Features of the intestine conditions at patients with a new coronavirus infection

Cover Page

Cite item

Full Text

Abstract

COVID-19 infection may present with gastrointestinal lesions in up to 25% of patients. One of the target organs of the SARS-CoV-2 virus is the intestine. The pathogenesis of intestinal damage in a new coronavirus infection remains unclear and requires further in-depth study. Possible mechanisms include a direct cytotoxic effect of the virus, a persistent reduction in butyrate-producing bacteria, side effects of drugs, Clostridioides difficile infection, microvascular thrombosis, and the immune-mediated inflammatory reactions in the intestine. The most common symptom of intestinal damage during coronavirus infection, both in the acute phase and in the post-COVID period, is diarrhea. The impact of many aggressive factors on the intestines can form both long-term functional disorders and be the cause of the onset of organic diseases. Treatment should be aimed at possible causes of intestinal damage (Clostridioides difficile), as well as reducing inflammation, restoring intestinal permeability, cytoprotection of mucosal cells, replenishing butyric acid deficiency. When choosing a therapy for intestinal disorders, preference should be given to drugs with a pleiotropic effect in order to influence various possible pathogenetic mechanisms.

About the authors

Tatiana В. Topchiy

Central State Medical Academy of Department of Presidential Affairs

Author for correspondence.
Email: tantop@mail.ru
ORCID iD: 0000-0003-4491-881X

канд. мед. наук, доц. каф. гастроэнтерологии

Russian Federation, Moscow

Maria D. Ardatskaya

Central State Medical Academy of Department of Presidential Affairs

Email: tantop@mail.ru
ORCID iD: 0000-0001-8150-307X

д-р мед. наук, проф. каф. гастроэнтерологии

Russian Federation, Moscow

Ludmila I. Butorova

Branch of Kirov Military Medical Academy

Email: tantop@mail.ru
ORCID iD: 0000-0003-4689-2844

канд. мед. наук, доц. каф. терапии неотложных состояний филиала

Russian Federation, Moscow

Leonid V. Маslovskii

Central State Medical Academy of Department of Presidential Affairs

Email: tantop@mail.ru
ORCID iD: 0000-0002-5111-8127

д-р мед. наук, доц. каф. гастроэнтерологии

Russian Federation, Moscow

Оleg N. Мinushkin

Central State Medical Academy of Department of Presidential Affairs

Email: tantop@mail.ru
ORCID iD: 0000-0002-7723-7992

д-р мед. наук, зав. каф. гастроэнтерологии, проф.

