Gastrointestinal COVID-19: Another side of the problem
Keywords:
COVID-19, coronavirus, digestive symptoms, gastroenterology, gut microbiota.Abstract
The Coronavirus disease 2019 (COVID-19) pandemic is an emergent problem in public health with new epidemiological, pathophysiological, diagnostic, therapeutic, and preventive aspects in constant discovery and development. Although initially the study of COVID-19 had centered on its respiratory manifestations, it has been observed that the SARS-CoV-2 infects numerous tissues, including the respiratory, cardiovascular, gastrointestinal (GI), and nervous systems. In particular, the presence of GI symptoms has garnered greater relevance as the pandemic progresses, serving in some cases as a prognostic factor for infection severity or as a diagnostic reference in absence of respiratory symptoms. A majority of the evidence indicates that patients with GI symptoms tend to have worse prognoses than those without them. It has been demonstrated that the SARS-CoV-2 infection modifies the gut microbiota in favor of opportunistic agents, resulting in a greater inflammatory response. Interventions on gut microbiota have been proposed as part of the treatment of COVID-19, but further evidence is required to substantiate its implementation. The objective of this review is to evaluate the epidemiological aspects related with the GI symptoms of COVID-19 patients, as well as the pathophysiological mechanisms underlying these symptoms and patients’ affectation by them.
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Allam Z. The First 50 days of COVID-19: A Detailed Chronological Timeline and Extensive Review of Literature Documenting the Pandemic. Surveying the Covid-19 Pandemic and its Implications. 2020;1-7.
World Health Organization. WHO Director-General’s opening remarks at the media briefing on COVID-19 - 11 March 2020 [Internet]. 2020 [citado 12 de mayo de 2020]. Disponible en: https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020
Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 20 de febrero de 2020;382(8):727-33.
Booth A, Reed AB, Ponzo S, Yassaee A, Aral M, Plans D, et al. Population risk factors for severe disease and mortality in COVID-19: A global systematic review and meta-analysis. Madeddu G, editor. PLoS ONE. 4 de marzo de 2021;16(3):e0247461.
Ni W, Yang X, Yang D, Bao J, Li R, Xiao Y, et al. Role of angiotensin-converting enzyme 2 (ACE2) in COVID-19. Crit Care. diciembre de 2020;24(1):422.
Cipriano M, Ruberti E, Giacalone A. Gastrointestinal Infection Could Be New Focus for Coronavirus Diagnosis. Cureus. 26 de marzo de 2020;12(3):e7422.
An P, Chen H, Ren H, Su J, Ji M, Kang J, et al. Gastrointestinal Symptoms Onset in COVID-19 Patients in Wuhan, China. Dig Dis Sci. 12 de noviembre de 2020;12:1-10.
Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China. JAMA. 17 de marzo de 2020;323(11):1061-9.
Luo S, Zhang X, Xu H. Don’t Overlook Digestive Symptoms in Patients With 2019 Novel Coronavirus Disease (COVID-19). Clinical Gastroenterology and Hepatology. junio de 2020;18(7):1636-7.
Rokkas T. Gastrointestinal involvement in COVID-19: a systematic review and meta-analysis. Ann Gastroenterol. 2020;33(4):355-65.
Nie K, Yang Y-Y, Deng M-Z, Wang X-Y. Gastrointestinal insights during the COVID-19 epidemic. WJCC. 26 de septiembre de 2020;8(18):3934-41.
Ramachandran P, Onukogu I, Ghanta S, Gajendran M, Perisetti A, Goyal H, et al. Gastrointestinal Symptoms and Outcomes in Hospitalized Coronavirus Disease 2019 Patients. Dig Dis. 2020;38(5):373-9.
Liu J, Tao L, Liu X, Yao H, Yu S, Wang Q, et al. GI symptoms and fever increase the risk of severe illness and death in patients with COVID-19. Gut. 30 de junio de 2020;70(2):442-4.
Chen R, Yu Y, Li W, Liu Y, Lu J, Chen F, et al. Gastrointestinal Symptoms Associated With Unfavorable Prognosis of COVID-19 Patients: A Retrospective Study. Front Med. 11 de noviembre de 2020;7:608259.
Renelus BD, Khoury N, Chandrasekaran K, Bekele E, Briggs WM, Jamorabo DS. Hospitalized coronavirus disease-2019 (COVID-19) patients with gastrointestinal symptoms have improved survival to discharge. Digestive and Liver Disease. diciembre de 2020;52(12):1403-6.
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet. marzo de 2020;395(10229):1054-62.
Ferm S, Fisher C, Pakala T, Tong M, Shah D, Schwarzbaum D, et al. Analysis of Gastrointestinal and Hepatic Manifestations of SARS-CoV-2 Infection in 892 Patients in Queens, NY. Clinical Gastroenterology and Hepatology. septiembre de 2020;18(10):2378-2379.e1.
Cao B, Wang Y, Wen D, Liu W, Wang J, Fan G, et al. A Trial of Lopinavir–Ritonavir in Adults Hospitalized with Severe Covid-19. N Engl J Med. 7 de mayo de 2020;382(19):1787-99.
GRID COVID-19 Study Group. Combating the COVID-19 pandemic in a resource-constrained setting: insights from initial response in India. BMJ Glob Health. noviembre de 2020;5(11):e003416.
Hindson J. COVID-19: faecal–oral transmission? Nat Rev Gastroenterol Hepatol. mayo de 2020;17(5):259-259.
