Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 21, 2020; 26(19): 2323-2332
Published online May 21, 2020. doi: 10.3748/wjg.v26.i19.2323
Gastrointestinal and hepatic manifestations of COVID-19: A comprehensive review
Ming Han Cha, Miguel Regueiro, Dalbir S Sandhu
Ming Han Cha, Department of Internal Medicine, Cleveland Clinic, Akron General, Akron, OH 44307, United States
Miguel Regueiro, Dalbir S Sandhu, Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH 44307, United States
Author contributions: Cha MH, Regueiro M, and Sandhu DS contributed equally to all aspects of the work.
Conflict-of-interest statement: The authors declare no conflicts of interest pertaining to this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Dalbir S Sandhu, MD, Assistant Professor, Director of Endoscopy, Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Akron General, 1 Akron General Ave, Akron, OH 44307, United States.
Received: April 10, 2020
Peer-review started: April 10, 2020
First decision: April 18, 2020
Revised: April 25, 2020
Accepted: May 16, 2020
Article in press: May 16, 2020
Published online: May 21, 2020

The severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) that causes coronavirus disease-2019 (COVID-19) is a global pandemic, manifested by an infectious pneumonia. Although patients primarily present with fever, cough and dyspnea, some patients also develop gastrointestinal (GI) and hepatic manifestations. The most common GI symptoms reported are diarrhea, nausea, vomiting, and abdominal discomfort. Liver chemistry abnormalities are common and include elevation of aspartate transferase, alanine transferase, and total bilirubin. Studies have shown that SARS-CoV-2 infects the GI tract via its viral receptor angiotensin converting enzyme II, which is expressed on enterocytes of the ileum and colon. Viral RNA has also been isolated from stool specimens of COVID-19 patients, which raised the concern for fecal-oral transmission in addition to droplet transmission. Although indirect evidence has suggested possible fecal-oral transmission of SARS-CoV-2, more effort is needed to establish the role of the fecal-oral transmission route. Further research will help elucidate the association between patients with underlying GI diseases, such as chronic liver disease and inflammatory bowel disease, and severity of COVID-19. In this review, we summarize the data on GI involvement to date, as well as the impact of COVID-19 on underlying GI diseases.

Keywords: COVID-19, SARS-CoV-2, Gastrointestinal, Liver, Diarrhea, Inflammatory bowel disease

Core tip: The coronavirus disease-2019 (COVID-19) pandemic, caused by the novel coronavirus termed severe acute respiratory syndrome coronavirus 2, is rapidly gripping the world. COVID-19 can cause a wide spectrum of disease, ranging from mild to severe symptoms and even death. Despite initial reports of the disease primarily presenting with respiratory symptoms, a surge in patients presenting with gastrointestinal symptoms is being reported. This review provides a detailed knowledge on gastrointestinal and hepatic manifestations of COVID-19.