The Thrilling Journey of SARS-CoV-2 into the Intestine: From Pathogenesis to Future Clinical Implications.

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has a direct impact on the gastrointestinal system, as up to 50% of fecal samples from coronavirus disease 2019 (COVID-19) patients contain detectable viral RNA despite a negative rhino-pharyngeal swab. This finding, together with an intestinal expression of angiotensin conversion enzyme 2 protein, suggests a possible fecal-oral transmission for SARS-CoV-2. Furthermore, gastrointestinal (GI) symptoms are common in COVID-19 patients including watery diarrhea, vomiting-particularly in children-nausea, and abdominal pain. Pathogenesis of SARS-CoV-2 infection presents significant similarities to those of some immune-mediated diseases, such as inflammatory bowel diseases or rheumatoid arthritis, leading to the hypothesis that targeted therapies used for the treatment of immune-mediated disease could be effective to treat (and possibly prevent) the main complications of COVID-19. In this review, we synthesize the present and future impact of SARS-CoV-2 infection on the gastrointestinal system and on gastroenterology practice, hypothesizing a potential role of the "gut-lung axis" and perhaps of the gut and lung microbiota into the interindividual differential susceptibility to COVID-19 19 disease. Finally, we speculate on the reorganization of outpatient gastroenterology services, which need to consider, among other factors, the major psychological impact of strict lockdown measures on the whole population.

• Authors: Franco Scaldaferri, Gianluca Ianiro, Giuseppe Privitera, Loris Riccardo Lopetuso, Lorenzo Maria Vetrone, Valentina Petito, Daniela Pugliese, Matteo Neri, Giovanni Cammarota, Yehuda Ringel, Guido Costamagna, Antonio Gasbarrini, Ivo Boskoski, Alessandro Armuzzi
• Journal: Inflammatory bowel diseases (Inflamm Bowel Dis) Vol. 26 Issue 9 Pg. 1306-1314 (08 20 2020) ISSN: 1536-4844 [Electronic] England
• PMID: 32720978 (Publication Type: Journal Article, Review)
• Copyright: © 2020 Crohn’s & Colitis Foundation. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: [email protected].

Chemical References

• RNA, Viral

Topics

• Betacoronavirus
• COVID-19
• Coronavirus Infections (complications, virology)
• Feces (virology)
• Gastrointestinal Diseases (virology)
• Gastrointestinal Tract (virology)
• Humans
• Pandemics
• Pneumonia, Viral (complications, virology)
• RNA, Viral (analysis)
• SARS-CoV-2