COVID-19 is spreading around the world, and faeces were popular and agreed for the presence of viral RNA with different studies reported. Its presence mean that the gastrointestinal (GI) tract is one of the hosting organ for such coronavirus.
How are other parts of the GI tract system affected by this virus?
Reference:
Clinical features of covid-19-related liver damage.
Clin Gastroenterol Hepatol. 2020 Apr 10.
https://doi.org/10.1016/j.cgh.2020.04.002
Pancreatic injury patterns in patients with COVID-19 pneumonia.
Gastroenterology. 2020 Apr 01.
https://doi.org/10.1053/j.gastro.2020.03.055
Please see the following RG links.
Article Covid-19 and the Digestive System
Article Gastrointestinal Presentation in COVID-19 in Indonesia: A Case Report
Article COVID-19: Gastrointestinal Manifestations and Potential Feca...
Article Gastrointestinal and Liver Manifestations in Patients with COVID-19
Article Review article: Gastrointestinal features in COVID-19 and th...
COVID-19 rapid guideline: gastrointestinal and liver conditions treated with drugs affecting the immune response.
London: National Institute for Health and Care Excellence; 2020 Apr 23. (NICE guideline; NG172)
https://www.nice.org.uk/guidance/ng172
Studies have conducted and reveals that mild to moderate liver injury, including elevated aminotransferases, hypoproteinemia, and prothrombin time prolongation, has been reported in the existing clinical investigations of COVID-19, whereas up to 60% of patients suffering from SARS had liver impairment.
for more information please refer the link
https://www.gastrojournal.org/article/S0016-5085(20)30281-X/pdf?referrer=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2F
An interesting question, Sunny Chi Lik Au.
I had been aware of the liver complications, but reading the Gastroenterology. 2020 Apr 01 link that you sent, I had been unaware of possible pancreatic involvement and associated diarrhoea, and (although it was a small percentage) renal involvement.
Neither had I been aware of the possible fecal-oral mode of transmission as your suggested in the reference from Dr Sunil Kumar.
I saw this article that also looks at this aspect:
Hindson, J. (2020). COVID-19: faecal–oral transmission?. Nature Reviews Gastroenterology & Hepatology, 1-1.
https://www.nature.com/articles/s41575-020-0295-7.pdf
This really does stress the hand hygiene aspect of keeping safe.
Please see the following RG links.
Article Covid-19 and the Digestive System
Article Gastrointestinal Presentation in COVID-19 in Indonesia: A Case Report
Article COVID-19: Gastrointestinal Manifestations and Potential Feca...
Article Gastrointestinal and Liver Manifestations in Patients with COVID-19
Article Review article: Gastrointestinal features in COVID-19 and th...
Please also take a look at the following links.
https://gut.bmj.com/content/gutjnl/early/2020/04/09/gutjnl-2020-321195.full.pdf
http://www.revistagastroenterologiamexico.org/contenidos/pdf/1-s2.0-S0375090620300446-main.pdf
https://www.thelancet.com/action/showPdf?pii=S2468-1253%2820%2930118-7
https://www.medrxiv.org/content/10.1101/2020.04.20.20064873v1.full.pdf
Liver-related transaminases are elevated in a substantial proportion of patients, although generally only mildly elevated. Currently, there is no firm evidence to suggest that the severity of digestive symptoms corresponds to the severity of COVID-19 clinical course, however, more severe alterations in liver enzymes may correlate with worse clinical courses. Given the use of antiviral and antibacterial agents in sicker patients, drug-induced liver injury cannot be ruled out either in these cases.
Read more in-depth through some interesting research articles.
Article COVID-19: Gastrointestinal Manifestations and Potential Feca...
Article Gastrointestinal and Liver Manifestations of COVID-19
Read the interesting articles through the below link.
COVID-19: Gastrointestinal Manifestations and Potential Fecal–Oral Transmission
https://www.gastrojournal.org/article/S0016-5085(20)30281-X/pdf
Directly simptoms conection with Covid 19 are: nausea, vomiting, diarrhoea.