Russian Federation, Moscow

References

  1. Ивашкин В.Т., Шептулин А.А., Зольникова О.Ю., и др. Новая коронавирусная инфекция (COVID-19) и система органов пищеварения. Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2020;30(2):7-13 [Ivashkin VT, Sheptulin AA, Zolnikova OYu, et al. New Coronavirus Infection (COVID-19) and Digestive System. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2020;30(2):7-13 (in Russian)]. doi: 10.22416/1382-4376-2020-30-3-7
  2. Perisetti A, Gajendran M, Mann R, et al. COVID-19 extrapulmonary illness – special gastrointestinal and hepatic considerations. Dis Mon. 2020;66(9):101064. doi: 10.1016/j.disamonth.2020.101064
  3. Marasco G, Maida M, Morreale GC, et al. Gastrointestinal Bleeding in COVID-19 Patients: A Systematic Review with Meta-Analysis. Can J Gastroenterol Hepatol. 2021;2021:1-9. doi: 10.1155/2021/2534975
  4. Cheung KS, Hung IFN, Chan PPY, et al. Gastrointestinal Manifestations of SARS-CoV-2 Infection and Virus Load in Fecal Samples From a Hong Kong Cohort: Systematic Review and Meta-analysis. Gastroenterology. 2020;159(1):81-95. doi: 10.1053/j.gastro.2020.03.065
  5. Ардатская М.Д., Буторова Л.И., Калашникова М.А., и др. Гастроэнтерологические симптомы у пациентов с COVID-19 легкой тяжести: возможности оптимизации антидиарейной терапии. Терапевтический архив. 2021;93(8):923-31 [Ardatskaya MD, Butorova LI, Kalashnikova MA, et al. Gastroenterological symptoms in COVID-19 patients with mild severity of the disease: opportunities to optimize antidiarrheal therapy. Terapevticheskii Arkhiv (Ter. Arkh.). 2021;93(8):923-31 (in Russian)]. doi: 10.26442/00403660.2021.08.201020
  6. Anaya JM, Rojas M, Salinas ML, et al.; Post-COVID study group. Post-COVID syndrome. A case series and comprehensive review. Autoimmun Rev. 2021;20(11):102947. doi: 10.1016/j.autrev.2021.102947
  7. Hashimoto T, Perlot T, Rehman A, et al. ACE2 Links amino acid malnutrition to microbial ecology and intestinal inflammation. Nature. 2012;487(7408):477-81. doi: 10.1038/nature11228
  8. Zhang H, Li H-B, Lyu J-R, et al. Specific ACE2 expression in small intestinal enterocytes may cause gastrointestinal symptoms and injury after 2019-nCoV infection. Int J Infect Dis. 2020;96(7408):19-24. doi: 10.1016/j.ijid.2020.04.027
  9. Carvalho A, Alqusairi R, Adams A, et al. SARS-CoV-2 Gastrointestinal Infection Causing Hemorrhagic Colitis: Implications for Detection and Transmission of COVID-19 Disease. Am J Gastroenterol. 2020;115(6):942-46. doi: 10.14309/ajg.0000000000000667
  10. Britton GJ, Chen-Liaw A, Cossarini F, et al. Limited intestinal inflammation despite diarrhea, fecal viral RNA and SARS-CoV-2-specific IgA in patients with acute COVID-19. medRxiv. 2020. doi: 10.1101/2020.09.03.20183947
  11. Jena A, Kumar-MP, Singh AK, Sharma V. Fecal calprotectin levels in COVID-19: Lessons from a systematic review on its use in inflammatory bowel disease during the pandemic. Dig Liver Dis. 2021;53(3):295-7. doi: 10.1016/j.dld.2020.10.021
  12. Saleh J, Peyssonnaux C, Singh KK, Edeas M. Mitochondria and microbiota dysfunction in COVID-19 pathogenesis. Mitochondrion. 2020;54:1-7. doi: 10.1016/j.mito.2020.06.008
  13. Chen J, Hall S, Vitetta L. Altered gut microbial metabolites could mediate the effects of risk factors in Covid-19. Rev Med Virol. 2021;31(5):1-13. doi: 10.1002/rmv.2211
  14. Tang L, Gu S, Gong Y, et al. Clinical significance of the correlation between changes in the major intestinal bacteria species and COVID-19 severity. Engineering. 2020;6(10):1178-84. doi: 10.1016/j.eng.2020.05.013
  15. Sultan S, Altayar O, Siddique SM, et al. AGA Institute. Electronic address: ewilson@gastro.org. AGA Institute Rapid Review of the Gastrointestinal and Liver Manifestations of COVID-19, Meta-Analysis of International Data, and Recommendations for the Consultative Management of Patients with COVID-19. Gastroenterology. 2020;159(1):320-34.e27. doi: 10.1053/j.gastro.2020.05.001
  16. Barlow A, Landolf KM, Barlow B, et al. Review of emerging pharmacotherapy for the treatment of coronavirus disease 2019. Pharmacotherapy. 2020;40(5):416-37. doi: 10.1002/phar.2398
