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1.
Pol Arch Intern Med ; 130(5): 420-430, 2020 05 29.
Article in English | MEDLINE | ID: covidwho-621657

ABSTRACT

The outbreak of the coronavirus disease 2019 (COVID­19) pandemic has become the biggest challenge for the whole human community since many years. It seems that the proper identification of all people infected with severe acute respiratory syndrome coronavirus 2 (SARS­CoV­2) is the best strategy to limit the transmission. However, in a significant proportion of patients, there are no clinical manifestations of the disease, and symptoms may be very mild or atypical. There is a growing body of evidence that digestive manifestations of COVID­19 are frequently reported and may precede typical respiratory symptoms. Moreover, SARS­CoV­2 particles were found in the gastrointestinal epithelial cells, and viral RNA was detected in the feces of patients with COVID­19. These data suggest that gastrointestinal symptoms in COVID­19 are not accidental findings and they may result from direct digestive involvement. Patients with new­onset diarrhea, abdominal pain, nausea, and vomiting without any other evident etiological factors should be tested for SARS­CoV­2 infection. Gastroenterologists and members of other medical specialties should also remember that the current epidemiological situation has changed diagnostic and therapeutic algorithms in the management of several gastrointestinal and liver disorders. This review article summarizes the currently available data on multiple gastroenterological aspects of COVID­19 and provides information on practical recommendations and position statements of the most prominent associations in the field of gastroenterology, which appeared in response to the emergence of the pandemic.


Subject(s)
Betacoronavirus/metabolism , Coronavirus Infections/complications , Digestive System Diseases/virology , Digestive System/virology , Pneumonia, Viral/complications , Coronavirus/metabolism , Coronavirus Infections/diagnosis , Coronavirus Infections/drug therapy , Coronavirus Infections/therapy , Digestive System/metabolism , Humans , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy
2.
Am J Gastroenterol ; 115(7): 1129-1132, 2020 07.
Article in English | MEDLINE | ID: covidwho-618936

ABSTRACT

INTRODUCTION: High rates of concurrent gastrointestinal manifestations have been noted in patients with corona virus disease 2019 (COVID-19); however, the association between these digestive manifestations and need for hospitalization has not been established. METHODS: This is a retrospective review of consecutive patients diagnosed with COVID-19. A total of 207 patients were identified; 34.5% of patients noted concurrent gastrointestinal symptoms, with 90% of gastrointestinal symptoms being mild. RESULTS: In a multivariate regression model controlled for demographics and disease severity, an increased risk of hospitalization was noted in patients with any digestive symptom (adjusted odds ratio 4.84, 95% confidence interval: 1.68-13.94). DISCUSSION: The presence of digestive symptoms in COVID-19 is associated with a need for hospitalization.


Subject(s)
Coronavirus Infections/complications , Gastrointestinal Diseases/etiology , Pneumonia, Viral/complications , Adult , Aged , Betacoronavirus , Digestive System Diseases/etiology , Digestive System Diseases/virology , Female , Gastrointestinal Diseases/virology , Hospitalization , Humans , Male , Middle Aged , Pandemics , Retrospective Studies
3.
J Clin Virol ; 128: 104386, 2020 07.
Article in English | MEDLINE | ID: covidwho-227004

ABSTRACT

There is an increasing number of confirmed cases and deaths caused by the Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) contributing to the Coronavirus disease 2019 (COVID-19) pandemic. At this point, the need for further disease characterization is critical. COVID-19 is well established as a respiratory tract pathogen; however, recent studies have shown an increasing number of patients reporting gastrointestinal manifestations such as diarrhea, nausea, vomiting, and abdominal pain. The time from onset of gastrointestinal symptoms to hospital presentation is often delayed compared to that of respiratory symptoms. It has been noted that SARS-CoV-2 RNA can be detected in fecal matter for an extended period of time, even after respiratory samples have tested negative and patients are asymptomatic. In this article, SARS-CoV-2 and its disease COVID-19 will be reviewed with consideration of the latest literature about gastrointestinal symptomatology, the mechanisms by which the virus may inflict damage, and the possibility of viral replication contributing to a fecal-oral route of transmission.


