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Diarrhea and Coronavirus Disease 2019 Infection.

David M Friedel1, Mitchell S Cappell2

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Gastroenterology Clinics of North America
|February 22, 2023
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Summary
This summary is machine-generated.

Gastrointestinal symptoms, particularly diarrhea, are common in COVID-19 patients. This review covers the causes, presentation, and management of diarrhea in coronavirus disease-2019.

Keywords:
ACE-2 (angiotensin converting enzyme-2)C difficileCOVID-19ColonoscopyDiarrheaGastrointestinal symptomsLong COVIDPandemicSARS-CoV-2 (severe acute respiratory syndrome coronavirus-2)Stool studies

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Area of Science:

  • Gastroenterology
  • Infectious Diseases
  • Internal Medicine

Background:

  • Coronavirus disease-2019 (COVID-19) primarily causes pulmonary symptoms but frequently presents with extrapulmonary manifestations, including gastrointestinal (GI) issues.
  • Diarrhea affects 10-20% of COVID-19 patients, sometimes as the sole presenting symptom, and can range from mild to life-threatening.
  • The presence of the COVID-19 virus entry receptor (angiotensin-converting enzyme-2) in the GI tract explains the high incidence of GI symptoms.

Purpose of the Study:

  • To review the pathophysiology, clinical presentation, evaluation, and treatment of diarrhea in COVID-19 patients.
  • To highlight the significance of GI symptoms in the context of the global pandemic.
  • To discuss the role of COVID-19 infection, treatments, and secondary infections in causing diarrhea.

Main Methods:

  • Review of existing literature on COVID-19 and associated gastrointestinal symptoms.
  • Analysis of pathophysiological mechanisms linking SARS-CoV-2 to the GI tract.
  • Summary of diagnostic workup and therapeutic strategies for COVID-19-related diarrhea.

Main Results:

  • Diarrhea in COVID-19 is typically acute, mild-to-moderate, and nonbloody, but can be chronic or severe.
  • Potential causes include direct viral infection, antibiotic therapy, and secondary infections like Clostridioides difficile.
  • Diagnostic evaluation involves routine labs, stool studies, and imaging, while treatment focuses on fluid/electrolyte replacement and antidiarrheal agents.

Conclusions:

  • Diarrhea is a significant extrapulmonary manifestation of COVID-19 with diverse causes and presentations.
  • Prompt evaluation and management are crucial, especially for severe cases or suspected C. difficile superinfection.
  • Diarrhea can persist in long COVID-19 and has been noted post-vaccination, warranting continued clinical attention.