  17. Tang W, Cao Z, Han M, et al. Hydroxychloroquine in patients with COVID-19: an open-label, randomized, controlled trial. medRxiv. 2020. doi: 10.1101/2020.04.10.20060558
  18. Million M, Lagier J-C, Gautret P, et al. Early treatment of COVID-19 patients with hydroxychloroquine and azithromycin: A retrospective analysis of 1061 cases in Marseille, France. Travel Med Infect Dis. 2020;35(10):101738. doi: 10.1016/j.tmaid.2020.101738
  19. Lin L, Jiang X, Zhang Z, et al. Gastrointestinal symptoms of 95 cases with SARS-CoV-2 infection. Gut. 2020;69(6):997-1001. doi: 10.1136/gutjnl-2020-321013
  20. Azimirad M, Noori M, Raeisi H, et al. How Does COVID-19 Pandemic Impact on Incidence of Clostridioides difficile Infection and Exacerbation of Its Gastrointestinal Symptoms? Front Med. 2021;8(6):997-1001. doi: 10.3389/fmed.2021.775063
  21. Lewandowski K, Rosołowski M, Kaniewska M, et al. Clostridioides difficile infection in coronavirus disease 2019 (COVID-19): an underestimated problem? Pol Arch Intern Med. 2021;131(2):121-7. doi: 10.20452/pamw.15715
  22. Yadlapati S, Jarrett SA, Lo KB, et al. Examining the Rate of Clostridioides (Formerly Clostridium) Difficile Infection Pre- and Post-COVID-19 Pandemic: An Institutional Review. Cureus. 2021;8(6):997-1001. doi: 10.7759/cureus.20397
  23. Luo Y, Grinspan LT, Fu Y, et al. Hospital-onset Clostridioides difficile infections during the COVID-19 pandemic. Infect Control Hosp Epidemiol. 2021;42(9):1165-6. doi: 10.1017/ice.2020.1223
  24. Ponce-Alonso M, Sáez de la Fuente J, Rincón-Carlavilla A, et al. Impact of the coronavirus disease 2019 (COVID-19) pandemic on nosocomial Clostridioides difficile infection. Infect Control Hosp Epidemiol. 2021;42(4):406-10. doi: 10.1017/ice.2020.454
  25. Sandhu A, Tillotson G, Polistico J, et al. Clostridioides difficile in COVID-19 Patients, Detroit, Michigan, USA, March–April 2020. Emerg Infect Dis. 2020;26(9):2272-4. doi: 10.3201/eid2609.202126
  26. Временные методические рекомендации. Профилактика, диагностика и лечение новой коронавирусной инфекции (COVID-19). Версия 15 (22.02.2022). Режим доступа: https://static-0.minzdrav.gov.ru/system/attachments/attaches/000/059/392/original/ВМР_COVID-19_V15.pdf. Ссылка активна на 11.07.2022 [Vremennye metodicheskie rekomendatsii. Profilaktika, diagnostika i lechenie novoi koronavirusnoi infektsii (COVID-19). Versiia 15 (22.02.2022). Available at: https://static-0.minzdrav.gov.ru/system/attachments/attaches/000/059/392/original/ВМР_COVID-19_V15.pdf. Accessed: 05.05.2022 (in Russian)].
  27. Полевая Е.В., Вахитов Т.Я., Ситкин С.И. Энтеросорбционные свойства псиллиума (Мукофалька®) и возможные механизмы его действия при кишечных инфекциях. Клинические перспективы гастроэнтерологии, гепатологии. 2011;2:35-9 [Polevaya YeV, Vakhitov TY, Sitkin SI. Enterosorbtion properties of psyllium (Mucofalk®) and its probable mechanisms at intestinal infections. Klinicheskie perspektivy gastroenterologii, gepatologii. 2011;2:35-9 (in Russian)].
  28. Тихонова Е.П., Кузьмина Т.Ю., Миноранская Е.И., Миноранская Н.С. Опыт применения Мукофалька® в лечении сальмонеллеза. Клинические перспективы гастроэнтерологии, гепатологии. 2011;4:36-9 [Tikhonova YeP, Kuzmina TYu, Minoranskaya YeI, Minoranskaya NS. The practical issues of application of Mucofalk® in Salmonella infection. Klinicheskie perspektivy gastroenterologii, gepatologii. 2011;4:36-9 (in Russian)].
  29. Ахмедов В.А. Коррекция нарушений микробного состава кишечника как потенциальное звено в комплексной терапии пациентов с COVID-19. Терапевтический архив. 2022;94(2):277-82 [Akhmedov VA. Correction of intestinal microbial composition disturbances as a potential link in complex therapy of patients with COVID-19. Terapevticheskii Arkhiv (Ter. Arkh.). 2022;94(2):277-82 (in Russian)]. doi: 10.26442/00403660.2022.02.201388
  30. Cho M, Liu W, Balzora S, et al. Clinical and Intestinal Histopathological Findings in SARS-CoV-2/COVID-19 Patients with Hematochezia. Case Rep Gastroenterol. 2021;15(1):408-17. doi: 10.1159/000513375
  31. Yang C, Hakenberg P, Weiß C, et al. Colon ischemia in patients with severe COVID-19: a single-center retrospective cohort study of 20 patients. Int J Colorectal Dis. 2021;36(12):2769-73. doi: 10.1007/s00384-021-03999-3
