Panic of Buying Toilet Papers: A Historical Memory or a Horrible Truth? Systematic Review of Gastrointestinal Manifestations of COVID-19

摘要

Context: Within only 30 days after the first announcement of infection with “SARS-CoV-2” in Wuhan, it spread to more than 20countries and become a pandemic by WHO as a “high alarming level of infection” with 136,343 involved cases all over the world.Methods: To uncover more about the probable gastrointestinal transmission and its clinical manifestations, we reviewed all researchpublications with keywords including: “COVID-19”, “SARS-CoV-2”, “Coronavirus”, “outbreak”, “ARAS-CoV” in Medline, Scopus,Google Scholar as well as all news in social media about “novel COVID-19 pandemic”. Out of 40 recent publications, 10 articles werestudied by 2 authors.Results: Although the SARS-CoV-2 tends to infect respiratory epithelial cells through the respiratory tracts, recent investigations detectedthe virus in the stool specimen, raising the question of the fecal-oral transmission route. Different studies showed that almostall gastrointestinal signs and symptoms were seen in elderly patients (more than 65 years old). including anorexia (40%), nonspecificabdominal pains (8%), diarrhea (10%) and nausea and Vomiting in about 8% of patients. Anorexia and generalized abdominalpain suffer many treated cases even 10 - 20 days after negative blood tests (like CRP, lymphopenia) and negative PCR of respiratorysamples. The main reason for this prolonged anorexia and abdominal pain may be due to the long persistence of COVID-19 in thegastrointestinal tracts after primary treatment.Conclusions: Comparing to SARS, patients with COVID-19 showed less diarrhea, nausea, vomiting and/or abdominal discomfortbefore respiratory symptoms. Feces as a potential contagious source of Viral RNA can last even after viral clearance in the respiratorytract. We strongly recommend all cured patients of COVID-19 to disinfect and clean their toilets until 17 - 20 days after negative bloodtests and solving their respiratory disorders. Gastrointestinal manifestations have seen in all men while no women referred with GIsigns.