COVID-19 and the digestive system: A comprehensive review

Area of Science:

• Gastroenterology and Hepatology
• Infectious Diseases
• Virology

Background:

• Coronavirus disease 2019 (COVID-19) pandemic caused by SARS-CoV-2 presents a global health emergency.
• Gastrointestinal (GI) symptoms, including nausea, diarrhea, and abdominal pain, occur in a significant percentage of COVID-19 patients.
• SARS-CoV-2 RNA is detectable in feces, suggesting potential fecal-oral transmission routes.

Purpose of the Study:

• To review the potential fecal-oral transmission of SARS-CoV-2.
• To discuss the spectrum of GI manifestations in COVID-19 patients.
• To explore pathophysiological mechanisms and infection control strategies related to GI involvement in COVID-19.

Main Methods:

• Literature review synthesizing existing research on COVID-19 and GI symptoms.
• Analysis of clinical studies reporting GI manifestations and their incidence rates.
• Examination of studies on SARS-CoV-2 receptor (angiotensin-converting enzyme 2) expression in the digestive tract.

Main Results:

• GI symptoms are common in COVID-19, varying widely in incidence and sometimes preceding respiratory symptoms.
• The digestive system is a significant clinical component of COVID-19, with potential for liver and pancreatic injury.
• Angiotensin-converting enzyme 2, the SARS-CoV-2 receptor, is expressed in various GI tissues, supporting direct viral invasion.

Conclusions:

• Fecal-oral transmission of SARS-CoV-2 is a plausible route, contributing to the pandemic's spread.
• Understanding GI manifestations and mechanisms is crucial for comprehensive COVID-19 patient management.
• Effective infection control measures are essential to mitigate transmission risks, including those related to GI involvement.