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COVID-19: Gastrointestinal manifestations, liver injury and recommendations

Zulal Ozkurt1, Esra Çınar Tanrıverdi2

  • 1Department of Infectious Disease, Atatürk University, School of Medicine, Erzurum 25100, Turkey.

World Journal of Clinical Cases
|February 25, 2022
PubMed

Insights

COVID-19 significantly impacts the gastrointestinal system and liver, increasing severe illness risk for patients with chronic gastrointestinal diseases. Prioritizing vaccination and tailored treatments is crucial for these vulnerable populations.

Area of Science:

  • Gastroenterology and Hepatology
  • Infectious Diseases
  • Internal Medicine

Background:

  • Coronavirus disease 2019 (COVID-19) has caused a global pandemic, affecting nearly 270 million people and causing 5 million deaths by December 2021.
  • Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) targets angiotensin-converting enzyme 2 (ACE2), prevalent in gastrointestinal and liver cells, leading to widespread organ involvement.
  • COVID-19 infection impacts all organs within the gastrointestinal system.

Purpose of the Study:

  • To review the gastrointestinal manifestations and liver damage associated with COVID-19 infection.
  • To investigate the risk of severe COVID-19 in patients with pre-existing chronic gastrointestinal diseases.
  • To examine current treatment guidelines for these patient groups.

Main Methods:

  • A comprehensive literature search was conducted across major electronic databases: PubMed, Scopus, and Cochran Library.
  • Keywords included COVID-19, liver injury, gastrointestinal system findings, and treatment protocols.
  • The review synthesized findings on clinical manifestations, risk factors, and management strategies.

Main Results:

  • Gastrointestinal and liver involvements are common COVID-19 manifestations, with diarrhea, anorexia, nausea/vomiting, and abdominal pain being frequent symptoms.
  • Mild hepatitis, indicated by elevated transaminases, is observed. Gastrointestinal involvement correlates with prolonged hospitalization, disease severity, and intensive care unit (ICU) admission.
  • Management and follow-up for patients with inflammatory bowel diseases, cirrhosis, hepatocellular carcinoma, or liver transplants were negatively impacted. Patients with these conditions, autoimmune diseases, or liver transplants face a higher risk of severe COVID-19.

Conclusions:

  • Gastrointestinal and liver complications are significant in COVID-19, particularly for patients with chronic gastrointestinal or liver conditions.
  • These patients exhibit an increased risk for severe COVID-19 outcomes, necessitating careful management.
  • Recommendations include prioritizing COVID-19 vaccination, delaying non-urgent procedures, utilizing telemedicine, and ensuring timely treatment for high-risk individuals.
Keywords:
COVID-19Gastrointestinal manifestationsLiver injuryLiver transplantationSARS-CoV-2

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