Apr 27 SARS-COV-2 infection (coronavirus disease 2019) for the gastrointestinal consultant
Kaveh Hajifathalian, Srihari Mahadev, Robert E Schwartz, Shawn Shah, Kartik Sampath, Felice Schnoll-Sussman, Robert S Brown Jr, David Carr-Locke, David E Cohen, Reem Z Sharaiha
ABSTRACT
The current severe acute respiratory syndrome 2 pandemic due to COVID 19 has caused an extreme burden on healthcare systems globally, and the number of cases is expected to continue to increase, at least for the foreseeable future.
It is estimated that the virus has infected more than 1.5 million individuals. Available reports suggest that gastrointestinal (GI) involvement in COVID 19 disease coronavirus is common and in some cases gastrointestinal symptoms may precede respiratory symptoms.
In addition to the direct effects of severe acute respiratory syndrome 2, infected patients remain at risk of complications commonly managed by gastroenterology and hepatology. The most commonly reported gastrointestinal manifestation of COVID-19 is diarrhea, which is reported in one-third to more than half of patients. Mild to moderate elevation of liver enzymes is also common, although acute liver failure has not been reported so far. Many of the medications used to treat COVID-19 may also be associated with gastrointestinal symptoms or liver damage and may be included in the differential diagnosis in these patients.
Although the diagnosis of infection is currently based on RNA analysis in respiratory tract samples, the available literature on fecal shedding of this virus suggests that this RNA test could be a useful diagnostic test. It is reasonable to delay all non-urgent endoscopic procedures during the peak of the pandemic and use additional protective equipment such as N95 respirators during endoscopy while. Most patients can be considered high risk for having been exposed to the virus.