Colorectal Surgery Unit, Department of Surgical Science, University of Cagliari , Cagliari, Italy.
Anahuac University, Comprehensive and Advanced Diagnostic Assessment for Cancer , Mexico City, Mexico.
Expert Rev Gastroenterol Hepatol. 2021 Jan;15(1):41-50. doi: 10.1080/17474124.2020.1821653. Epub 2020 Nov 24.
The new Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is the etiologic agent of coronavirus disease 2019. Some authors reported pieces of evidence that patients with SARS-CoV-2 infection could have direct involvement of the gastrointestinal tract, and in symptomatic cases, gastrointestinal symptoms (diarrhea, nausea/vomiting, abdominal pain) could be very common.
In this article, we reviewed current-published data of the gastrointestinal aspects involved in SARS-CoV-2 infection, including prevalence and incidence of specific symptoms, the presumptive biological mechanism of GI infection, prognosis, clinical management, and public health-related concerns on the possible risk of oral-fecal transmission.
Different clues point to direct virus infection and replication in mucosal cells of the gastrointestinal tract. In vitro studies showed that SARS-CoV-2 could enter into the gastrointestinal epithelial cells by the Angiotensin-Converting enzyme two membrane receptor. These findings, coupled with the identification of viral RNA found in stools of patients, clearly suggest that direct involvement of the gastrointestinal tract is very likely. This can justify most of the gastrointestinal symptoms but also suggest a risk for an oral-fecal route for transmission, additionally or alternatively to the main respiratory route.
新型严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）是 2019 年冠状病毒病的病原体。一些作者报告了一些证据表明，感染 SARS-CoV-2 的患者可能直接涉及胃肠道，在有症状的病例中，胃肠道症状（腹泻、恶心/呕吐、腹痛）可能非常常见。
本文综述了 SARS-CoV-2 感染相关的胃肠道方面的现有研究数据，包括特定症状的患病率和发病率、胃肠道感染的假定生物学机制、预后、临床管理以及与可能的经口-粪传播风险相关的公共卫生关注。
不同的线索指向病毒在胃肠道黏膜细胞中的直接感染和复制。体外研究表明，SARS-CoV-2 可以通过血管紧张素转换酶 2 膜受体进入胃肠道上皮细胞。这些发现，加上在患者粪便中发现病毒 RNA 的鉴定，清楚地表明胃肠道的直接受累很可能发生。这可以解释大多数胃肠道症状，但也提示存在通过胃肠道途径传播的风险，这种途径可以是主要的呼吸道传播途径的补充或替代。