Subject(s)
Betacoronavirus/physiology , Coronavirus Infections/epidemiology , Diarrhea/virology , Digestive System Diseases/epidemiology , Pandemics , Pneumonia, Viral/epidemiology , Betacoronavirus/genetics , Betacoronavirus/isolation & purification , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Coronavirus Infections/virology , Digestive System Diseases/prevention & control , Digestive System Diseases/virology , Feces/virology , Gastrointestinal Tract/virology , Humans , Liver/virology , Oxygen/administration & dosage , Pancreas/virology , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Pneumonia, Viral/virology , Respiration, Artificial , Virus Replication , Vomiting/virology
4.
Pol Arch Intern Med ; 130(5): 420-430, 2020 05 29.
Article in English | MEDLINE | ID: covidwho-155128

ABSTRACT

The outbreak of the coronavirus disease 2019 (COVID­19) pandemic has become the biggest challenge for the whole human community since many years. It seems that the proper identification of all people infected with severe acute respiratory syndrome coronavirus 2 (SARS­CoV­2) is the best strategy to limit the transmission. However, in a significant proportion of patients, there are no clinical manifestations of the disease, and symptoms may be very mild or atypical. There is a growing body of evidence that digestive manifestations of COVID­19 are frequently reported and may precede typical respiratory symptoms. Moreover, SARS­CoV­2 particles were found in the gastrointestinal epithelial cells, and viral RNA was detected in the feces of patients with COVID­19. These data suggest that gastrointestinal symptoms in COVID­19 are not accidental findings and they may result from direct digestive involvement. Patients with new­onset diarrhea, abdominal pain, nausea, and vomiting without any other evident etiological factors should be tested for SARS­CoV­2 infection. Gastroenterologists and members of other medical specialties should also remember that the current epidemiological situation has changed diagnostic and therapeutic algorithms in the management of several gastrointestinal and liver disorders. This review article summarizes the currently available data on multiple gastroenterological aspects of COVID­19 and provides information on practical recommendations and position statements of the most prominent associations in the field of gastroenterology, which appeared in response to the emergence of the pandemic.


Subject(s)
Betacoronavirus/metabolism , Coronavirus Infections/complications , Digestive System Diseases/virology , Digestive System/virology , Pneumonia, Viral/complications , Coronavirus/metabolism , Coronavirus Infections/diagnosis , Coronavirus Infections/drug therapy , Coronavirus Infections/therapy , Digestive System/metabolism , Humans , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy
6.
Rev Esp Enferm Dig ; 112(5): 389-396, 2020 05.
Article in English | MEDLINE | ID: covidwho-125039

ABSTRACT

The purpose of this rapid review is to provide an update on the impact of SARS-CoV-2 infection on Gastroenterology and Hepatology departments, our patients, and our new way of working. The gastrointestinal tract and the liver are affected by SARS-CoV-2, especially in patients with immunosuppressive therapies. Patients with liver transplantation should be followed closely. Digestive endoscopy is a high-risk procedure for the transmission of SARS-CoV-2. While the pandemic lasts, we must adapt its indications and promote protective measures for patients and healthcare professionals alike. The COVID-19 pandemic has changed our priorities and the way we work, although we do not know what the repercussions will be after normality is reinstated.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/transmission , Digestive System Diseases/virology , Digestive System/virology , Pandemics , Pneumonia, Viral/transmission , Coronavirus Infections/virology , Digestive System Diseases/diagnosis , Digestive System Diseases/therapy , Disease Transmission, Infectious/prevention & control , Endoscopy, Digestive System/adverse effects , Humans , Immunosuppressive Agents/adverse effects , Infection Control/methods , Liver Transplantation , Pneumonia, Viral/virology
7.
Am J Gastroenterol ; 115(6): 916-923, 2020 06.
Article in English | MEDLINE | ID: covidwho-77893

ABSTRACT

OBJECTIVES: Coronavirus disease 2019 (COVID-19) most commonly presents with respiratory symptoms, including cough, shortness of breath, and sore throat. However, digestive symptoms also occur in patients with COVID-19 and are often described in outpatients with less severe disease. In this study, we sought to describe the clinical characteristics of COVID-19 patients with digestive symptoms and mild disease severity. METHODS: We identified COVID-19 patients with mild disease and one or more digestive symptoms (diarrhea, nausea, and vomiting), with or without respiratory symptoms, and compared them with a group presenting solely with respiratory symptoms. We followed up patients clinically until they tested negative for COVID-19 on at least 2 sequential respiratory tract specimens collected ≥24 hours apart. We then compared the clinical features between those with digestive symptoms and those with respiratory symptoms. RESULTS: There were 206 patients with low severity COVID-19, including 48 presenting with a digestive symptom alone, 69 with both digestive and respiratory symptoms, and 89 with respiratory symptoms alone. Between the 2 groups with digestive symptoms, 67 presented with diarrhea, of whom 19.4% experienced diarrhea as the first symptom in their illness course. The diarrhea lasted from 1 to 14 days, with an average duration of 5.4 ± 3.1 days and a frequency of 4.3 ± 2.2 bowel movements per day. Concurrent fever was found in 62.4% of patients with a digestive symptom. Patients with digestive symptoms presented for care later than those with respiratory symptoms (16.0 ± 7.7 vs 11.6 ± 5.1 days, P < 0.001). Nevertheless, patients with digestive symptoms had a longer duration between symptom onset and viral clearance (P < 0.001) and were more likely to be fecal virus positive (73.3% vs 14.3%, P = 0.033) than those with respiratory symptoms. DISCUSSION: We describe a unique subgroup of COVID-19 patients with mild disease severity marked by the presence of digestive symptoms. These patients are more likely to test positive for viral RNA in stool, to have a longer delay before viral clearance, and to experience delayed diagnosis compared with patients with only respiratory symptoms.


Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections , Diarrhea , Digestive System Diseases , Pandemics , Pneumonia, Viral , RNA, Viral/analysis , China/epidemiology , Clinical Laboratory Techniques/methods , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Diarrhea/diagnosis , Diarrhea/etiology , Digestive System Diseases/diagnosis , Digestive System Diseases/physiopathology , Digestive System Diseases/virology , Feces/virology , Female , Humans , Male , Middle Aged , Outcome Assessment, Health Care , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Severity of Illness Index , Symptom Assessment/methods
8.
J Dig Dis ; 21(4): 199-204, 2020 Apr.
Article in English | MEDLINE | ID: covidwho-42091

ABSTRACT

An epidemic of an acute respiratory syndrome caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Wuhan, China, now known as coronavirus disease 2019 (COVID-19), beginning in December 2019, has attracted an intense amount of attention worldwide. As the natural history and variety of clinical presentations of this disease unfolds, extrapulmonary symptoms of COVID-19 have emerged, especially in the digestive system. While the respiratory mode of transmission is well known and is probably the principal mode of transmission of this disease, a possibility of the fecal-oral route of transmission has also emerged in various case series and clinical scenarios. In this review article, we summarize four different aspects in published studies to date: (a) gastrointestinal manifestations of COVID-19; (b) microbiological and virological investigations; (c) the role of fecal-oral transmission; and (d) prevention and control of SARS-CoV-2 infection in the digestive endoscopy room. A timely understanding of the relationship between the disease and the digestive system and implementing effective preventive measures are of great importance for a favorable outcome of the disease and can help climnicians to mitigate further transmission by taking appropriate measures.


Subject(s)
Coronavirus Infections/transmission , Cross Infection/prevention & control , Digestive System Diseases , Endoscopy, Digestive System/standards , Gastroenterology/standards , Infection Control/standards , Pneumonia, Viral/transmission , Betacoronavirus/isolation & purification , Coronavirus Infections/complications , Coronavirus Infections/virology , Cross Infection/etiology , Cross Infection/virology , Digestive System Diseases/diagnosis , Digestive System Diseases/etiology , Digestive System Diseases/microbiology , Digestive System Diseases/virology , Hospital Units/standards , Humans , Pandemics , Personal Protective Equipment/standards , Pneumonia, Viral/complications , Pneumonia, Viral/virology
9.
J Gastroenterol Hepatol ; 35(5): 744-748, 2020 May.
Article in English | MEDLINE | ID: covidwho-18490

ABSTRACT

The novel coronavirus disease is currently causing a major pandemic. It is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a member of the Betacoronavirus genus that also includes the SARS-CoV and Middle East respiratory syndrome coronavirus. While patients typically present with fever and a respiratory illness, some patients also report gastrointestinal symptoms such as diarrhea, vomiting, and abdominal pain. Studies have identified the SARS-CoV-2 RNA in stool specimens of infected patients, and its viral receptor angiotensin converting enzyme 2 was found to be highly expressed in gastrointestinal epithelial cells. These suggest that SARS-CoV-2 can actively infect and replicate in the gastrointestinal tract. This has important implications to the disease management, transmission, and infection control. In this article, we review the important gastrointestinal aspects of the disease.


Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections , Digestive System Diseases/virology , Digestive System/virology , Pandemics , Peptidyl-Dipeptidase A/biosynthesis , Pneumonia, Viral , Aerosols/adverse effects , Betacoronavirus/metabolism , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Coronavirus Infections/metabolism , Coronavirus Infections/transmission , Digestive System/cytology , Digestive System/metabolism , Digestive System Diseases/metabolism , Disease Transmission, Infectious/prevention & control , Humans , Infection Control/methods , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , Pneumonia, Viral/metabolism , Pneumonia, Viral/transmission , RNA, Viral/isolation & purification
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