Potential effects of SARS-CoV-2 on the gastrointestinal tract and liver

Biomed Pharmacother. 2021 Jan;133:111064. doi: 10.1016/j.biopha.2020.111064. Epub 2020 Nov 28.

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.

Keywords: COVID-19; Gastrointestinal tract; Gut-lung axis; Inflammatory cytokine storm; Liver injury; Liver transplant.

Publication types

  • Review

MeSH terms

  • Angiotensin-Converting Enzyme 2 / metabolism
  • Anorexia / etiology
  • Antiviral Agents / adverse effects
  • Bile Ducts / metabolism
  • Bile Ducts / virology
  • COVID-19 / complications*
  • COVID-19 / epidemiology
  • COVID-19 / immunology
  • COVID-19 / pathology
  • Chemical and Drug Induced Liver Injury / etiology
  • Comorbidity
  • Cytokine Release Syndrome / etiology
  • Cytopathogenic Effect, Viral
  • Gastrointestinal Diseases / epidemiology
  • Gastrointestinal Diseases / etiology*
  • Gastrointestinal Microbiome
  • Gastrointestinal Tract / metabolism
  • Gastrointestinal Tract / pathology
  • Gastrointestinal Tract / virology
  • Humans
  • Immunosuppressive Agents / adverse effects
  • Liver / metabolism
  • Liver / pathology
  • Liver / virology
  • Liver Diseases / epidemiology
  • Liver Diseases / etiology*
  • Liver Transplantation
  • Non-alcoholic Fatty Liver Disease / etiology
  • Non-alcoholic Fatty Liver Disease / pathology
  • Non-alcoholic Fatty Liver Disease / virology
  • Pandemics*
  • Postoperative Complications
  • Receptors, Virus / metabolism
  • SARS-CoV-2 / pathogenicity*

Substances

  • Antiviral Agents
  • Immunosuppressive Agents
  • Receptors, Virus
  • ACE2 protein, human
  • Angiotensin-Converting Enzyme 2