ABSTRACT
Background: Although SARS-CoV-2 has mainly respiratory manifestations, gastrointestinal symptoms are observed in 30% of cases. The ACE-2 receptor used by SARS-CoV-2 to infect cells is highly expressed in the brush border of enterocytes. However, studying the small intestine in live patients is a challenge in the field of clinical research. A minimally invasive alternative for studying the small intestine is the use of capsule endoscopy, which could be useful in the context of COVID-19. Here, we describe endoscopic changes in the mucosa of the small intestine secondary to severe SARS-CoV-2 infection in hospitalized patients. Methods: We performed a prospective observational study in hospitalized patients with a severe COVID-19 according to NIH guidelines. Participants with a positive COVID-19 PCR from nasopharyngeal swab, hemodynamically stable, able to swallow, and without additional respiratory co-infections, were enrolled between January 27th and May 17th, 2021 at the largest tertiary COVID-19 referral center in Mexico City. Demographic and clinical characteristics were collected for each participant from clinical files. A PillCam capsule from Medtronic® was used for Capsule Endoscopy (CE). Each capsule study was reviewed separately by two trained endoscopists. Detection of SARS-CoV-2 RNA in stool samples was performed according to CDC guidelines for all participants. Results: Twenty volunteers were enrolled in the study. Diarrhea was the most common gastrointestinal symptom (78%). CE study was normal in 6 participants, while the rest showed at least one intestinal finding. The most frequent finding was shortening or atrophy of villi and hyperemia (45%);followed by red spots (40%), and ulcers (15%). Two participants with shortening or atrophy of villi also presented denuded mucosa. CE findings were observed mainly in duodenum and jejunum. Participants showing changes in villi also presented positive SARS-CoV-2 RNA in stool. Conclusion: We observed that macroscopic changes in the small intestine mucosa, specifically in villi, occurred frequently in severe COVID-19 patients. These changes were accompanied by the presence of SARS-CoV-2 RNA in stool. We proposed the term COVID-19 Enteropathy to encompass these findings. Further studies are warranted to establish mechanisms of SARS-CoV-2-associated gastrointestinal disease.