Farncombe Family Digestive Health Research Institute, Division of Gastroenterology, McMaster University, Hamilton, Ontario, Canada,
Translational Gastroenterology Unit, Experimental Medicine Division, Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom.
Dig Dis. 2021;39(2):119-139. doi: 10.1159/000512152. Epub 2020 Oct 9.
COVID-19 was initially considered a respiratory disease but the SARS-CoV-2 virus can lead to serious systemic consequences affecting major organs including the digestive system.
This review brings new clinically important information for the gastroenterologist. This includes: the mechanisms of tissue damage seen with the SARS-CoV-2 virus; the consequences of immunosuppression in patients with inflammatory bowel disease (IBD) and chronic liver disease with the additional risks of decompensation in patients with cirrhosis; the impact of COVID-19 on gastrointestinal emergencies, on gastrointestinal endoscopy, diagnosis and treatments. These highlight the need to understand the clinical pharmacology, toxicology and therapeutic implications of drugs commonly used by gastroenterologists and their links with COVID-19. Key Messages: Any part of the digestive system may be affected by the SARS-CoV-2 virus, and those with pre-existing disease are at greatest risk of adverse outcomes. The risk for drug-drug interactions is considerable in patients seriously ill with COVID-19 who often require mechanical ventilation and life support. Some repurposed drugs used against SARS-CoV-2 can cause or aggravate some of the COVID-19-related gastrointestinal symptoms and can also induce liver injury. Ongoing clinical studies will hopefully identify effective drugs with a more favourable risk-benefit ratio than many initially tried treatments.
COVID-19 最初被认为是一种呼吸道疾病，但 SARS-CoV-2 病毒可导致严重的全身后果，影响包括消化系统在内的主要器官。
这篇综述为胃肠病学家带来了新的具有重要临床意义的信息。其中包括：SARS-CoV-2 病毒引起的组织损伤机制；炎症性肠病（IBD）和慢性肝病患者免疫抑制的后果，以及肝硬化患者失代偿的额外风险；COVID-19 对胃肠道急症、胃肠内镜、诊断和治疗的影响。这些都强调了需要了解胃肠病学家常用药物的临床药理学、毒理学和治疗学意义及其与 COVID-19 的关联。
SARS-CoV-2 病毒可影响消化道的任何部位，而那些患有先前疾病的患者发生不良后果的风险最大。COVID-19 重症患者发生药物-药物相互作用的风险相当大，这些患者常需要机械通气和生命支持。一些用于治疗 SARS-CoV-2 的已上市药物可引起或加重一些与 COVID-19 相关的胃肠道症状，也可引起肝损伤。正在进行的临床研究有望确定比许多最初尝试的治疗更具有利风险效益比的有效药物。
