Anonymous User
Login / Registration

Gastroenterologie
a hepatologie

Gastroenterology and Hepatology

Gastroent Hepatol 2020; 74(5): 415–423. doi:10.14735/amgh2020415.

Covid-19 and hepato-gastroenterology

Julius Špičák1

+ Affiliation

Summary

The new coronavirus disease (covid-19) pandemic has become a global health and social issue with specific context in gastroenterology and hepatology. The organisational and restrictive measures are similar to those in other instrumental specialties and include the protection of patients and staff in reaction to the current epidemiological situation and presumed infection route. In addition to this specific protection, the effects of covid-19 on other aspects of the field leading to potential limitation of health care and adversely affecting other diseases must be minimised. In endoscopy, this protection is predominantly oral in focus due to the respiratory route of the infection; transmission through excrement and instruments is possible but insignificant. Gastrointestinal and liver manifestations of the infection represent a significant part of the overall symptomatology and may correlate with the severity of the disease. Covid-19 does not deteriorate the course of inflammatory bowel disease (IBD) and likewise, the immunosuppressive and biological treatment of IBD patients does not worsen in the course of the infection. Higher mortality was reported with corticosteroid therapy. The combination of liver disease and covid-19 is under investigation. Viral hepatitis does not represent a significant risk; however, non-alcoholic steatohepatitis and advanced liver cirrhosis are risk factors. The available data on the effects of transplantation are sporadic; its insignificance is further supported by our own experience at IKEM as well as documented data on renal insufficiency and kidney transplant, which show a higher risk. Furthermore, interactions of antiviral and immunosuppressive drugs are being investigated. Atazanavir, lopinavir and to a lesser extent chloroquine and hydrochloroquine are not considered to be suitable. On the other hand, there are no considerable interactions with remdesivir.

Keywords

COVID-19, inflammatory bowel disease, immunosuppression, biologic therapy, NAFLD, liver transplantation

To read this article in full, please register for free on this website.

