Systematic Reviews
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 16, 2021; 9(17): 4199-4209
Published online Jun 16, 2021. doi: 10.12998/wjcc.v9.i17.4199
COVID-19 in gastroenterology and hepatology: Lessons learned and questions to be answered
Shao Liu, Mi-Mi Tang, Jie Du, Zhi-Cheng Gong, Shu-Sen Sun
Shao Liu, Mi-Mi Tang, Jie Du, Zhi-Cheng Gong, Department of Pharmacy, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
Shao Liu, Mi-Mi Tang, Jie Du, Zhi-Cheng Gong, Department of Pharmacy, The Hunan Institute of Pharmacy Practice and Clinical Research, Changsha 410008, Hunan Province, China
Shao Liu, Mi-Mi Tang, Jie Du, Zhi-Cheng Gong, Institute of Hospital Pharmacy, Central South University, Changsha 410008, Hunan Province, China
Shu-Sen Sun, Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Western New England University, Springfield, MA 01119, United States
Author contributions: Liu S and Tang MM wrote the manuscript; Du J searched the related literature; Gong ZC and Sun SS revised the manuscript.
Supported by the Key Research and Development Program of Hunan Province, No. 2020SK3022.
Conflict-of-interest statement: The authors declare no conflict of interests for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
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: Shu-Sen Sun, PharmD, PhD, Chief Pharmacist, Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Western New England University, 1215 Wilbraham Road, Springfield, MA 01119, United States. shusen.sun@wne.edu
Received: January 20, 2021
Peer-review started: January 20, 2021
First decision: February 9, 2021
Revised: February 26, 2021
Accepted: April 23, 2021
Article in press: April 23, 2021
Published online: June 16, 2021
Processing time: 125 Days and 18.2 Hours
Abstract
BACKGROUND

Although coronavirus disease 2019 (COVID-19) presents primarily as a lower respiratory tract infection, increasing data suggests multiorgan, including the gastrointestinal (GI) tract and liver, involvement in patients who are infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

AIM

To provide a comprehensive overview of COVID-19 in gastroenterology and hepatology.

METHODS

Relevant studies on COVID-19 related to the study aim were undertaken through a literature search to synthesize the extracted data.

RESULTS

We found that digestive symptoms and liver injury are not uncommon in patients with COVID-19 and varies in different individuals. The most common GI symptoms reported are diarrhea, nausea, vomiting, and abdominal discomfort. Other atypical GI symptoms, such as loss of smell and taste and GI bleeding, have also been reported along with the evolvement of COVID-19. Liver chemistry abnormalities mainly include elevation of aspartate transferase, alanine transferase, and total bilirubin. It is postulated to be related to the binding of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus to the angiotensin converting enzyme-2 receptor located on several different human cells.

CONCLUSION

Standardized criteria should be established for diagnosis and grading of the severity of GI symptoms in COVID-19 patients. Gastroenterology and hepatology in special populations, such as children and elderly, should be the focus of further research. Future long-term data regarding GI symptoms should not be overlooked.

Keywords: COVID-19; SARS-CoV-2; Gastroenterology; Hepatology; Endoscopy; Inflammatory bowel disease

Core Tip: Recent studies suggest multiorgan, including in the gastrointestinal tract and liver, involvement in patients who are infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Digestive symptoms and liver injury are not uncommon in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and symptoms vary between individuals. The most common gastrointestinal symptoms reported are diarrhea, nausea, vomiting, and abdominal discomfort. Liver chemistry abnormalities are also common, including elevation of aspartate transferase, alanine transferase, and total bilirubin. It is postulated to be related to the binding of severe acute respiratory syndrome coronavirus 2 virus (SARS-CoV-2) to the angiotensin converting enzyme-2 receptor located on several different human cells.