Clinical Features and Pathogenic Mechanisms of Gastrointestinal Injury in COVID-19

Keiichi Mitsuyama; Kozo Tsuruta; Hidetoshi Takedatsu; Shinichiro Yoshioka; Masaru Morita; Mikio Niwa; Satoshi Matsumoto

doi:10.3390/jcm9113630

Clinical Features and Pathogenic Mechanisms of Gastrointestinal Injury in COVID-19

J Clin Med. 2020 Nov 11;9(11):3630. doi: 10.3390/jcm9113630.

Authors

Keiichi Mitsuyama^{1

2}, Kozo Tsuruta^{1

2}, Hidetoshi Takedatsu^{1

2}, Shinichiro Yoshioka^{1

2}, Masaru Morita^{1

2}, Mikio Niwa³, Satoshi Matsumoto⁴

Affiliations

¹ Inflammatory Bowel Disease Center, Kurume University Hospital, 67 Asahimachi, Kurume, Fukuoka 830-0011, Japan.
² Division of Gastroenterology, Department of Medicine, School of Medicine, Kurume University, 67 Asahimachi, Kurume, Fukuoka 830-0011, Japan.
³ Institute for Advanced Sciences, 1-1-1 Umezono, Tsukuba, Ibaraki 305-8560, Japan.
⁴ Yakult Central Institute for Microbiological Research, Kunitachi, Tokyo 186-0011, Japan.

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of the global coronavirus disease 2019 (COVID-19) outbreak. Along with the respiratory tract, the gastrointestinal (GI) tract is one of the main extra-pulmonary targets of SARS-CoV-2 with respect to symptom occurrence and is a potential route for virus transmission, most likely due to the presence of angiotensin-converting enzyme 2. Therefore, understanding the mechanisms of GI injury is crucial for a harmonized therapeutic strategy against COVID-19. This review summarizes the current evidence for the clinical features of and possible pathogenic mechanisms leading to GI injury in COVID-19.

Keywords: ACE2; COVID-19; SARS-CoV-2; TMPRSS2; gastrointestinal tract; gut microbiota; intestine; renin-angiotensin-aldosterone system; thrombosis; tryptophan.

Publication types

Review