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COVID-19 extrapulmonary illness - special gastrointestinal and hepatic considerations.
Dis Mon. 2020 Sep; 66(9):101064.DM

Abstract

Coronaviruses have caused three global outbreaks in the last 20 years, which include Severe Acute Respiratory Syndrome (SARS) caused by SARS-CoV (SARS-CoV-1), Middle East Respiratory Syndrome (MERS) by MERS-CoV and Coronavirus Disease-2019 (COVID-19) due to SARS-CoV-2. These outbreaks share many similarities, including clinical presentation, transmission, and management. Although respiratory manifestations are responsible for most of the morbidity and mortality in these conditions, extra-pulmonary manifestations such as gastrointestinal symptoms are also increasingly recognized as important symptoms. Important gastrointestinal symptoms include nausea, vomiting, anorexia, diarrhea, and abdominal pain. Hepatic manifestations such as abnormal aminotransferases are also noted in these patients. Early identification of GI symptoms is crucial as some patients can present only with GI manifestations in the absence of pulmonary symptoms. Furthermore, patients with diarrhea have tested positive for viral RNA in the stool. This has been reported even after the resolution of respiratory symptoms and can extend up to many days from the onset of symptoms. Because of this phenomenon, there is a theoretical risk of fecal-oral transmission and the potential spread of the disease. Though GI symptoms are frequently observed, understanding the pathogenesis of these symptoms is crucial, as it can not only of public health importance but could also identify infected patients early in the spread. Understanding the different GI and hepatic manifestations with underlying mechanisms of symptoms can assist in the therapeutic management of these patients. In this article, we summarize various GI and hepatic manifestations with their prevalence, underlying pathophysiology with emphasis on stool positivity.

Links

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Authors+Show Affiliations

Perisetti A
Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA. Electronic address: abhilash.perisetti@gmail.com.
Gajendran M
Department of Internal Medicine, Texas Tech University, Paul L Foster School of Medicine, El Paso, Texas 79905, USA. Electronic address: mahesh.gajendran@ttuhsc.edu.
Mann R
Department of Internal Medicine, Saint Agnes Medical Center, 1303 E Herndon Ave, Fresno, CA 93730, USA. Electronic address: rupindrmann@yahoo.com.
Elhanafi S
Division of Gastroenterology and Hepatology, Texas Tech University, Paul L Foster School of Medicine, El Paso, Texas 79905, USA. Electronic address: Sherif.Elhanafi@ttuhsc.edu.
Goyal H
Department of Internal Medicine, Division of Gastroenterology and Hepatology, The Wright Center of Graduate Medical Education, Scranton, Pennsylvania, USA. Electronic address: doc.hemant@yahoo.com.

MeSH

COVID-19COVID-19 TestingGastrointestinal DiseasesHumansLiver DiseasesSARS-CoV-2

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

32807535

Citation

Perisetti, Abhilash, et al. "COVID-19 Extrapulmonary Illness - Special Gastrointestinal and Hepatic Considerations." Disease-a-month : DM, vol. 66, no. 9, 2020, p. 101064.
Perisetti A, Gajendran M, Mann R, et al. COVID-19 extrapulmonary illness - special gastrointestinal and hepatic considerations. Dis Mon. 2020;66(9):101064.
Perisetti, A., Gajendran, M., Mann, R., Elhanafi, S., & Goyal, H. (2020). COVID-19 extrapulmonary illness - special gastrointestinal and hepatic considerations. Disease-a-month : DM, 66(9), 101064. https://doi.org/10.1016/j.disamonth.2020.101064
Perisetti A, et al. COVID-19 Extrapulmonary Illness - Special Gastrointestinal and Hepatic Considerations. Dis Mon. 2020;66(9):101064. PubMed PMID: 32807535.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - COVID-19 extrapulmonary illness - special gastrointestinal and hepatic considerations. AU - Perisetti,Abhilash, AU - Gajendran,Mahesh, AU - Mann,Rupinder, AU - Elhanafi,Sherif, AU - Goyal,Hemant, Y1 - 2020/07/28/ PY - 2020/8/19/pubmed PY - 2020/12/15/medline PY - 2020/8/19/entrez KW - Abdominal pain KW - Anorexia KW - COVID-19 KW - Coronavirus disease-2019 KW - Coronaviruses KW - Diarrhea KW - Gastrointestinal manifestations KW - Hepatic manifestations KW - MERS-CoV KW - Middle east respiratory syndrome KW - Nausea KW - SARS-CoV-1 KW - SARS-CoV-2 KW - Severe acute respiratory syndrome KW - Vomiting SP - 101064 EP - 101064 JF - Disease-a-month : DM JO - Dis Mon VL - 66 IS - 9 N2 - Coronaviruses have caused three global outbreaks in the last 20 years, which include Severe Acute Respiratory Syndrome (SARS) caused by SARS-CoV (SARS-CoV-1), Middle East Respiratory Syndrome (MERS) by MERS-CoV and Coronavirus Disease-2019 (COVID-19) due to SARS-CoV-2. These outbreaks share many similarities, including clinical presentation, transmission, and management. Although respiratory manifestations are responsible for most of the morbidity and mortality in these conditions, extra-pulmonary manifestations such as gastrointestinal symptoms are also increasingly recognized as important symptoms. Important gastrointestinal symptoms include nausea, vomiting, anorexia, diarrhea, and abdominal pain. Hepatic manifestations such as abnormal aminotransferases are also noted in these patients. Early identification of GI symptoms is crucial as some patients can present only with GI manifestations in the absence of pulmonary symptoms. Furthermore, patients with diarrhea have tested positive for viral RNA in the stool. This has been reported even after the resolution of respiratory symptoms and can extend up to many days from the onset of symptoms. Because of this phenomenon, there is a theoretical risk of fecal-oral transmission and the potential spread of the disease. Though GI symptoms are frequently observed, understanding the pathogenesis of these symptoms is crucial, as it can not only of public health importance but could also identify infected patients early in the spread. Understanding the different GI and hepatic manifestations with underlying mechanisms of symptoms can assist in the therapeutic management of these patients. In this article, we summarize various GI and hepatic manifestations with their prevalence, underlying pathophysiology with emphasis on stool positivity. SN - 1557-8194 UR - https://www.unboundmedicine.com/medline/citation/32807535/COVID_19_extrapulmonary_illness___special_gastrointestinal_and_hepatic_considerations_ DB - PRIME DP - Unbound Medicine ER -