Potential Effects of SARS-CoV-2 on the Gastrointestinal Tract and Liver

Overview

Journal Biomed Pharmacother

Specialties Biology
General Medicine
Pharmacology

Date 2020 Dec 31

PMID 33378966

Citations 46

Authors

Han-Yu Lei

Ying-He Ding

Kai Nie

Yin-Miao Dong

Jia-Hao Xu

Meng-Ling Yang

Meng-Qi Liu

Le Wei

M I Nasser

Lin-Yong Xu

Ping Zhu

Ming-Yi Zhao

Affiliations

Soon will be listed here.

Abstract

COVID-19 is a pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Early reported symptoms include fever, cough, and respiratory symptoms. There were few reports of digestive symptoms. However, with COVID-19 spreading worldwide, symptoms such as vomiting, diarrhoea, and abdominal pain have gained increasing attention. Research has found that angiotensin-converting enzyme 2 (ACE2), the SARS-CoV-2 receptor, is strongly expressed in the gastrointestinal tract and liver. Whether theoretically or clinically, many studies have suggested a close connection between COVID-19 and the digestive system. In this review, we summarize the digestive symptoms reported in existing research, discuss the impact of SARS-CoV-2 on the gastrointestinal tract and liver, and determine the possible mechanisms and aetiology, such as cytokine storm. In-depth exploration of the relationship between COVID-19 and the digestive system is urgently needed.

Citing Articles

Prevalence of gastrointestinal symptoms after recovery from COVID-19: A questionnaire-based study in the Aseer region.

Alzahrani M, Altalhiyyah K, Albariqi M, Alkhayri M, Alshahrani S, Alnasser S SAGE Open Med. 2025; 13():20503121251314067.

PMID: 39850940 PMC: 11755544. DOI: 10.1177/20503121251314067.

Liver function abnormality on admission predicts long COVID syndrome in digestive system.

Wu H, Zhang Y, Tang W, Lv M, Chen Z, Meng F Heliyon. 2024; 10(19):e37664.

PMID: 39386803 PMC: 11462002. DOI: 10.1016/j.heliyon.2024.e37664.

Assessment of abnormal liver function tests and associated factors among COVID-19-infected patients in Addis Ababa, Ethiopia, 2022: a facility-based comparative cross-sectional study.

Mekuanint A, Ambachew S, Worede A, Asrie F, Sinishaw M, Gelaw Y BMJ Open. 2024; 14(9):e076647.

PMID: 39260868 PMC: 11409313. DOI: 10.1136/bmjopen-2023-076647.

Host factors of SARS-CoV-2 in infection, pathogenesis, and long-term effects.

Zhang Y, Chen S, Tian Y, Fu X Front Cell Infect Microbiol. 2024; 14:1407261.

PMID: 38846354 PMC: 11155306. DOI: 10.3389/fcimb.2024.1407261.

Distinct Patterns of Liver Chemistry Changes in Pediatric Acute Hepatitis of Unknown Origin and COVID-19 Patients: A Systematic Review.

Van Wylick C, Lewis L, Mulder D Cureus. 2024; 16(4):e58307.

PMID: 38752102 PMC: 11094484. DOI: 10.7759/cureus.58307.

References

Kukla M, Skonieczna-Zydecka K, Kotfis K, Maciejewska D, Loniewski I, Lara L . COVID-19, MERS and SARS with Concomitant Liver Injury-Systematic Review of the Existing Literature. J Clin Med. 2020; 9(5). PMC: 7290752. DOI: 10.3390/jcm9051420. View

Leegwater E, Strik A, Wilms E, Bosma L, Burger D, Ottens T . Drug-induced Liver Injury in a Patient With Coronavirus Disease 2019: Potential Interaction of Remdesivir With P-Glycoprotein Inhibitors. Clin Infect Dis. 2020; 72(7):1256-1258. PMC: 7337726. DOI: 10.1093/cid/ciaa883. View

Yang Z, Xu M, Yi J, Jia W . Clinical characteristics and mechanism of liver damage in patients with severe acute respiratory syndrome. Hepatobiliary Pancreat Dis Int. 2005; 4(1):60-3. View

