Understanding more about COVID-19 and the digestive system – Dr Chieng Jin Yu

Starting September of 2020, the total active COVID 19 cases continued to climb with more than 2000 patients newly diagnosed per day recently, reaching about 135,000 cases cumulatively. Referring to my article “COVID 19 and the digestive system” published on 22 May 2020, let us know more about COVID 19 with our digestive system.

Besides respiratory symptom, how common are gastrointestinal (GI) presentation among the COVID 19 patients in Malaysia?

Benedict Lim et al had published the first Malaysian study about COVID-19 in November 2020.¹ This study comprised of 5889 cases with RT-PCR confirmed COVID-19, aged above 12 years old, admitted to eighteen designated hospitals in Malaysia between 1^st February and 30^th May 2020. In his paper, COVID 19 associated gastrointestinal presentations were diarrhea (5.1%), nausea and/or vomiting (1.8%).

Acute liver injury (6.7%) was the commonest extra-pulmonary complication, followed by acute kidney injury and acute respiratory distress syndrome. Only 0.2% of the patients had experienced GI bleeding. Diarrhea was reported as one of the significant determinants for severity (p<0.05).

However, the incidence of GI symptom among COVID-19 patients with COVID-19 in Malaysia was low if compared with other countries.

 

Can the virus spread through fecal oral route?

Respiratory droplet transmission was identified as the main route of transmission of the COVID-19 virus. This virus shows a high affinity to angiotensin converting enzyme 2 (ACE2) receptors, making sites of high ACE2 receptor expression, especially lungs and GI tract as major target for infection. There had few case series reported to be infected through fecal oral route. However, to date, most guidelines recommend droplet and contact infection in COVID-19, and fecal oral route is still not recommended as a potential transmission route.

 

Any role for stool viral test in diagnosis of COVID-19?

Interestingly, many studies have demonstrated that the viral RNA stay in stool for longer periods than in the respiratory tract. There have been many cases reported with virus detected in the stool sample, but upper respiratory sample testing was negative, especially in children with COVID 19 and multisystem inflammatory syndrome (MIS-C). The ability to confirm diagnosis in those with negative upper respiratory PCR results could be important for establishing the initial diagnosis, especially for those with high clinical suspicion of disease but negative upper respiratory testing.

 

What is the risk of patients with chronic liver disease (CLD) for COVID-19?

According to a case-control study involving 62.2 million adult patients in the US², patients with CLD, especially African Americans, were at higher risk for COVID-19. Moreover, patients with COVID-19 and a recent encounter for CLD had a much significant mortality rate and a hospitalization rate.

As we know, the common etiologies of CLD are Hepatitis B/C, and alcoholic liver disease. These patients could have abnormal immune function, immunodeficiency and systemic inflammation due to disease itself. More data are required to further investigate the risk of patients with CLD for COVID 19.

Any role of prebiotics and probiotics in treatment of COVID-19?

Many scientists are in agreement about the close relationship between gut and lung, which is known as “gut-lung axis”. GI tract inflammation is believed to result in lung inflammation through this connection. Prebiotics or probiotics could have a role in modulating the COVID-19 patients’ immune system, and to further reduce the inflammation. However, there is currently no evidence that can associate the efficacy of the use of probiotics in reducing symptoms or severity of the disease. More studies are required to achieve a better understanding of the application of prebiotics or probiotics in patients with COVID-19.

 

By Dr Chieng Jin Yu, Medical Lecturer, Consultant Gastroenterologist and Hepatologist, Universiti Putra Malaysia (UPM).

[This article belongs to The Malaysian Medical Gazette. Any republication (online or offline) without written permission from The Malaysian Medical Gazette is prohibited.] 

 

References:

1. Benedict Lim Heng Sim, Suresh Kumar Chidambaram, Xin Ci Wong, Mohan Dass Pathmanathan, Kalaiarasu M. Peariasamy, Chee Peng Hor, Hiu Jian Chua, Pik Pin Goh. Clinical characteristics and risk factors for severe COVID-19 infections in Malaysia: A nationwide observational study. The Lancet Regional Health – Western Pacific 4 (2020) 100055.
2. 2. Wang QQ, Pamel BD, Xu R. Covid-19 risk, disparities and outcomes in patients with chronic liver disease in the United States. EClinicalMedicine (2020).

Related Posts via Taxonomies

• Penyakit asma dan COVID-19: Adakah saya perlu risau? – Dr Mohd Aizuddin Abd Rahman
• Bahayakah COVID-19 kepada Pesakit Buah Pinggang Kronik dan Dialisis? – Dr Nur Hidayati Mohd Sharif
• Are young children more prone to infection post-pandemic? – Dr Lim Yin Sear & Dr Mahfuzah Mohamed
• Pandemic Precautions for People with Diabetes & Obesity – Malaysian Endocrine and Metabolic Society
• Sampai bila nak hilang? : Pasca Jangkitan COVID-19 – Dr Shaiful Ehsan
• Have we reached the peak of infection? – Jamari Mohtar
• Vaksin COVID-19, apa yang anda perlu tahu? – Dr Mohammad Hj. Che’ Man & Dr Shahidah Che Alhadi
• Malaysia should prepare for a double pandemic: COVID-19 and diabetes – Professor Dr Noran Naqiah Hairi, Professor Dr Moy Foong Ming & Dr Wan Kim Sui
• Benarkah mRNA vaksin COVID-19 boleh mengubah genetik manusia? – Dr Nuruliza Roslan, Dr Marjanu Hikmah Elias & Dr Eddy Hasrul Hassan
• COVID – 19 Testing: Are we doing enough? – Dr Helmy Hazmi