Evidence Review
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Oct 28, 2020; 8(5): 348-374
Published online Oct 28, 2020. doi: 10.13105/wjma.v8.i5.348
Gastrointestinal and hepatic manifestations of COVID-19 infection: Lessons for practitioners
Syed B Pasha, Ahmed Swi, Ghassan M Hammoud
Syed B Pasha, Department of Internal Medicine, University of Missouri, Columbia, MO 65212, United States
Ahmed Swi, Ghassan M Hammoud, Division of Gastroenterology and Hepatology, University of Missouri School of Medicine, Columbia, MO 65212, United States
Author contributions: Hammoud GM conceived the idea; Pasha SB and Swi A wrote the manuscript; Hammoud GM reviewed and revised the manuscript.
Conflict-of-interest statement: None of the authors have any conflict of interest to disclose.
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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Ghassan M Hammoud, MD, MPH Professor, Division of Gastroenterology and Hepatology, University of Missouri School of Medicine, 1 Hospital Drive, Columbia, MO 65212, United States. hammoudg@health.missouri.edu
Received: July 30, 2020
Peer-review started: July 30, 2020
First decision: September 13, 2020
Revised: September 26, 2020
Accepted: October 26, 2020
Article in press: October 26, 2020
Published online: October 28, 2020
Abstract

Originating from Wuhan in China, coronavirus disease 2019 (COVID-19) spread globally within months and was declared a pandemic by World Health Organization in March 2020, making it one of the biggest healthcare calamities of our time. As more data on COVID-19 infection became available, what was initially thought to be a simple respiratory illness was found to be more complex. Many extra-pulmonary manifestations are now frequently reported for COVID-19 in available literature, most commonly gastrointestinal and hepatopancreato-biliary manifestations. Due to early scarcity of data, extra pulmonary manifestations were initially overlooked and may have contributed to nosocomial spread of the infection. Practitioners, especially gastroenterologists, who frequently encounter patients with these symptoms, need to be aware of them. This can not only help minimize the nosocomial spread, ensure safety of provider but also help conserve already stretched-thin healthcare resources. A tremendous amount of COVID-19 related literature is getting added to the growing pool every day, making it difficult for providers to follow. The aim of our review is to summarize the available evidence for gastrointestinal and hepatopancreatobiliary manifestations of COVID-19. We here briefly discussed the possible pathophysiologic mechanism for these manifestations and summarized the recommendations put forward by multiple gastrointestinal societies regarding safe and effective clinical practice during the ongoing pandemic.

Keywords: COVID-19, Severe acute respiratory syndrome, Coronavirus, Angiotensin converting enzyme, Gastrointestinal, Liver

Core Tip: This review is to summarize the available evidence for extrapulmonary manifestations of coronavirus disease 2019 infection, particularly emphasizing on gastrointestinal and hepatopancreatobiliary manifestations. Here we briefly discussed the possible pathophysiologic mechanism for the disease, and summarized the recommendations of multiple gastrointestinal societies regarding safe and effective clinical practice during the ongoing pandemic. Lastly, we've touched briefly upon management of chronic liver disease and transplant patients.