Disciplina de Cirurgia Geral e do Trauma, Pontifícia Universidade Católica de São Paulo, Sorocaba, SP, Brasil.
Laboratório de Transplante e Cirurgia do Fígado, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
Arq Bras Cir Dig. 2022 Jan 5;34(3):e1620. doi: 10.1590/0102-672020210002e1620. eCollection 2022.
It is currently understood that severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) directly enters target cells by binding to the angiotensin-converting enzyme 2 (ACE2) receptor. Accordingly, tissues with high expression levels of ACE2 are more susceptible to infection, including pulmonary alveolar epithelial cells, small intestine enterocytes, cholangiocytes, and vascular endothelial cells. Considering the atypical manifestations of COVID-19 and the challenges of early diagnosis, this review addresses the possible gastrointestinal complications of the disease.
The phrase "Gastrointestinal complication of COVID" was searched in the PubMed, Medline, and SciELO databases. Due to the heterogeneity of the studies included in the present review, a narrative synthesis of the available qualitative data was performed.
The literature search retrieved 28 articles, primarily case reports and case series, for the qualitative analysis of gastrointestinal complications of COVID-19, in addition to two retrospective cohort and one case-control. The studies focused on hemorrhagic, thrombotic, ischemic, and perforation complications, in addition to acute pancreatitis and pneumatosis intestinalis.
There is a straight relationship between high expression levels of ACE2 in the gastrointestinal tract and its greater susceptibility to direct infection by SARS-CoV-2. So, it is important to consider the gastrointestinal infection manifestations for early diagnosis and treatment trying to avoid more serious complications and death.
目前已知严重急性呼吸综合征冠状病毒 2 型（SARS-CoV-2）通过与血管紧张素转换酶 2（ACE2）受体结合而直接进入靶细胞。因此，ACE2 高表达的组织更容易受到感染，包括肺泡上皮细胞、小肠肠上皮细胞、胆管细胞和血管内皮细胞。鉴于 COVID-19 的非典型表现和早期诊断的挑战，本综述探讨了该病可能出现的胃肠道并发症。
在 PubMed、Medline 和 SciELO 数据库中搜索“COVID 的胃肠道并发症”。由于本综述纳入的研究存在异质性，因此对现有定性数据进行了叙述性综合分析。
文献检索共检索到 28 篇文章，主要是病例报告和病例系列，用于对 COVID-19 的胃肠道并发症进行定性分析，此外还有两项回顾性队列研究和一项病例对照研究。这些研究的重点是出血、血栓形成、缺血和穿孔并发症，以及急性胰腺炎和肠气肿。
胃肠道 ACE2 高表达与易受 SARS-CoV-2 直接感染之间存在直接关系。因此，有必要考虑胃肠道感染的表现，以便进行早期诊断和治疗，尽量避免更严重的并发症和死亡。