Is possibile and increasses of lab value of function labs tests, especially by patients with earlier liver disease, with predisposition for MODS in these patients.
Three percent (3%) of the patients’ may develop GI symptoms. These are anorexia, diarrhoea, vomiting, nausea, abdominal pain and gastrointestinal bleeding. Adult and children patients can present with digestive symptoms in the absence of respiratory symptoms.
Ref: Article Review article: Gastrointestinal features in COVID-19 and th...
It looks as if it attacks all the organs; see this article, from Medscape Nurses, entitled 'The Great Invader: How COVID-19 Attacks Every Organ'.
https://www.medscape.com/viewarticle/929284?nlid=135264_5621&src=WNL_mdplsfeat_200428_mscpedit_nurs&uac=112868PY&spon=24&impID=2363415&faf=1#vp_4
This is for educational use only - We had a presumptive SARS-2 G.I. case. This patient was already suffering from immune issues which were being well-managed for over one year. Then in March, he presented with the classic SARS-2 symptoms (minus shortness of breath thank goodness), namely: low grade fever, dry cough, malaise, sore throat, sputum production, mild headache. After low dose per os medical-food grade
since the ACE-2 receptor can be found in the visceral human organs, so the port of entry is clear. If we talking about GI tract, the symptomps can be malaise, nausea, vomitus and pain in abdomen region. For the diagnosis should be the secret of GI track and faeces examined by RT PCR.
Thank you
It's just some case of diarrhea, nausea, loss of appetite.. .It's not specific symptom.
Mainly nausea and vomiting. Also can appear lower symptoms such diarrhea and abdominal pain
Article COVID-19: Gastrointestinal Manifestations and Potential Feca...
if the virus was be present in feces that mean tolerant of acidity of stomach !!!
In over half of the patients, faecal samples remained positive for SARS-CoV2 RNA for a mean of 11 days after clearance of respiratory tract samples.
Live SARS-CoV-2 was detected on electron microscopy in stool samples from two patients who did not have diarrhoea, highlighting the potential of faecal-oral transmission.
The virus has been found in stools, so its possible to find symptoms along the whole gastrointestinal tract but mainly in the colon and rectum
Sunny Chi Lik Au
The largest and most comprehensive study evaluating digestive signs and symptoms in patients with COVID-19 is from Wuhan, (reviewed 1141 cases over 7 week)
16% - gastrointestinal symptoms only.
Most common symptoms included loss of appetite.
Nausea and vomiting - 67 %
Diarrhoea - 37%, and
Abdominal pain - 25% of those who presented with GI symptoms.
AST and ALT were both mildly elevated in majority of patients.
Notably, the study is retrospective in nature with a relatively small sample size, thus these results may not be generalizable.
Article Review article: Gastrointestinal features in COVID-19 and th...
This is a review article which may help.
Please see the link below.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7172485/pdf/acg-publish_ahead_of_print-10.14309_ajg.0000000000000667.pdf
Read the following interesting articles.
Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: a descriptive, cross-sectional, multicenter study.Am J Gastroenterol. 2020; (published online April 14.)DOI:10.14309/ajg.0000000000000620
Manifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19: a systematic review and meta-analysis.
Lancet Gastroenterol Hepatol. 2020; (published online May 12.)
https://doi.org/10.1016/S2468-1253(20)30126-6
Prolonged presence of SARS-CoV-2 viral RNA in faecal samples.
Lancet Gastroenterol Hepatol. 2020; 5: 434-435
Characteristics of pediatric SARS-CoV-2 infection and potential evidence for persistent fecal viral shedding.
Nat Med. 2020; 26: 502-505
Review article: gastrointestinal features in COVID‐19 and the possibility of faecal transmission
Article Review article: Gastrointestinal features in COVID-19 and th...
