Gastrointestinal coronavirus disease 2019: epidemiology, clinical features, pathogenesis, prevention, and management

ABSTRACT

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.

KEYWORDS:

• Coronavirus
• Covid-19
• gastrointestinal involvement
• fecal-oral transmission
• management

Article highlights

• A significant portion of patients with SARS-CoV-2 infection develops gastrointestinal symptoms such as diarrhea, vomiting, and abdominal pain.

• SARS-Cov-2 enters into the gastrointestinal cells by binding of the envelope’s spike protein (S) with the angiotensin-converting enzyme 2 (ACE2) membrane receptor of the host cell.

• A high level of ACE2 receptor found in the gastrointestinal epithelium and virus nucleocapsid protein detected in the cell cytoplasm suggest a direct involvement of the gastrointestinal tract.

• The virus replication in the gastrointestinal tract may occur even after clearance of the virus in the respiratory tract.

• The available evidence suggests the possibility of a fecal-oral transmission. If confirmed, this can have enormous implications for public and global health.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This paper was not funded.