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Review
. 2022 Oct;50(10):3000605221129543.
doi: 10.1177/03000605221129543.

COVID-19 induces gastrointestinal symptoms and affects patients' prognosis

Shuxun Jin  1   2 , Xiaofeng Lu  1 , Chaoyang Xu  1   2
Affiliations
Review

COVID-19 induces gastrointestinal symptoms and affects patients' prognosis

Shuxun Jin et al. J Int Med Res. 2022 Oct.

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection caused the pandemic of coronavirus disease 2019 (COVID-19). Gastrointestinal (GI) involvement is common among patients with COVID-19, and GI symptoms can appear earlier than respiratory symptoms. Except for direct infectious effects, patients infected with SARS-CoV-2 are at risk of complications requiring gastroenterological management. Diarrhea is the most common GI symptom in patients with COVID-19 and occurs in up to half of them. Other GI symptoms, such as anorexia, discomfort, nausea, abdominal pain, loss of taste sensation, and vomiting, have been reported. GI symptoms are associated with a poor prognosis. Fecal viral excretion may have clinical significance because of the possible fecal-oral transmission of infection. In the present narrative review article, six different aspects of studies published to date are summarized as follows: GI manifestations of COVID-19, the roles of fecal-oral transmission, poor prognosis of GI symptoms; abnormal abdominal imaging findings, COVID-19 in patients with irritable bowel disease, and prevention and control of SARS-CoV-2 infection in the digestive endoscopy room. Timely understanding of the association between COVID-19 and the digestive system and effective preventive measures are critical to improve this disease and help clinicians take appropriate measures to mitigate further transmission.

Keywords: Severe acute respiratory syndrome coronavirus 2; abdominal imaging; coronavirus disease 2019; endoscopy; gastrointestinal symptom; inflammatory bowel disease.

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Conflict of interest statement

The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
Schematic diagram of the transmission and pathogenesis of severe acute respiratory syndrome coronavirus 2 in the gastrointestinal tract. ACE2, angiotensin receptor 2; TMPRSS, transmembrane serine protease.
Figure 2.
Figure 2.
The lung–gut axis in coronavirus disease 2019. ACE2 receptors are expressed in the lungs and intestinal epithelium. SARS-CoV-2 recognizes ACE2 receptors in host cells, and the virus begins to replicate in host cells. In the lungs, once the virus enters the cell, it activates the immune system, which is characterized by pro-inflammatory cytokines and immune cell recruitment. If the virus is not sufficiently cleared, the immune response further develops into cytokine storm syndrome. In the gut, the virus targets cells and triggers an immune response in a similar way. The immune response also destroys intestinal permeability, causing intestinal microorganisms and related metabolites to enter the bloodstream, leading to further biological disorders. SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; TNF, tumor necrosis factor; IL, interleukin; INF, interferon; ACE2, angiotensin receptor 2.
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