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Gastrointestinal coronavirus disease 2019: epidemiology, clinical features, pathogenesis, prevention, and management
Simona Deidda1, Lorena Tora2, Davide Firinu3
1Colorectal Surgery Unit, Department of Surgical Science, University of Cagliari , Cagliari, Italy.
Introduction:
The new Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is the etiologic agent of coronavirus disease 2019. Some authors reported pieces of evidence that patients with SARS-CoV-2 infection could have direct involvement of the gastrointestinal tract, and in symptomatic cases, gastrointestinal symptoms (diarrhea, nausea/vomiting, abdominal pain) could be very common.
Area Covered:
In this article, we reviewed current-published data of the gastrointestinal aspects involved in SARS-CoV-2 infection, including prevalence and incidence of specific symptoms, the presumptive biological mechanism of GI infection, prognosis, clinical management, and public health-related concerns on the possible risk of oral-fecal transmission.
Expert Opinion:
Different clues point to direct virus infection and replication in mucosal cells of the gastrointestinal tract. In vitro studies showed that SARS-CoV-2 could enter into the gastrointestinal epithelial cells by the Angiotensin-Converting enzyme two membrane receptor. These findings, coupled with the identification of viral RNA found in stools of patients, clearly suggest that direct involvement of the gastrointestinal tract is very likely. This can justify most of the gastrointestinal symptoms but also suggest a risk for an oral-fecal route for transmission, additionally or alternatively to the main respiratory route.
Insights
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) can infect the gastrointestinal tract, causing common symptoms like diarrhea. This suggests a potential oral-fecal transmission route for the virus.
Area of Science:
- Gastroenterology
- Virology
- Infectious Diseases
Background:
- Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) causes COVID-19.
- Gastrointestinal (GI) symptoms are frequently reported in SARS-CoV-2 infected patients.
- Evidence suggests direct GI tract involvement in SARS-CoV-2 infection.
Purpose of the Study:
- To review published data on GI aspects of SARS-CoV-2 infection.
- To explore the prevalence, mechanisms, and transmission risks of GI involvement.
- To summarize clinical management and public health concerns related to GI symptoms.
Main Methods:
- Systematic review of current literature on SARS-CoV-2 and the GI tract.
- Analysis of data on symptom prevalence, incidence, and biological mechanisms.
- Evaluation of prognosis, clinical management strategies, and transmission routes.
Main Results:
- SARS-CoV-2 can infect and replicate in GI mucosal cells.
- The virus utilizes the Angiotensin-Converting Enzyme 2 (ACE2) receptor for entry into GI epithelial cells.
- Viral RNA detection in stool samples confirms GI tract involvement.
Conclusions:
- Direct SARS-CoV-2 infection of the GI tract is highly probable.
- GI symptoms in COVID-19 patients can be attributed to direct viral infection.
- A significant risk of oral-fecal transmission exists, in addition to the respiratory route.
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