RESUMEN
BACKGROUND: Coronavirus disease 2019 (COVID-19) is associated with gastrointestinal and hepatic manifestation in up to one fifth of patients. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the etiologic agent of COVID-19, infects gastrointestinal epithelial cells expressing angiotensin-converting enzyme 2 (ACE2) receptors triggering a cascade of events leading to mucosal and systemic inflammation. Symptomatic patients display changes in gut microbiota composition and function which may contribute to intestinal barrier dysfunction and immune activation. Evidence suggests that SARS-CoV-2 infection and related mucosal inflammation impact on the function of the enteric nervous system and the activation of sensory fibers conveying information to the central nervous system, which, may at least in part, contribute symptom generation such as vomiting and diarrhea described in COVID-19. Liver and pancreas dysfunctions have also been described as non-respiratory complications of COVID-19 and add further emphasis to the common view of SARS-CoV-2 infection as a systemic disease with multiorgan involvement. PURPOSE: The aim of this review was to highlight the current knowledge on the pathophysiology of gastrointestinal SARS-CoV-2 infection, including the crosstalk with the gut microbiota, the fecal-oral route of virus transmission, and the potential interaction of the virus with the enteric nervous system. We also review the current available data on gastrointestinal and liver manifestations, management, and outcomes of patients with COVID-19.
Asunto(s)
COVID-19/complicaciones , COVID-19/fisiopatología , Enfermedades Gastrointestinales/etiología , Enfermedades Gastrointestinales/fisiopatología , Microbioma Gastrointestinal/fisiología , Tracto Gastrointestinal/fisiopatología , Animales , Diarrea/etiología , Diarrea/fisiopatología , Diarrea/virología , Disbiosis/etiología , Disbiosis/fisiopatología , Disbiosis/virología , Sistema Nervioso Entérico/fisiopatología , Sistema Nervioso Entérico/virología , Enfermedades Gastrointestinales/virología , Tracto Gastrointestinal/virología , Humanos , Hepatopatías/etiología , Hepatopatías/fisiopatología , Hepatopatías/virología , Enfermedades Pancreáticas/etiología , Enfermedades Pancreáticas/fisiopatología , Enfermedades Pancreáticas/virologíaRESUMEN
Apart from the mechanisms reported by Fernandes et al, the thromboembolic pathogenesis should also be taken into account in patients with severe COVID-19 and prophylaxis with low molecular weight heparin should be implemented.
Asunto(s)
COVID-19/complicaciones , Enfermedades Pancreáticas/virología , Tromboembolia/virología , COVID-19/diagnóstico , COVID-19/fisiopatología , Humanos , Enfermedades Pancreáticas/diagnóstico , Enfermedades Pancreáticas/fisiopatología , Tromboembolia/diagnóstico , Tromboembolia/fisiopatologíaRESUMEN
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus that causes coronavirus disease 2019 (COVID-19) in human beings, has caused a serious public health issue.1 Attention to pancreatic injury is lacking, which may impact patients' prognosis. In this study, we explored the expression and distribution of angiotensin-converting enzyme 2 (ACE2), the receptor of SARS-CoV-2, in the pancreas. Combined with clinical data, we showed that pancreatic injury can occur in some COVID-19 patients.