Published online Sep 26, 2020. doi: 10.12998/wjcc.v8.i18.3934
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
Processing time: 75 Days and 12 Hours
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.
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!