Jeong HW, Kim S-M, Kim H-S, Kim Y-I, Kim JH, Cho JY, et al. Viable SARS-CoV-2 in various specimens from COVID-19 patients. Clinical Microbiology and Infection. noviembre de 2020;26(11):1520-4.
Wei X-S, Wang X, Niu Y-R, Ye L-L, Peng W-B, Wang Z-H, et al. Diarrhea is Associated with Prolonged Symptoms and Viral Carriage in Corona Virus Disease 2019. Clinical Gastroenterology and Hepatology. julio de 2020;18(8):1753-1759.e2.
Kang M, Wei J, Yuan J, Guo J, Zhang Y, Hang J, et al. Probable Evidence of Fecal Aerosol Transmission of SARS-CoV-2 in a High-Rise Building. Ann Intern Med. 15 de diciembre de 2020;173(12):974-80.
Zang R, Gomez Castro MF, McCune BT, Zeng Q, Rothlauf PW, Sonnek NM, et al. TMPRSS2 and TMPRSS4 promote SARS-CoV-2 infection of human small intestinal enterocytes. Sci Immunol. 13 de mayo de 2020;5(47):eabc3582.
Wölfel R, Corman VM, Guggemos W, Seilmaier M, Zange S, Müller MA, et al. Virological assessment of hospitalized patients with COVID-2019. Nature. 28 de mayo de 2020;581(7809):465-9.
Williams MA, O’Callaghan A, Corr SC. IL-33 and IL-18 in Inflammatory Bowel Disease Etiology and Microbial Interactions. Front Immunol. 14 de mayo de 2019;10:1091.
Nowarski R, Jackson R, Gagliani N, de Zoete MR, Palm NW, Bailis W, et al. Epithelial IL-18 Equilibrium Controls Barrier Function in Colitis. Cell. diciembre de 2015;163(6):1444-56.
Effenberger M, Grabherr F, Mayr L, Schwaerzler J, Nairz M, Seifert M, et al. Faecal calprotectin indicates intestinal inflammation in COVID-19. Gut. agosto de 2020;69(8):1543-4.
Ghazavi A, Ganji A, Keshavarzian N, Rabiemajd S, Mosayebi G. Cytokine profile and disease severity in patients with COVID-19. Cytokine. enero de 2021;137:155323.
Schirmer M, Smeekens SP, Vlamakis H, Jaeger M, Oosting M, Franzosa EA, et al. Linking the Human Gut Microbiome to Inflammatory Cytokine Production Capacity. Cell. noviembre de 2016;167(4):1125-1136.e8.
Burchill E, Lymberopoulos E, Menozzi E, Budhdeo S, McIlroy JR, Macnaughtan J, et al. The Unique Impact of COVID-19 on Human Gut Microbiome Research. Front Med. 16 de marzo de 2021;8:652464.
Zuo T, Zhang F, Lui GCY, Yeoh YK, Li AYL, Zhan H, et al. Alterations in Gut Microbiota of Patients With COVID-19 During Time of Hospitalization. Gastroenterology. septiembre de 2020;159(3):944-955.e8.
Geva-Zatorsky N, Sefik E, Kua L, Pasman L, Tan TG, Ortiz-Lopez A, et al. Mining the Human Gut Microbiota for Immunomodulatory Organisms. Cell. febrero de 2017;168(5):928-943.e11.
Tao W, Zhang G, Wang X, Guo M, Zeng W, Xu Z, et al. Analysis of the intestinal microbiota in COVID-19 patients and its correlation with the inflammatory factor IL-18. Medicine in Microecology. septiembre de 2020;5:100023.
Zuo T, Zhan H, Zhang F, Liu Q, Tso EYK, Lui GCY, et al. Alterations in Fecal Fungal Microbiome of Patients With COVID-19 During Time of Hospitalization until Discharge. Gastroenterology. octubre de 2020;159(4):1302-1310.e5.
Villapol S. Gastrointestinal symptoms associated with COVID-19: impact on the gut microbiome. Translational Research. diciembre de 2020;226:57-69.
Ye Q, Wang B, Zhang T, Xu J, Shang S. The mechanism and treatment of gastrointestinal symptoms in patients with COVID-19. American Journal of Physiology-Gastrointestinal and Liver Physiology. 1 de agosto de 2020;319(2):G245-52.
Haridas A, Mukker P. Gastrointestinal Symptoms and Immune Response in COVID 19 - Review of a Cat and Mouse Game Theory. AJMCR. 27 de octubre de 2020;9(1):24-31.
Domínguez-Díaz C, García-Orozco A, Riera-Leal A, Padilla-Arellano JR, Fafutis-Morris M. Microbiota and Its Role on Viral Evasion: Is It With Us or Against Us? Front Cell Infect Microbiol. 18 de julio de 2019;9:256.
Wang J, Li F, Wei H, Lian Z-X, Sun R, Tian Z. Respiratory influenza virus infection induces intestinal immune injury via microbiota-mediated Th17 cell–dependent inflammation. Journal of Experimental Medicine. 17 de noviembre de 2014;211(12):2397-410.
Stenstad H, Ericsson A, Johansson-Lindbom B, Svensson M, Marsal J, Mack M, et al. Gut-associated lymphoid tissue–primed CD4+ T cells display CCR9-dependent and -independent homing to the small intestine. Blood. 1 de mayo de 2006;107(9):3447-54.
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