COVID-19 and Gastrointestinal Disease: Implications for the Gastroenterologist.

Richard H. Hunta James E. Eastb Angel Lanasc Peter Malfertheinerd, e Jack Satsangif, g Carmelo Scarpignatoh, i Gwilym J. Webbj.

Aliment Pharmacol Ther. 2019 Oct;50(8):919-929. doi: 10.1111/apt.15441. Epub 2019 Sep 4.

Abstract

Background: COVID-19 was initially considered a respiratory disease but the SARS-CoV-2 virus can lead to serious system- ic consequences affecting major organs including the digestive system.

Summary: This review brings new clinically im- portant information for the gastroenterologist. This includes: the mechanisms of tissue damage seen with the SARS-CoV-2 virus; the consequences of immunosuppression in patients with inflammatory bowel disease (IBD) and chronic liver disease with the additional risks of decompensation in patients with cirrhosis; the impact of COVID-19 on gastrointestinal emergencies, on gastrointestinal endoscopy, diagnosis and treatments. These highlight the need to understand the clin- ical pharmacology, toxicology and therapeutic implications of drugs commonly used by gastroenterologists and their links with COVID-19. Key Messages: Any part of the digestive system may be affected by the SARS-CoV-2 virus, and those with pre-existing disease are at greatest risk of adverse out- comes. The risk for drug-drug interactions is considerable in patients seriously ill with COVID-19 who often require mechanical ventilation and life support. Some repurposed drugs used against SARS-CoV-2 can cause or aggravate some of the COVID-19-related gastrointestinal symptoms and can also induce liver injury. Ongoing clinical studies will hope- fully identify effective drugs with a more favourable risk- benefit ratio than many initially tried treatments.

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