Navigating the Gastrointestinal Implications of Coronavirus 19: Strategies and Lessons Learned

Main Article Content

Karteek Chennupati, MD Sanjana Bendi, DO Paritharsh Gantasala, MD, FACP Asim Kichloo, MD, FACP

Abstract

In 2019, an outbreak of COVID-19 caused by SARS-CoV2 spread worldwide, affecting millions of individuals. This was colloquially termed the “COVID-19 Pandemic.” As the pandemic progressed, multiple variants of SARS-CoV2 continued to evolve, including the most recent JN1, and spread worldwide, causing a broad spectrum of symptoms affecting multiple organ systems. The purpose of this article is to comprehensively explore COVID-19 through the lens of the Gastrointestinal system (GI) and review the treatments. The prevalence of GI symptoms in COVID-affected patients ranged from 28.2% to 50% throughout the pandemic. The predominant symptoms include nausea, diarrhea, reflux, abdominal pain, and emesis. Interestingly, these symptoms persisted for an extended time, sometimes the most bothersome, even after the resolution of an active infection. Due to the nature and prevalence of these symptoms, it is imperative that we understand the mechanism of interaction of SARS CoV2 and the GI system and its pathophysiology. Despite being the less common transmission route, the fecal-oral route is to be considered when devising public health strategies. The term “Long Covid” has been coined due to the long-term symptoms after active infection, and interestingly, GI symptoms have a significant prevalence. Though unclear, the pathogenesis is thought to be due to gut dysbiosis and dysbiosis of the gut-brain connection.


In this article, we have also discussed the GI symptoms and treatment of COVID infection in inflammatory bowel disease, pediatric population. We have also discussed guidelines by gastroenterology societies for care prior to, during, and after endoscopy, as well as ostomy care in COVID patients.

Keywords: Gastrointestinal Implications of Coronavirus 19, COVID-19

Article Details

How to Cite
CHENNUPATI, Karteek et al. Navigating the Gastrointestinal Implications of Coronavirus 19: Strategies and Lessons Learned. Medical Research Archives, [S.l.], v. 12, n. 5, may 2024. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/5342>. Date accessed: 19 june 2024. doi: https://doi.org/10.18103/mra.v12i5.5342.
Section
Research Articles

References

1. Slabakova Y, Gerasoudis S, Miteva D, et al. SARS-COV-2 variant-specific gastrointestinal symptoms of COVID-19: 2023 update. MDPI. October 2, 2023. AccessedApril 1, 2024. https://www.mdpi.com/2036-7422/14/4/32.

2. Al-Momani H, Aolymat I, Almasri M, Mahmoud SA, Mashal S. Prevalence of gastro-intestinal symptoms among COVID-19 patients and the association with disease clinical outcomes. Future science OA. April 21, 2023. Accessed March 26, 2024. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10167716/.

3. Sha A, Liu Y, Zhao X. SARS-COV-2 and gastrointestinal diseases. Frontiers in microbiology. May 30, 2023. Accessed April 5, 2024. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10267706/.

4. Al-Momani H, Aolymat I, Almasri M, Mahmoud SA, Mashal S. Prevalence of gastro-intestinal symptoms among COVID-19 patients and the association with disease clinical outcomes. Future science OA. April 21, 2023. Accessed March 30, 2024. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10167716/.

5. Fehr, A. R., & Perlman, S. (2015). Coronaviruses: An overview of their replication and pathogenesis. Methods in molecular biology (Clifton, N.J.). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4369385/.

6. Katella K. 3 things to know about jn.1, the new coronavirus strain. Yale Medicine. January 31, 2024. Accessed April 2, 2024. https://www.yalemedicine.org/news/jn1-coronavirus-variant-covid.

7. Satapathy P, Kumar P, Mehta V, et al. Global spread of covid-19’s JN.1 variant: Implications and public health responses. New microbes and new infections. February 5, 2024. Accessed April 4, 2024. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10864788/.

8. 1. Plummer AM, Matos YL, Lin HC, et al. Gut-brain pathogenesis of post-acute COVID-19 neurocognitive symptoms. Frontiers in neuroscience. September 28, 2023. Accessed March 29, 2024. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10568482/.