According to Am J Gastroenterol 2020 Mar 30 . The study reported that 23% of patients presented with diarrhea, nausea or vomiting; 34% had both digestive and respiratory symptoms; and the remainder had only respiratory symptoms. Diarrhea was the most common GI manifestation of COVID-19 and the first symptom of COVID-19 in 19% of patients
please see this article:
https://www.webmd.com/lung/covid19-digestive-symptoms
The common GIT manifestation is “Diarrhea” around 19% of COVID-19 patient
There can be several affecting mainly to the gastrointestinal tract, but in general, are mild or moderate
Acute pancreatitis if present may increase the severity of the disease
In the intestinal form, the main symptom is diarrhea. Elevated body temperature is present. Sometimes the intestinal form is observed together with the respiratory one. In this case, the patients are in critical condition.
In generally, gastrointestinal manifestations are mild in comparisson with respiratory symptoms. After resolution of Covid 19 infection, is continued and for two weeks elimination of this virus via feces.
We have to observe carefully because some patients who start with diarrhea may have more severe respiratory symptoms, with the need of intensive care.
Gastrointestinal (GI) symptoms are seen in patients with COVID-19. The prevalence could be as high as 50%, but most studies show ranges from 16% to 33%. Presenting with GI symptoms increases the risk of testing positive for SARs-CoV-2. Approximately 50% of patients with COVID-19 have detectable virus in their stool.
Several studies have shown the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the digestive tract and stools. Approximately 50% of patients with coronavirus disease 2019 (COVID-19) have detectable viral RNA in the stool.SARS-CoV-2 nucleocapsid protein has been found in gastric, duodenal, and rectal glandular epithelial cells.Viral RNA also has been found in esophageal, gastric, duodenal, and rectal biopsies but only in patients with severe disease, suggesting that the presence of SARS-CoV-2 in gastrointestinal (GI) tissue is associated with a more severe disease course. Live virus has also been detected in the stool of patients with COVID-19 by electron microscopy.Although these findings raise the possibility of fecal-oral transmission, this mode of transmission has not been confirmed.
The pathophysiology of digestive symptoms associated with COVID-19 remains unclear. SARS-CoV-2 appears to enter host cells by binding to the angiotensin-converting enzyme-2 (ACE2) receptor and using the transmembrane serine protease 2 for spike protein priming.ACE2 is highly expressed in the small bowel and colon. Data have shown co-expression of ACE2 and transmembrane serine protease 2 in esophageal cells and absorptive enterocytes from both the ileum and colon. Another study reported the infection of enterocytes by SARS-CoV-2 in small intestinal organoids. These findings support the possibility of viral invasion of enterocytes and provide a potential mechanism for SARS-CoV-2–associated GI symptoms.
Infectious SARS-CoV-2 has been isolated from stool samples of COVID-19 patients and shown to infect human intestinal organoids. There is also a clinical study from Austria that showed evidence for intestinal inflammation induced by SARS-CoV-2 in which patients with current or resolved diarrhea had higher concentrations of fecal calprotectin than patients without diarrhea.
Although the presence of SARS-CoV-2 RNA in the stool was not initially thought to be associated with digestive symptoms, recent data indicate that patients with GI symptoms may be more likely to have detectable fecal RNA than patients with respiratory symptoms only. In a study out of Wuhan, China, 69% of patients with diarrhea had detectable RNA in the stool as opposed to only 17% of patients without diarrhea.
Viral RNA can be detected in stool several weeks after symptom onset. Another study from China found that respiratory samples remained positive for an average of 16.7 days after symptom onset, whereas fecal samples remained positive for about 27.9 days. In addition, patients with diarrhea may have more prolonged fecal shedding than patients without diarrhea. What is unknown is whether these patients are infective and if there is a fecal-oral spread to coronavirus.
Please also go through the following RG links.
Article Gastrointestinal Manifestations in COVID-19 Infection and It...
Article Potential Causes and Consequences of Gastrointestinal Disord...
Article 2019 Novel Coronavirus Infection: Gastrointestinal Manifestations
Article Clinical Insights into the Gastrointestinal Manifestations of COVID-19
Article Gastrointestinal symptoms as the first, atypical indication ...
Article Gastrointestinal and Liver Manifestations of COVID-19
Article Gastrointestinal Manifestations of SARS-CoV-2 Infection and ...
Article SARS-CoV-2 infection with gastrointestinal symptoms as the f...
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