Published online Apr 14, 2020. doi: 10.3748/wjg.v26.i14.1546
Peer-review started: March 23, 2020
First decision: March 31, 2020
Revised: April 8, 2020
Accepted: April 11, 2020
Article in press: April 11, 2020
Published online: April 14, 2020
The current pandemic due to the severe acute respiratory syndrome coronavirus 2 has caused an extreme burden for health care systems globally, and the number of cases is expected to continue to increase, at least in the immediate future. The virus is estimated to have infected more than 1.5 million individuals. The available reports suggest that gastrointestinal (GI) involvement in coronavirus disease 2019 (COVID-19) is common and in some cases the GI symptoms may precede the respiratory symptoms. In addition to direct effects of severe acute respiratory syndrome coronavirus 2, the infected patients remain at risk for the complications commonly managed by gastroenterology and hepatology consultants. The most commonly reported GI manifestation of COVID-19 is diarrhea, which is reported in a third to up to more than half of the patients. Mild to moderate elevation of the liver enzymes are also common, although no case of acute liver failure has been reported so far. Many of the medications used for treatment of COVID-19 can also be associated with GI symptoms or liver injury and can be included in the differential diagnosis in these patients. Although the diagnosis of the infection is currently based on RNA analysis in respiratory samples, the available literature on fecal shedding of this virus suggests that fecal RNA testing might prove to be a useful diagnostic test. It is reasonable to delay all non-urgent endoscopic procedures during the peak of the pandemic and use additional protective equipment such as N95 respirators during endoscopy while most patients can be considered high risk for having been exposed to the virus.
Core tip: The coronavirus disease 2019 (COVID-19) has become the first pandemic of the 21st century, engaging the health care providers in almost all countries around the world. Similar to previous coronavirus infections such as severe acute respiratory syndrome coronavirus, the COVID-19 is associated with a high prevalence of gastrointestinal (GI) and liver manifestations and abnormalities. Here we present a comprehensive summary of the available evidence on GI involvement of COVID-19 and its implications for the GI consultants.