9. Haunhorst, S., Bloch, W., Wagner, H., Ellert, C., Krüger, K., Vilser, D. C., Finke, K., Reuken, P., Pletz, M. W., Stallmach, A., & Puta, C. (2022, September 16). Long Covid: A narrative review of the clinical aftermaths of COVID-19 with a focus on the putative pathophysiology and aspects of physical activity. Oxford open immunology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9494493/.

10. Center aColumbia UIM. Gastrointestinal symptoms in COVID-19: The long and the short of it: Current opinion in gastroenterology. LWW. November 2022. Accessed April 5, 2024. https://journals.lww.com/co-gastroenterology/abstract/2022/11000/gastrointestinal_symptoms_in_covid_19__the_log6.aspx.

11. Ghazanfar H, Kandhi S, Shin D, et al. Impact of COVID-19 on the gastrointestinal tract: A clinical review. Cureus. March 20, 2022. Accessed April 3, 2024. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9017282/.

12. National Wastewater Surveillance System (NWSS). Centers for Disease Control and Prevention. March 14, 2023. Accessed April 6, 2024. https://www.cdc.gov/nwss/wastewater-surveillance.html.

13. Simsek C, Erul E, Balaban HY. Role of gastrointestinal system on transmission and pathogenesis of SARS-COV-2. World journal of clinical cases. July 16, 2021. AccessedApril 2, 2024. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8281423/.

14. Galanopoulos M, Gkeros F, Doukatas A, et al. Covid-19 pandemic: Pathophysiology and manifestations from the gastrointestinal tract. World journal of gastroenterology. August 21, 2020. Accessed April 4, 2024. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7445869/.

15. Tao S-S, Wang X-Y, Yang X-K, et al. Covid-19 and inflammatory bowel disease crosstalk: From emerging association to clinical proposal. Journal of medical virology. December 2022. Accessed April 3, 2024. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9538900/.

16. Kamath C, Brenner EJ. The safe use of inflammatory bowel disease therapies during the COVID-19 pandemic. Current research in pharmacology and drug discovery. 2022. Accessed April 2, 2024. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9040409/#:~:text=Anti%2DTNF%20therapies%2C%20ustekinumab%2C,et%20al.%2C%202020).

17. Puoti MG, Rybak A, Kiparissi F, Gaynor E, Borrelli O. SARS-COV-2 and the gastrointestinal tract in children. Frontiers. January 22, 2021. Accessed April 1, 2024. https://www.frontiersin.org/articles/10.3389/fped.2021.617980/full.

18. AF; OJWC. Gastrointestinal manifestations and nutritional therapy during COVID-19 pandemic: A practical guide for pediatricians. Einstein (Sao Paulo, Brazil). 2020. Accessed April 3, 2024. https://pubmed.ncbi.nlm.nih.gov/32667418/

19. Information on covid-19 treatment, prevention and research. National Institutes of Health. February 29, 2024. Accessed April 10, 2024. https://www.covid19treatmentguidelines.nih.gov/.

20. Vasant, D. H., & Whorwell, P. J. (2019, August). Gut-focused hypnotherapy for functional gastrointestinal disorders: Evidence-base, practical aspects, and the Manchester Protocol. Neurogastroenterology and motility. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6850508/

21. 1. Plummer AM, Matos YL, Lin HC, et al. Gut-brain pathogenesis of post-acute COVID-19 neurocognitive symptoms. Frontiers in neuroscience. September 28, 2023. Accessed April 2, 2024. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10568482/.

22. Chiu PWY, Ng SC, Inoue H, et al. Practice of endoscopy during COVID-19 pandemic: Position statements of the Asian Pacific Society for Digestive Endoscopy (APSDE-COVID statements). Gut. June 2020. Accessed April 5, 2024. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7211066/#:~:text=The%20disinfection%20and%20reprocessing%20of,should%20not%20be%20re%2Dused.

23. Glasgow E. Patient safety and endoscopy during the COVID-19 pandemic. American Gastroenterological Association. March 5, 2022. Accessed April 4, 2024. https://gastro.org/news/patient-safety-and-endoscopy-during-the-covid-19-pandemic/?hilite=COVID.

24. Ostomies, J-pouches, and COVID-19. Crohn’s & Colitis Foundation. August 8, 2023. Accessed April 5, 2024. https://www.crohnscolitisfoundation.org/coronavirus/ostomies-j-pouches.