SciELO - Scientific Electronic Library Online

 
vol.35 issue2Letter to the editor. Endoscopic Diagnosis of HookwormsEvidence of gastrointestinal disturbances in COVID-19: manifestations and theories in pathophysiology author indexsubject indexarticles search
Home Pagealphabetic serial listing  

Services on Demand

Journal

Article

Indicators

Related links

  • On index processCited by Google
  • Have no similar articlesSimilars in SciELO
  • On index processSimilars in Google

Share


Revista colombiana de Gastroenterología

Print version ISSN 0120-9957On-line version ISSN 2500-7440

Rev. colomb. Gastroenterol. vol.35 no.2 Bogotá Apr./June 2020

https://doi.org/10.22516/25007440.553 

Letter

COVID-19: A new perspective in gastroenterology

Rommel Zambrano-Huailla1 

1 Gastroenterology Service, Hospital III de Emergencias Grau EsSalud in Lima, Peru


Since its appearance in Wuhan, Hubei province, in central China, and due to its rapid spread and severity, the Coronavirus disease (COVID-19) has been declared a “public health emergency of international importance” by the World Health Organization (WHO). It is worth mentioning that this is the sixth time that the WHO has made a pronouncement of such magnitude since the approval of International Health Regulations in 2005. 1

This disease is transmitted from person to person through aerosols generated by coughs or sneezes. In its most critical stage, severe acute respiratory syndrome (SARS) develops. SARS is a condition requires mechanical ventilation for a large percentage of patients. Nevertheless several already-published studies and several others that are in-publication also report gastrointestinal symptoms in infected patients. In these patients, the presence of diarrhea stands out (Table 1). 2-6

Table 1 Gastrointestinal manifestations of patients with COVID-19 

COVID-19 uses angiotensin-converting enzyme 2 to enter the cell. This enzyme is not only found in the lungs but is also expressed in cells of the digestive tract, and in cholangiocytes and hepatocytes which could explain the reports of gastrointestinal manifestations. 7,8 In turn, this would support the possibility of fecal-oral transmission of the disease. 7 This context automatically turns endoscopic centers into high-risk sites.

A number of medical societies have published their recommendations and guidelines for endoscopic procedures and outpatient follow-up. The American Association of Gastroenterology (AGA) recommends correct use of personal protective equipment and the use of negative pressure rooms during the endoscopy of patients with a confirmed COVID-19 diagnoses as well as for those suspected of having COVID-19. 9

For its part, the European Association for the Study of the Liver (EASL) suggests using telemedicine to reduce exposure of vulnerable patients to COVID -19 through outpatient appointments. 10 Daily clinical practice will undergo changes in the coming months and will depend on our ability to adapt so that we can continue offering the same standards of care to our patients.

From another point of view, this is an opportunity for development of research into manifestations of COVID-19 in the digestive tract, as well as its impacts on patients with chronic gastrointestinal diseases. To gain a better understanding of the behavior of this disease in our region.

Despite difficulties in determining the real impact of this epidemic, new opportunities have been created for development of skills and tools that will set the course for patient care

Referencias

1. Ramos C, C D. Covid-19 : la nueva enfermedad causada por un coronavirus. Salud Publica Mex [Internet]. 2020;62(2):225-7. Available from: https://doi.org/10.21149/11276Links ]

2. Majeed MB, Majeed MB, Agrawal R, Wang Y, Attar B, Patel P, et al. Prevalence of gastrointestinal symptoms in COVID-19 patients and impact of medical resources on disease transmission. Available-at SSRN. 3572865(2020). https://doi.org/10.2139/ssrn.3572865Links ]

3. Garg S, Kim L, Whitaker M, O’Halloran A, Cummings C, Holstein R, et al. Hospitalization Rates and Characteristics of Patients Hospitalized with Laboratory-Confirmed Coronavirus Disease 2019 - COVID-NET, 14 States, March 1-30, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(15):458-64. https://doi.org/10.15585/mmwr.mm6915e3Links ]

4. Kim T, Park O, Ph D, Kim G, Ph D. Infectious Diseases Epidemiological and Clinical Characteristics of Early 101 Deceased Patients in the Coronavirus Disease-19 (COVID-19) Outbreak in Republic of Korea. (2020). Available-at SSRN https//ssrn.com/abstract=3571538. https://doi.org/10.2139/ssrn.3571538Links ]

5. Cheung KS, Hung IF, Chan PP, Lung KC, Tso E, Liu R, et al. Gastrointestinal Manifestations of SARS-CoV-2 Infection and Virus Load in Fecal Samples from the Hong Kong Cohort and Systematic Review and Meta-analysis. Gastroenterology [Internet]. 2020. https://doi.org/10.1053/j.gastro.2020.03.065Links ]

6. Escalera-antezana JP, Lizon-ferrufino NF, Maldonado-alanoca A, Alarcón-de-la-vega G, Alvarado-arnez LE, Balderrama-saavedra MA, et al. Clinical features of the first cases and a cluster of Coronavirus Disease 2019 (COVID-19) in Bolivia imported from Italy and Spain. Travel Med Infect Dis [Internet]. 2020;(March):101653. Available from: https://doi.org/10.1016/j.tmaid.2020.101653Links ]

7. Xiao F, Tang M, Zheng X, Liu Y, Shan H. Evidence for Gastrointestinal Infection of SARS-CoV-2. Gastroenterology . 2020;S0016-5085. https://doi.org/10.1053/j.gastro.2020.02.055Links ]

8. Chai X, Hu L, Zhang Y, Han W, Lu Z, Ke A. Specific ACE2 Expression in Cholangiocytes May Cause Liver Damage After 2019-nCoV Infection. bioRxiv [Internet]. 2020;2020.02.03.931766. Available from: http://biorxiv.org/content/early/2020/02/04/2020.02.03.931766.abstractLinks ]

9. Sultan S, Lim JK, Altayar O, Davitkov P, Joseph D, Siddique SM, et al. AGA Institute Rapid Recommendations for Gastrointestinal Procedures During the COVID-19 Pandemic. Gastroenterology [Internet]. 2020; Available from: https://doi.org/10.1053/j.gastro.2020.03.072Links ]

10. Boettler T, Newsome PN, Mondelli MU, Maticic M, Cordero E. Care of patients with liver disease during the COVID-19 pandemic: EASL-ESCMID Position Paper. JHEP Reports [Internet]. 2020;2(3):100113. Available from: www.sciencedirect.com/science/article/pii/S2589555920300471 https://doi.org/10.1016/j.jhepr.2020.100113Links ]

Received: April 29, 2020; Accepted: May 12, 2020

*Correspondence: Rommel Zambrano-Huailla MD. rommel_334@hotmail.com

Creative Commons License Este es un artículo publicado en acceso abierto bajo una licencia Creative Commons