Chau T, Lee K, Yao H, Tsang T, Chow T, Yeung Y . SARS-associated viral hepatitis caused by a novel coronavirus: report of three cases. Hepatology. 2004; 39(2):302-10. PMC: 7165792. DOI: 10.1002/hep.20111. View

Ali N . Relationship Between COVID-19 Infection and Liver Injury: A Review of Recent Data. Front Med (Lausanne). 2020; 7:458. PMC: 7385135. DOI: 10.3389/fmed.2020.00458. View

Liu B, Wang Y, Zhao Y, Shi H, Zeng F, Chen Z . Successful treatment of severe COVID-19 pneumonia in a liver transplant recipient. Am J Transplant. 2020; 20(7):1891-1895. PMC: 9800465. DOI: 10.1111/ajt.15901. View

Beaugerie L, Rahier J, Kirchgesner J . Predicting, Preventing, and Managing Treatment-Related Complications in Patients With Inflammatory Bowel Diseases. Clin Gastroenterol Hepatol. 2020; 18(6):1324-1335.e2. DOI: 10.1016/j.cgh.2020.02.009. View

Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S . Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Intern Med. 2020; 180(7):934-943. PMC: 7070509. DOI: 10.1001/jamainternmed.2020.0994. View

Tsang K, Ho P, Ooi G, Yee W, Wang T, Chan-Yeung M . A cluster of cases of severe acute respiratory syndrome in Hong Kong. N Engl J Med. 2003; 348(20):1977-85. DOI: 10.1056/NEJMoa030666. View

10.

Huang J, Zheng K, George J, Gao H, Wei R, Yan H . Fatal outcome in a liver transplant recipient with COVID-19. Am J Transplant. 2020; 20(7):1907-1910. PMC: 7262021. DOI: 10.1111/ajt.15909. View

11.

Zhang C, Shi L, Wang F . Liver injury in COVID-19: management and challenges. Lancet Gastroenterol Hepatol. 2020; 5(5):428-430. PMC: 7129165. DOI: 10.1016/S2468-1253(20)30057-1. View

12.

Montastruc F, Thuriot S, Durrieu G . Hepatic Disorders With the Use of Remdesivir for Coronavirus 2019. Clin Gastroenterol Hepatol. 2020; 18(12):2835-2836. PMC: 7381904. DOI: 10.1016/j.cgh.2020.07.050. View

13.

Wang Y, Liu S, Liu H, Li W, Lin F, Jiang L . SARS-CoV-2 infection of the liver directly contributes to hepatic impairment in patients with COVID-19. J Hepatol. 2020; 73(4):807-816. PMC: 7211738. DOI: 10.1016/j.jhep.2020.05.002. View

14.

Haak B, Wiersinga W . The role of the gut microbiota in sepsis. Lancet Gastroenterol Hepatol. 2017; 2(2):135-143. DOI: 10.1016/S2468-1253(16)30119-4. View

15.

Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C . Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med. 2020; 8(4):420-422. PMC: 7164771. DOI: 10.1016/S2213-2600(20)30076-X. View

16.

Mao R, Liang J, Shen J, Ghosh S, Zhu L, Yang H . Implications of COVID-19 for patients with pre-existing digestive diseases. Lancet Gastroenterol Hepatol. 2020; 5(5):425-427. PMC: 7103943. DOI: 10.1016/S2468-1253(20)30076-5. View

17.

Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J . Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020; 323(11):1061-1069. PMC: 7042881. DOI: 10.1001/jama.2020.1585. View

18.

Xu K, Cai H, Shen Y, Ni Q, Chen Y, Hu S . [Management of COVID-19: the Zhejiang experience]. Zhejiang Da Xue Xue Bao Yi Xue Ban. 2020; 49(2):147-157. PMC: 8800711. DOI: 10.3785/j.issn.1008-9292.2020.02.02. View

19.

Guan W, Ni Z, Hu Y, Liang W, Ou C, He J . Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020; 382(18):1708-1720. PMC: 7092819. DOI: 10.1056/NEJMoa2002032. View

20.

Bangash M, Patel J, Parekh D . COVID-19 and the liver: little cause for concern. Lancet Gastroenterol Hepatol. 2020; 5(6):529-530. PMC: 7270582. DOI: 10.1016/S2468-1253(20)30084-4. View