COVID-19 and Gastrointestinal Disease. Implications for the Gastroenterologist

Abstract

COVID-19 was initially considered to be a respiratory disease but soon after the pandemic established it became clear that the SARS-CoV-2 virus which caused the disease could lead to serious systemic consequences affecting most of the major organs including the digestive tract, liver and pancreas. This review brings together the new information which is clinically relevant to the gastroenterologist including the origins of the disease, mechanisms of tissue damage and how this affects specific patient groups, including those with inflammatory bowel disease, comorbidities and the role of immunosuppression, chronic liver disease and the risk of decompensation for those with cirrhosis. The impact of COVID-19 for gastrointestinal emergencies is addressed together with the implications for the conduct of endoscopic and other interventional and diagnostic procedures. The importance of fully understanding the pharmacology and therapeutic implications of drugs commonly used by the gastroenterologist and their relationship with COVID-19 are also highlighted. The risk for drug-drug interactions is considerable in patients seriously ill with COVID-19 who are often requiring mechanical ventilation and life-support. Some re-purposed drugs used against SARS-CoV-2 can cause or aggravate some of the COVID-19 GI symptoms and also can induce iatrogenic liver injury. Ongoing clinical studies will hopefully identify effective drugs with a risk-benefit ratio which will be more favorable than many recently tried treatments.