Affiliations 

  • 1 Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
  • 2 School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
  • 3 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ping Tung Christian Hospital, Ping Tung, Taiwan
  • 4 Department of Medicine and Gastroenterology Unit, Hospital Queen Elizabeth, Kota Kinabalu, Sabah, Malaysia
Malays J Med Sci, 2021 Dec;28(6):186-193.
PMID: 35002498 DOI: 10.21315/mjms2021.28.6.14

Abstract

Digestive disorder symptoms in COVID-19 may be similar in form to post-infectious functional gastrointestinal disorder (PI-FGID). To cause clinical effects, SARS-CoV-2 must reach the bowels and gastric hypochlorhydria may facilitate such transit. Asian elderly are predisposed to greater infection rate and severity of COVID-19, and the high prevalence of gastric atrophy and intake of proton-pump inhibitor in this aged group might explain the risk. Persistence shedding of SARS-CoV-2 in stools indicates that faecal transmission should not be disregarded. Gut involvement in COVID-19 is mediated by angiotensin-converting enzyme 2 (ACE2) receptor, which serves as the entry point for SARS-CoV-2 in the small bowel. ACE2 dysregulation has an impact on the homeostasis of gut microbiota and altered inflammatory response. Liver injury is variable in COVID-19 and is likely a result of by-stander effects rather than actual viropathic process. Further research is needed to understand if gut involvement is a cause or effect of SARS-CoV-2.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.