Gastrointestinal and hepatic diseases during the COVID-19 pandemic:Manifestations,mechanism and management

摘要

Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)is considered the causative pathogen of coronavirus disease 2019(COVID-19)and has become an international danger to human health.Although respiratory transmission and symptoms are still the essential manifestations of COVID-19,the digestive system could be an unconventional or supplementary route for COVID-19 to be transmitted and manifested,most likely due to the presence of angiotensin-converting enzyme 2(ACE2)in the gastrointestinal tract.In addition,SARS-CoV-2 can trigger hepatic injury via direct binding to the ACE2 receptor in cholangiocytes,antibodydependent enhancement of infection,systemic inflammatory response syndrome,inflammatory cytokine storms,ischemia/reperfusion injury,and adverse events of treatment drugs.Gastrointestinal symptoms,including anorexia,nausea,vomiting,and diarrhea,which are unusual in patients with COVID-19,and some digestive signs may occur without other respiratory symptoms.Furthermore,SARS-CoV-2 can be found in infected patients’stool,demonstrating the likelihood of transmission through the fecal-oral route.In addition,liver function should be monitored during COVID-19,particularly in more severe cases.This review summarizes the evidence for extra-pulmonary manifestations,mechanisms,and management of COVID-19,particularly those related to the gastrointestinal tract and liver.