Podsumowanie

Przewód pokarmowy odgrywa istotną rolę w przebiegu COVID-19. Tropizm SARS-CoV-2 w kierunku komórek nabłonka żołądka, jelit, wątroby i dróg żółciowych może bezpośrednio prowadzić do ich uszkodzenia. Droga fekalno-oralna (obok drogi kropelkowej) jest wysoce prawdopodobnym szlakiem transmisji zakażenia. Z punktu widzenia epidemiologicznego należy zatem zwracać szczególną uwagę na występowanie objawów żołądkowo-jelitowych jako wczesnej manifestacji COVID-19. Może się to przyczynić do podjęcia szybkich działań diagnostyczno-terapeutycznych, a przede wszystkim pozwoli na niezwłoczne wdrożenie procedur izolacji i ograniczenie szerzenia się zakażenia.

Zasady postępowania z pacjentami z chorobami przewlekłymi przewodu pokarmowego powinny się opierać na dostępnych rekomendacjach ekspertów i wytycznych organizacji gastroenterologicznych. Planowe porady i nadzór nad chorymi należy kontynuować najlepiej z wykorzystaniem narzędzi telemedycyny, zaś konieczne konsultacje i procedury pilne powinny być przeprowadzane z zachowaniem ścisłych rygorów profilaktyki transmisji infekcji.

Z uwagi na dynamiczny rozwój wiedzy nad biologią, diagnostyką i leczeniem SARS-CoV-2 oraz COVID-19 należy skrupulatnie śledzić piśmiennictwo i doniesienia, uwzględniając możliwość modyfikacji rekomendacji i wytycznych postępowania.

Abstract

The impact of an infection with coronavirus SARS-CoV-2 (COVID-19) on the gastrointestinal tract

Although the most common clinical presentation of an infection with the novel coronavirus (SARS-CoV-2), i.e. the new coronavirus disease, called COVID-19 (Coronavirus Disease 2019), is acute respiratory disease, the gastrointestinal tract may also be involved with symptoms such as diarrhea, nausea and vomiting. The major route of transmission are respiratory droplets, but the fecal-oral route also increases the spread of the virus. During a pandemic period appropriate epidemiological guidelines need to be respected at gastroenterology and endoscopy centers. Patients with gastrointestinal disorders, including inflammatory bowel disease, especially those receiving immunosuppressive and immunomodulatory therapy, should strictly respect the rules of isolation and be remotely supported by health providers with the use of telemedicine solutions.

Piśmiennictwo

1. Wu F, Zhao S, Yu B, et al. A new coronavirus associated with human respiratory disease in China. Nature 2020. doi: https://doi.org/10.1038/s4158 6-020-2008-3

2. Chan JF, Kok KH, Zhu Z, et al. Genomic characterization of the 2019 novel human-pathogenic coronavirus isolated from a patient with atypical pneumonia after visiting Wuhan. Emerg Microbes Infect 2020;9:221-36

3. Lu R, Zhao X, Li J, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet 2020. doi: 10.1016/S0140-6736(20)30251-8

4. Zhang H, Kang Z, Gong H, et al. The digestive system is a potential route of 2019-nCov infection: a bioinformatics analysis based on single-cell transcriptomes. BioRxiv 927806. https://doi.org/10.1101/2020.01.30.927806

5. Yeo C, Kaushal S, Yeo D. Enteric involvement of coronaviruses: is faecal-oral transmission of SARS-CoV-2 possible? Lancet Gastroenterol. Hepatol 2020. https://doi.org/10.1016/S2468-1253(20)30048-0

6. Peiris J, Chu CM, Cheng V, et al. Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study. Lancet 2003;361:1767-72

7. Fang D, Ma J, Guan J, et al. Manifestations of digestive system in hospitalized patients with novel coronavirus pneumonia in Wuhan, China: a single-center, descriptive study. Chin J Dig 2020,40. https://doi.org/10.3760/cma.j.issn.0254-1432.2020.0005

8. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506

9. Tian Y, Rong L, Nian W, et al. Review article: gastrointestinal features in COVID-19 and the possibility of faecal transmission. Aliment Pharmacol Ther 2020;00:1-9. https://doi.org/10.1111/apt.15731

10. Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients with 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA 2020. https://doi.org/10.1001/jama.2020.1585

11. Ping A, Hongbin C, Xiaoda J, et al. Clinical features of 2019 novel coronavirus pneumonia presented gastrointestinal symptoms but without fever onset. Preprints with the Lancet 2020. https://ssrn.com/abstr act=3532530

12. Holshue ML, DeBolt C, Lindquist S, et al. First Case of 2019 Novel Coronavirus in the United States. N Engl J Med 2020;382(10):929-36. https://doi.org/10.1056/NEJMoa2001191

13. Song Y, Liu P, Shi XL, et al. SARS-CoV-2 induced diarrhoea as onset symptom in patient with COVID-19. Gut 2020. https://doi.org/10.1136/gutjnl-2020-320891

14. Liu W, Zhang Q, Chen J, et al. Detection of Covid-19 in children in early January 2020 in Wuhan, China. N Engl J Med 2020. https://doi.org/10.1056/NEJMc 2003717

15. Thosar A, Mayee R. Itopride: an updated review of its pharmacological properties and use as a prokinetic. Int J Inst Ph Life Sci 2013;3(2):13-19

16. Chan KH, Poon LL, Cheng VC, et al. Detection of SARS coronavirus in patients with suspected SARS. Emerg Infect Dis 2004;10:294-99

