Institute of Digestive Health and Liver Diseases, Mercy Medical Center, Baltimore, MD, USA.
Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
Dig Dis Sci. 2021 Sep;66(9):2865-2875. doi: 10.1007/s10620-020-06625-4. Epub 2020 Oct 5.
The worldwide pandemic of COVID-19, caused by the virus SARS-CoV-2, continues to cause significant morbidity and mortality in both low- and high-income countries. Although COVID-19 is predominantly a respiratory illness, other systems including gastrointestinal (GI) system and liver may be involved because of the ubiquitous nature of ACE-2 receptors in various cell lines that SARS-CoV-2 utilizes to enter host cells. It appears that GI symptoms and liver enzyme abnormalities are common in COVID-19. The involvement of the GI tract and liver correlates with the severity of disease. A minority (10-20%) of patients with COVID-19 may also present initially with only GI complaints. The most common GI symptoms are anorexia, loss of smell, nausea, vomiting, and diarrhea. Viral RNA can be detected in stool in up to 50% of patients, sometimes even after pharyngeal clearance, but it is unclear whether fecal-oral transmission occurs. Liver enzymes are elevated, usually mild (2-3 times), in a substantial proportion of patients. There are many confounding factors that could cause liver enzyme abnormalities including medications, sepsis, and hypoxia. Although infection rates in those with preexisting liver disease are similar to that of general population, once infected, patients with liver disease are more likely to have a more severe disease and a higher mortality. There is a paucity of objective data on the optimal preventive or management strategies, but few recommendations for GI physicians based on circumstantial evidence are discussed.
由病毒 SARS-CoV-2 引起的 COVID-19 全球大流行继续在低收入和高收入国家造成重大发病率和死亡率。尽管 COVID-19 主要是一种呼吸道疾病，但由于 ACE-2 受体在 SARS-CoV-2 用于进入宿主细胞的各种细胞系中普遍存在，其他系统（包括胃肠道[GI]系统和肝脏）也可能受到影响。似乎 COVID-19 常见胃肠道症状和肝酶异常。胃肠道受累和肝脏与疾病的严重程度相关。少数（10-20%）COVID-19 患者最初可能仅出现胃肠道症状。最常见的胃肠道症状是食欲不振、嗅觉丧失、恶心、呕吐和腹泻。多达 50%的患者粪便中可检测到病毒 RNA，有时甚至在清除咽部后也是如此，但尚不清楚是否发生粪-口传播。相当一部分患者的肝酶升高，通常为轻度（2-3 倍）。许多混杂因素可导致肝酶异常，包括药物、败血症和缺氧。尽管患有慢性肝病的患者的感染率与一般人群相似，但一旦感染，肝病患者更有可能出现更严重的疾病和更高的死亡率。关于最佳预防或管理策略的客观数据很少，但根据间接证据，我们讨论了一些针对胃肠病医生的建议。
