Evidence Review
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 26, 2020; 8(18): 3934-3941
Published online Sep 26, 2020. doi: 10.12998/wjcc.v8.i18.3934
Gastrointestinal insights during the COVID-19 epidemic
Kai Nie, Yuan-Yuan Yang, Min-Zi Deng, Xiao-Yan Wang
Kai Nie, Yuan-Yuan Yang, Min-Zi Deng, Xiao-Yan Wang, Department of Gastroenterology, The Third Xiangya Hospital of Central South University, Changsha 410000, Hunan Province, China
Author contributions: Nie K reviewed the literature and wrote the manuscript; Yang YY and Deng MZ collected the literature and data; Wang XY gave precious advice in writing.
Supported by National Natural Science Foundation of China, No. 81970494.
Conflict-of-interest statement: We declare no conflicts of interests in the 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: Xiao-Yan Wang, MD, Chief Doctor, Department of Gastroenterology, The Third Xiangya Hospital of Central South University, No. 138 Tongzipo Road, Yuelu District, Changsha 410013, Hunan Province, China. wxy220011@163.com
Received: July 8, 2020
Peer-review started: July 8, 2020
First decision: July 24, 2020
Revised: July 28, 2020
Accepted: August 26, 2020
Article in press: August 26, 2020
Published online: September 26, 2020
Abstract

Coronavirus disease-2019 (COVID-19) has so far caused hundreds of mortalities worldwide. Although respiratory symptoms are the main complication in COVID-19 patients, the disease is also associated with gastrointestinal problems, with diarrhea, nausea, and vomiting being primary COVID-19 symptoms. Thus, cancer and inflammatory bowel disease (IBD) management, stool viral tests, and virus exposure are major concerns in the context of COVID-19 epidemic. In patients with colorectal cancer and IBD, the colonic mucosa exhibits elevated angiotensin-converting enzyme 2 receptor levels, enhancing COVID-19 susceptibility. In some cases, positive viral stool tests may be the only indicator of infection at admission or after leaving quarantine. Without supplemental stool tests, the risk of undetected COVID-19 transmission is high. Moreover, viral exposure during the regular or emergency endoscopic examination should be avoided. We carefully discuss key gastrointestinal concerns with regard to COVID-19 and call for more attention to such problems.

Keywords: COVID-19, SARS-CoV-2, Diarrhea, Colorectal cancer, Inflammatory bowel disease, Stool tests

Core Tip: Severe acute respiratory syndrome coronavirus 2 has an affinity to angiotensin-converting enzyme 2 (ACE2), which is abundantly expressed in the intestinal epithelium. Increased intestinal expression of ACE2 in colorectal cancer and inflammatory bowel disease underlies the high coronavirus disease-2019 (COVID-19) risk among these patients. Besides, the stool viral test should not be ignored among COVID-19 management. Strict prevention reduces viral exposure during endoscopy. The earlier we discern, the more we consider, and the more human we protect!