  32. Norsa L, Bonaffini PA, Caldato M, et al. Intestinal ischemic manifestations of SARS-CoV-2: Results from the ABDOCOVID multicentre study. World J Gastroenterol. 2021;27(32):5448-59. doi: 10.3748/wjg.v27.i32.5448
  33. Elbadry M, Medhat MA, Zaky S, El Kassas M. Ulcerative colitis as a possible sequela of COVID-19 Infection: The endless story. Arab J Gastroenterol. 2022;23(2):134-7. doi: 10.1016/j.ajg.2022.01.006
  34. Imperatore N, Bennato R, D'Avino A, et al. SARS-CoV-2 as a Trigger for De Novo Ulcerative Colitis. Inflamm Bowel Dis. 2021;27(7):e87-8. doi: 10.1093/ibd/izab040
  35. Senthamizhselvan K, Ramalingam R, Mohan P, et al. De Novo Crohn's Disease Triggered After COVID-19: Is COVID-19 More Than an Infectious Disease? ACG Case Rep J. 2021;8(8):e00652. doi: 10.14309/crj.0000000000000652
  36. Ungaro RC, Agrawal M, Brenner EJ, et al. New Gastrointestinal Symptoms Are Common in Inflammatory Bowel Disease Patients With COVID-19: Data From an International Registry. Inflamm Bowel Dis. 2022;28(2):314-7. doi: 10.1093/ibd/izab184
  37. Salvatori S, Baldassarre F, Mossa M, Monteleone G. Long COVID in Inflammatory Bowel Diseases. J Clin Med. 2021;10(23):5575. doi: 10.3390/jcm10235575
  38. Гриневич В.Б., Кравчук Ю.А., Педь В.И., и др. Ведение пациентов с заболеваниями органов пищеварения в период пандемии COVID-19. Клинические рекомендации Научного общества гастроэнтерологов России. Экспериментальная и клиническая гастроэнтерология. 2020;94(7):4-51 [Grinevich VB, Kravchuk YA, Ped VI, et al. Management of patients with digestive diseases during the COVID-19 pandemic: Clinical Practice Guidelines by the Gastroenterological Scientific Society of Russia. Exp Clin Gastroenterol. 2020;94(7):4-51 (in Russian)]. doi: 10.31146/1682-8658-ecg-179-7-4-51
  39. Li R, Huang X, Yang L, et al. Integrated Analysis Reveals the Targets and Mechanisms in Immunosuppressive Effect of Mesalazine on Ulcerative Colitis. Front Nutr. 2022;9(7):4-51. doi: 10.3389/fnut.2022.867692
  40. Gross V, Bunganic I, Belousova EA, et al. International BUC-57 Study Group. 3g mesalazine granules are superior to 9 mg budesonide for achieving remission in active ulcerative colitis: a double-blind, double-dummy, randomised trial. J Crohns Colitis. 2011;5(2):129-38. doi: 10.1016/j.crohns.2010.11.006
  41. Lichtenstein GR, Gordon GL, Zakko S, et al. Long-Term Benefit of Mesalamine Granules for Patients Who Achieved Corticosteroid-Induced Ulcerative Colitis Remission. Dig Dis Sci. 2016;61(1):221-9. doi: 10.1007/s10620-015-3866-7
  42. Ghoshal UC, Ghoshal U, Rahman MM, et al. Post-infection functional gastrointestinal disorders following coronavirus disease-19: A case-control study. J Gastroenterol Hepatol. 2022;37(3):489-98. doi: 10.1111/jgh.15717
  43. Settanni CR, Ianiro G, Ponziani FR, et al. COVID-19 as a trigger of irritable bowel syndrome: A review of potential mechanisms. World J Gastroenterol. 2021;27(43):7433-45. doi: 10.3748/wjg.v27.i43.7433
  44. Захаренко С.М. Постковидные поражения кишечника: механизмы формирования и подходы к терапии. СПб.: Военно-медицинская академия им. С.М. Кирова, 2021 [Zakharenko SM. Postkovidnye porazheniia kishechnika: mekhanizmy formirovaniia i podkhody k terapii. Saint Petersburg: Voenno-meditsinskaia akademiia im. SM. Kirova, 2021 (in Russian)].

Supplementary files

Supplementary Files
Action
1. JATS XML
2. Fig. 1. Possible pathogenetic mechanisms of intestinal damage in COVID-19.

Download (138KB)
3. Fig. 2. Adsorption capacity of various enterosorbents [27].

Download (99KB)
4. Fig. 3. Dynamics of clinical manifestations in acute intestinal infections during Mucofalk therapy [28].

Download (66KB)
5. Fig. 4. Proposed pathophysiological mechanisms for the formation of irritable bowel syndrome in patients with novel coronavirus infection [43].

Download (145KB)
6. Fig. 5. Scheme of intestinal rehabilitation after an intestinal infection [44].

Download (99KB)

Copyright (c) 2022 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
 
 


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies