The mechanism and treatment of gastrointestinal symptoms in patients with COVID-19

Abstract

In addition to the typical respiratory response, new coronavirus pneumonia (COVID-19) is also associated with very common gastrointestinal symptoms. Cases with gastrointestinal symptoms are more likely to be complicated by liver injury and acute respiratory distress syndrome (ARDS), and diarrhea can also lead to electrolyte disturbances, causing nausea and vomiting, headache, fatigue, etc. If not treated in time, coma and circulatory failure may ensue. As SARS-CoV-2 infects the human body through the combination of ACE2 in the gastrointestinal tract, the mechanism underlying the gastrointestinal symptoms may involve damage to the intestinal mucosal barrier and promotion of the production of inflammatory factors, causing cytokine storms. Indeed, after cells in the lungs become infected by SARS-CoV-2, effector CD4⁺ T cells reach the small intestine through the gut-lung axis, causing intestinal immune damage and diarrhea; early extensive use of antibacterial and antiviral drugs can also lead to diarrhea in patients. Thus, treatment options for COVID-19 patients should be promptly adjusted when they have gastrointestinal symptoms. Additionally, when drug-induced diarrhea occurs, drugs should be withdrawn or reduced, and microecological regulators should be applied to maintain the intestinal microecological balance and prevent secondary bacterial infections. To guarantee effective treatment, attention should be paid to the patient's enteral nutrition and digestive tract function. As SARS-CoV-2 has been detected in the feces of COVID-19 patients, future prevention and control efforts must consider the possibility of fecal-oral transmission of the virus.