Gastrointestinal Manifestations of COVID-19

ABSTRACT

Gastrointestinal manifestations of SARS-CoV-2 are reported in 10-50% of patients, being diarrhea, nausea, vomiting, and abdominal pain the most frequent ones. Gastrointestinal manifestations could be present without respiratory symptoms, leading to delayed diagnosis. In addition, COVID-19 is commonly associated with hepatic dysfunction manifesting with elevation of hepatic enzymes and total bilirubin levels, observed in up to 50% of the COVID-19 patients. Other less common gastrointestinal manifestations include acute cholecystitis, pancreatitis, and oral lesions. Clinicians should be also aware that the gastrointestinal tract is also frequently involved in COVID-19-related complications. As a matter of fact, several studies reported ileus, intestinal ischemia, perforation, and gastrointestinal bleeding during the course of COVID-19 disease. Lastly, the inappropriate and excessive use of antibiotics has led to an increase in Clostridioides difficile infection with consequent prolonged hospitalization and higher mortality. Although, the exact pathogenesis of gastrointestinal involvement is not completed understood, four main mechanisms have been advocated the direct angiotensin converting enzyme 2 mediated viral cytotoxicity, cytokine-induced inflammation, gut dysbiosis, and vascular abnormalities. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.