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World J Clin Cases. Jul 16, 2021; 9(20): 5427-5434
Published online Jul 16, 2021. doi: 10.12998/wjcc.v9.i20.5427
Role of gastrointestinal system on transmission and pathogenesis of SARS-CoV-2
Cem Simsek, Enes Erul, Hatice Yasemin Balaban
Cem Simsek, Hatice Yasemin Balaban, Department of Gastroenterology, Hacettepe University Faculty of Medicine, Ankara 06100, Turkey
Enes Erul, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara 06100, Turkey
Author contributions: Balaban HY designed the research study; Simsek C and Erul E performed the research, analyzed the data and wrote the manuscript; Balaban HY revised the final manuscript; all authors have read and approved the final manuscript.
Conflict-of-interest statement: None of the authors has a potential conflict of interest.
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: Cem Simsek, MD, Doctor, Department of Gastroenterology, Hacettepe University Faculty of Medicine, Sihhiye, Ankara 06100, Turkey. cemgsimsek@gmail.com
Received: March 17, 2021
Peer-review started: March 17, 2021
First decision: April 5, 2021
Revised: April 20, 2021
Accepted: June 3, 2021
Article in press: June 3, 2021
Published online: July 16, 2021
Abstract

Coronavirus disease 2019 (COVID-19) continues to pose a significant threat to global health. Primary prevention remains as a major strategy against the pandemic. Current evidence proves that aerosol and droplet-based routes are the main means of transmission of COVID-19 but other ways should be sought in order to prevent possible collateral transmission. The gastrointestinal system may be one such route. Angiotensin converting enzyme 2 is the target entry receptor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that is abundantly expressed in the gastrointestinal tract. SARS-CoV-2 is able to infect human enterocytes similar to severe acute respiratory syndrome and Middle Eastern respiratory syndrome. Herein this review, we discuss the current knowledge regarding the role of gastrointestinal transmission in transmission and pathophysiology of COVID-19.

Keywords: SARS-CoV-2, COVID-19, Gastrointestinal system, Transmission, Pathogenesis

Core Tip: Angiotensin converting enzyme 2 is the target entry receptor for severe acute respiratory syndrome coronavirus 2 which is abundantly expressed in lung as well as in the gastric, duodenal, and rectal epithelium. This raises the question on potential transmission of the virus through gut via fecal-oral route. In addition to many studies showing viral RNA in feces, studies with animal models strengthen the evidence that the virus can be transmitted through the fecal-oral route. We underline the importance of raising awareness for the control of the pandemic by updating the information about the fecal-oral transmission route.