including gastrointestinal (GI) system and liver may be involved because of the ubiquitous nature of ACE-2 receptors in various cell lines that SARS-CoV-2 utilizes to enter host cells. It appears that GI symptoms and liver enzyme abnormalities are common in COVID-19. The involvement of the GI tract and liver correlates with the severity of disease. A minority (10–20%) of patients with COVID-19 may also present initially with only GI complaints. The most common GI symptoms are anorexia, loss of smell, nausea, vomiting, and diarrhea. Viral RNA can be detected in stool in up to 50% of patients, sometimes even after pharyngeal clearance, but it is unclear whether fecal–oral transmission occurs. Liver enzymes are elevated, usually mild (2–3 times), in a substantial proportion of patients. There are many confounding factors that could cause liver enzyme abnormalities including medications, sepsis, and hypoxia. Although infection rates in those with preexisting liver disease are similar to that of general population, once infected, patients with liver disease are more likely to have a more severe disease and a higher mortality. There is a paucity of objective data on the optimal preventive or management strategies, but few recommendations for GI physicians based on circumstantial evidence are discussed. Keywords COVID-19 · SARS-CoV-2 · Liver manifestations: GI symptoms · Liver enzymes
Introduction The ongoing pandemic of coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) continues to be a major concern in many countries around the world [1]. Of those who develop COVID-19, ~ 15% develop severe disease and ~ 5% become critically ill resulting in death in half of them. To date, the highest case fatality rates from COVID19 have been reported in the USA, Brazil, the UK, Italy, Spain, France, and Mexico. This novel coronavirus infection, which may have originated from the wet markets of Wuhan * Paul J. Thuluvath [email protected] 1
Institute of Digestive Health and Liver Diseases, Mercy Medical Center, Baltimore, MD, USA
2
Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
3
Department of Internal Medicine, Barbara and Zucker School of Medicine for Hofstra/Northwell Health, Manhasset, NY, USA
Province in China in December 2019, causes predominantly acute respiratory symptoms. As of July 8, 2020, more than 12 million people have been diagnosed with this infection worldwide and of these, over 550,000 have died [2].
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