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©The Author(s) 2023.
World J Clin Cases. Aug 6, 2023; 11(22): 5252-5272
Published online Aug 6, 2023. doi: 10.12998/wjcc.v11.i22.5252
Published online Aug 6, 2023. doi: 10.12998/wjcc.v11.i22.5252
Table 5 Prevalence and underlying mechanism for common gastrointestinal autonomic dysfunction in patients with coronavirus disease 2019
Symptom(s) | Incidence | Underlying mechanism |
Nausea and/or vomiting | Nausea: 1.0%-12.5%, vomiting 1.0%-27.5% | Release of neuroactive agents from enteroendocrine cells and inflammatory mediations → abdominal vagal nerve stimulation of dorsal medulla → projection of information to higher brain regions → nausea and vomiting |
Diarrhea | 2% and 50% | Targeting intestinal ACE2 by the virus → cytokine storms, increased intestinal barrier permeability, and gut dysbiosis → diarrhoea. Hepatic and pancreatic injuries may also cause diarrhea. Antibiotic-induced iatrogenic diarrhea caused by activating Clostridium spp. should also be considered |
Anorexia | Up to 40% | Social pressure. Neuromodulation → miscommunication between brain-gut-adipose tissues → changes in brain serotonin and tryptophan concentrations → anorexia, anosmia, and related odor perception impairment → development and aggravation of anorexia |
Abdominal pain | 6.0% (vary depending on the population) | Inflammation-induced release of many cytokines and chemokines → activating pain-sensing neurons. ↑ Eosinophils → ↑eosinophil-derived neurotoxins → abdominal pain. Intestinal inflammatory infiltration → ↑ intestinal mucosal permeability and the direct effect of viruses can aggravate dysbiosis and cause changes in. Tryptophan metabolism → initiating peristaltic and secretory reflexes in the viscera and exacerbating inflammatory bowel disease symptoms, including abdominal pain. COVID-19 infection → ↓Na, K, Ca, and Mg → abdominal pain |
Acid reflux | 1.1% | Increased serotonin levels. Esophageal mucosal barrier damage caused by cytokine storms. Relaxation of the lower esophageal sphincter. Gastric and duodenal dysfunction leading to obstruction of gastric emptying |
Gastrointestinal bleeding | 1%-4.5% | Peptic and rectal ulcers. Impaired gastrointestinal mucosa integrity. Treatment-related (secondary bleeding) |
Intestinal ischemia injury | Not well established | Venous thrombosis, pulmonary embolism, and mesenteric ischemia |
- Citation: Elbeltagi R, Al-Beltagi M, Saeed NK, Bediwy AS. COVID-19-induced gastrointestinal autonomic dysfunction: A systematic review. World J Clin Cases 2023; 11(22): 5252-5272
- URL: https://www.wjgnet.com/2307-8960/full/v11/i22/5252.htm
- DOI: https://dx.doi.org/10.12998/wjcc.v11.i22.5252