COVID-19 and the Digestive System


Novel coronavirus pneumonia (NCP) (coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has evolved into a global pandemic. Patients with COVID-19 typically present respiratory symptoms. However, extrapulmonary presentations are common. Digestive symptoms such as diarrhea, abdominal pain and jaundice are frequently reported in patients with COVID-19. Furthermore, COVID-19 patients could present digestive symptoms only and no respiratory presentations. Evidence has reported that the severity of these respiratory and digestive symptoms, when they show, are closely associated.The intestinal damage caused by SARS-CoV-2 infection has been verified by autopsy and biopsy. The SARS-COV-2 RNA has been detected in the feces of COVID-19 patients. Angiotensin-converting enzyme 2 (ACE2) is the functional receptor of SARS-CoV, and is critical to the cellular entry of SARS-CoV. It is reported that ACE2 expression is roughly 100-fold higher in the gastrointestinal tract (particularly the colon) than in the respiratory system.The digestive tract may serve as an infection route for COVID-19 according to clinical and pathological evidence. We should pay more attention to the digestive symptoms reported in patients infected with the virus, and consider SARS-CoV-2 stool test to help diagnosis and monitor for viral clearance.

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