17. Holshue ML, DeBolt C, Lindquist S, et al. First Case of 2019 Novel Coronavirus in the United States. N Engl J Med 2020;382(10):929-36. https://doi.org/10.1056/NEJMoa2001191

18. Yang Z, Li G, Dai X, et al. Three cases of novel coronavirus pneumonia with viral nucleic acids still positive in stool after throat swab detection turned negative. Chin J Dig 2020;40:E002-E002. https://doi.org/10.3760/cma.j.issn.0254-1432.2020.0002

19. Zhang J, Wang S, Xue Y. Fecal specimen diagnosis 2019 novel coronavirus-infected pneumonia. J Med Virol 2020. https://doi.org/10.1002/jmv.25742

20. Ling Y, Xu SB, Lin YX, et al. Persistence and clearance of viral RNA in 2019 novel coronavirus disease rehabilitation patients. Chin Med J (Engl) 2020. https://doi.org/10.1097/CM9.00000 00000 000774

21. Xiao F, Tang M, Zheng X, et al. Evidence for gastrointestinal infection of SARS-CoV-2. Gastroenterology 2020. https://doi.org/10.1053/j.gastro.2020.02.055

22. Wander P, Epstein M, Bernstein D. COVID-19 presenting as acute hepatitis. Am J Gastroenterolog. https://journals.lww.com/ajg/Documents/COVID19_Bernstein_et_al_AJG_Preproof.pdf?fbclid=IwAR0EGxCk0gkix9uJhiwNUxGKYJQkQEn6YjKX2YERmkmvJEedaHcoRP0j-M

23. Guan GW, Gao L, Wang JW, et al. Exploring the mechanism of liver enzyme abnormalities in patients with novel coronavirus-infected pneumonia. Zhonghua Gan Zang Bing Za Zhi 2020;28:E002. https://doi.org/10.3760/cma.j.issn.1007-3418.2020.02.002

24. Chai XQ, Hu LF, Zhang Y, et al. Specific ACE2 Expression in Cholangiocytes May Cause Liver Damage After 2019-nCoV Infection. Preprint bioRxiv 2020. https://doi.org/10.1101/2020.02.03.931766

25. British Society of Gastroenterology (BSG) advice for management of inflammatory bowel diseases during the COVID-19 pandemic. https://www.bsg.org.uk/covid-19-advice/bsg-advice-for-management-of-inflammatory-bowel-diseases-during-the-covid-19-pandemic/

26. IOIBD: IOIBD Update on COVID19 for Patients with Crohn’s Disease and Ulcerative Colitis. https://www.ioibd.org/ioibd-update-on-covid19-for-patients-with-crohns-disease-and-ulcerative-colitis

27. IBD MANAGEMENT during COVID-19 outbreak 31.03.2020. https://www.ibdscope.com/previous-webinars/

28. Rejestr SECURE-IBD (Surveillance Epidemiology of Coronavirus Under Research Exclusion). https://covidibd.org

29. Zhu LR, Mao R, Fiorino G, et al.; 2nd Interview COVID-19 ECCO Taskforce, 2020. https://www.ecco-ibd.eu/publications/covid-19.html

30. Wisniewski A, Kirchgesner J, Seksik P, et al. Increased incidence of systemic serious viral infections in patients with inflammatory bowel disease associates with active disease and use of thiopurines. UEGJ 2019. https://doi.org/10.1177/2050640619889763

31. An P, Ji M, Ren H. Protection of 318 Inflammatory Bowel Disease Patients From the Outbreak and Rapid Spread of COVID-19 Infection in Wuhan, China. Lancet 2020. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3543590

32. Lorenzo Norsa L, Indriolo A, Sansotta N, et al. Uneventful course in IBD patients during SARS-CoV-2 outbreak in northern Italy. Gastroenterology 2020. doi: https://doi.org/10.1053/j.gastro.2020.03.062

33. Łodyga M, Eder P, Dobrowolska A. Stanowisko Polskiego Towarzystwa Gastroenterologii i Konsultanta Krajowego w Dziedzinie Gastroenterologii dotyczące postępowania z pacjentem z nieswoistą chorobą zapalną jelit w dobie pandemii COVID-19. http://www.ptg-e.org.pl

34. Rubin DT, Feuerstein JD, Wang AY, et al. AGA Clinical Practice Update on Management of Inflammatory Bowel Disease During the COVID-19 Pandemic: Expert Commentary. Gastroenterology 2020. https://doi.org/10.1053/j.gastro.2020.04.012

35. UEG: COVID-19 & Digestive Health. https://www.youtube.com/watch v=w60DVdKkuGw&feature=youtu.be

36. Mao R, Liang J, Shen J, et al. Implications of COVID-19 for patients with pre-existing digestive diseases. Lancet Gastroenterol Hepatol 2020. https://doi.org/10.1016/S2468-1253(20)30076-5

37. Repici A, Maselli R, Colombo M, et al. Coronavirus (COVID-19) outbreak: what the department of endoscopy should know. Gastrointest Endosc 2020. https://doi.org/10.1016/j.gie.2020.03.019

38. Marek T, Reguła J, Rydzewska G. Wytyczne Polskiego Towarzystwa Gastroenterologii i konsultanta krajowego w dziedzinie gastroenterologii dotyczące wykonywania endoskopii przewodu pokarmowego w związku z epidemią COVID-19. Gastroenterologia Kliniczna 2020;12(1):1-6

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