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World J Gastroenterol. Aug 21, 2020; 26(31): 4579-4588
Published online Aug 21, 2020. doi: 10.3748/wjg.v26.i31.4579
COVID-19 pandemic: Pathophysiology and manifestations from the gastrointestinal tract
Michail Galanopoulos, Filippos Gkeros, Aris Doukatas, Grigorios Karianakis, Christos Pontas, Nikolaos Tsoukalas, Nikos Viazis, Christos Liatsos, Gerassimos J Mantzaris
Michail Galanopoulos, Christos Liatsos, Department of Gastroenterology, 401 General Military Hospital of Athens, Athens 11525, Attiki, Greece
Filippos Gkeros, Christos Pontas, Nikos Viazis, Gerassimos J Mantzaris, Department of Gastroenterology, Evangelismos, Ophthalmiatreion Athinon and Polyclinic Hospitals, Athens 10676, Attiki, Greece
Aris Doukatas, Grigorios Karianakis, Medical Office of Hellenic Army General Staff, 401 General Military Hospital of Athens, Athens 11525, Attiki, Greece
Nikolaos Tsoukalas, Department of Oncology, 401 General Military Hospital of Athens, Athens 11525, Attiki, Greece
Author contributions: Galanopoulos M designed the review; Galanopoulos M, Gkeros F, Doukatas A, Karianakis G and Pontas C analyzed and interpreted the data; Tsoukalas N, Viazis N and Liatsos C drafted the manuscript; Mantzaris GJ critically revised the paper.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other coauthors contributed their efforts in 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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Michail Galanopoulos, FEBG, MD, PhD, Doctor, Department of Gastroenterology, 401 General Military Hospital of Athens, 138 Mesogeion Avenue and Katechaki Street, Athens 11525, Attiki, Greece. galanopoulosdr@gmail.com
Received: May 6, 2020
Peer-review started: May 6, 2020
First decision: May 26, 2020
Revised: June 2, 2020
Accepted: August 12, 2020
Article in press: August 12, 2020
Published online: August 21, 2020
Core Tip

Core tip: Although respiratory transmission and symptoms are still the primary route and expression of coronavirus disease 2019 (COVID-19), the gastrointestinal system could be an alternative or additional way for COVID-19 to be transmitted and manifested, most likely due to the presence of Angiotensin converting enzyme type 2 receptors which are observed throughout its length. The main aim of this article is mainly to focus on the manifestations of the gastrointestinal tract and their pathophysiological background, so that physicians on the one hand, not to underestimate or disregard digestive symptoms due to the small number of patients exhibiting exclusively this symptomatology and, on the other, to have severe acute respiratory syndrome coronavirus 2 on their mind when the “gastroenteritis” type symptoms predominate.