Benefits for subscribers

Benefits for logged users

Literature

1. Ellinghaus D, Degenhardt F, Bujanda L et al. Genomwide association study of severe COVID-19 with respiratory failure. N Engl j Med 2020. [online]. Available from: https: //www.nejm.org/doi/pdf/10.1056/NEJMoa2020283. doi: 10.1056/NEJMoa2020283.
2. Magro F, Abreu C, Rahier JF. The daily impact of COVID-19 in gastroenterology. United European Gastroenterol J 2020; 8 (5): 520–527. doi: 10.1177/2050640620920157.
3. Lin L, Jiang X, Zhang Z et al. Gastrointestinal symptoms of 95 causes with SARS-CoV-2 infection. Gut 2020; 69 (6): 997–1001. doi: 10.1136/gutjnl-2020-321013.
4. Su S, Shen J, Zhu L et al. Involvement of digestive system in Covid.19: manifestations, pathology, management and challenges. Ther Adv Gastroenterol 2020; 13. [online]. Available from: https: //covid19.elsevierpure.com/zh/publications/involvement-of-digestive-system-in-covid-19-manifestations-patholdoi: 10.1177/ 1756284820934626.
5. Mao R, Qiu Y, He JS et al. Manifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2020; 5 (7): P667–P678. doi: https: //doi.org/10.1016/S2468-1253 (20) 30126-6.
6. Xiao F, Tang M, Zheng S et al. Evidence for gastrointestinal infection of SARS-CoV-2. Gastroenterology 2020; 158 (6): 1831–1833. doi: 10.1053/j.gastro.2020.02.055.
7. Wang W, Xu Y, Gao R et al. Detection of SARS-CoV-2 in different types of clinical specimen. JAMA 2020; 323 (18): 1843–1844. doi: 10.1001/jama.2020.3786.
8. Tian Y, Rong L, Nian W et al. Review article: Gastrointestinal features in COVID-19 and the possibility of faecal transmission. Aliment Pharmacol Therap 2020; 51 (9): 843–851. doi: 10.1111/apt.15731.
9. Gralnek IM, Hassan C, Beilenhoff U et al. ESGE and ESGENA position statement on gastrointestinal endoscopy and the COVID-19 pandemic. Endoscopy 2020; 52 (6): 483–490. doi: 10.1055/a-1155-6229.
10. Taxonera C, Sagastagoitika I, Alba C et al. 2019 novel coronavirus disease in patients with inflammatory bowel syndrome. [online]. Available from: https: //onlinelibrary.wiley.com/doi/10.1111/apt.15804. doi: 10.1111/apt.15 804
11. Azzam NA, Aljdbreen A, Almuhareb A et al. Disability and quality of life before and during the COVID-19 outbreak: A cross-sectional study in inflammatory bowel disease patients. Saudi J Gastroenterol 2020; 26 (5): 256–262. doi: 10.4103/sjg.SJG_175_20.
12. Brenner EJ, Ungaro RC, Colombel JF et al. SECURE-IBD database public data update [online]. Available from: https: //covidibd.org/current-data/.
13. Rubin DT, Feuerstein JD, Wang AY et al. AGA Clinical Practice Update on Management of Inflammatory Bowel Disease During the COVID-19 Pandemic: Expert Commentary. Gastroenterology 2020; 159 (1): 350–357. doi: 10.1053/j.gastro.2020.04.012.
14. Wang SH, Han P, Xiao F et al. Manifestations of liver injury in 333 hospitalized patients withcoronavirus disease 2019. Chin J Dig 2020; 40: 157–161
15. Guan GW, Gao L, Wang JW et al. Exploring the mechanism of liver enzymes abnormalities in patients with novel coronavirus-infected pneumonia. Zhonghua Gan Zang Bing Za Zhi 2020; 28: 100–106.
16. Kumar MP, Mishra S, Jha DK et al. Coronavirus disease (COVID-19) and the liver. A comprehensive review and metaanalysis. Hepatol Int 2020; 1–12. doi: 10.1007/s12072-020-10071-9.
17. Youssef M, Hussein M, Attia AS et al. COVID-19 and liver dysfunction: a systematic review and meta-analysis of retrospective studies. doi: 10.1002/jmv.26055.
18. Parohan M, Yaghoubi S, Seraji A. Liver injury is associated with severe coronavirus disease 2019 (COVID-19) infection. A systematic review and meta-analysis of retrospective studies. Hepatol Res 2020; 50 (8): 924–935. doi: 10.1111/hepr.13510.
19. Ji D, Quin E, Xu J et al. Non-alcoholic fatty liver disease in patients with COVID-19: a retrospective study. J Hepatol 2020; 73 (2): 451–453. doi: 10.1016/j.jhep.2020.03.044.
20. Zheng KI, Gao F, Wang XB et al. Letter to the Editor: Obesity as a risk factor for greater severity of COVID-19 in patients with metabolic associated fatty liver disease. Metabolism 2020; 108: 154244. doi: 10.1016/j.metabol.2020.154244.
21. Portincasa P, Krawczyk M, Smyk W et al. COVID-19 and non-alcoholic fatty liver disease: two intersecting pandemics. Eur J Clin Invest 2020; 50 (10): e13338. doi: 10.1111/eci.13338.
22. Yang L, Li Ch, Wang J et al. A case series of COVID‐19 patients with chronic hepatitis B virus infection. J Med Virol 2020. doi: 10.1002/jmv.26201
23. Di Giorgio A, Nicastro E, Speziani C et al. Health status of patients with autoimmune liver disease during SARS-CoV-2 outbreak in northern Italy. J Hepatol 2020; 73 (3): 702–705. doi: 10.1016/j.jhep.2020.05.008.
24. Kushner T, Cafardi J. Chronic liver disease and COVID-19: Alcohol use disorder/alcohol-associated liver disease,/non-alcoholic fatty liver disease/non-Alcoholic steatohepatitis, autoimmune liver disease, and compensated cirrhosis. Clinical Liver Disease 2020; 15: 195–199. doi: 10.1002/cld.974.
25. Iavarone M, D’Ambrosio R, Soria A et al. High rates of 30-d mortality in patients with cirrhosis and COVID-19. J Hepatol 2020; S0168-8278 (20) 30365-2. doi: 10.1016/j.jhep.2020.06. 001.
26. Bajaj JS, Garcia-Tsao G, Biggins SW et al. Comparison of mortality risk in patients with cirrhosis and COVID-19 compared with patients with cirrhosis alone and COVID-19 alone: multicentre matched cohort. Gut. doi: 10.1136/gutjnl-2020-322118.
27. Nicastro E, Di Giorgio A, Zambelli M et al. Impact of the Severe Acute Respiratory Syndrome Coronavirus 2 Outbreak on Pediatric Liver Transplant Recipients in Lombardy, Northern Italy. Liver Transpl 2020; 26 (10): 1359–1362. doi: 10.1002/lt.25840.
28. Bhoori S, Rossi RE, Citterio D et al. Coronaviruses and immunosuppressed patients: the facts during the third epidemic. Lancet Gastroenterol Hepatol 2020; 5 (6): 532–533. doi: 10.1016/S2468-1253 (20) 30116-3.
29. Nacif LS, Zanini LY, Waisberg DR et al. COVID-19 n solid organ transplantation patients: a systematic review. Clinics (Sao Paulo) 2020; 75: e1983. doi: 10.6061/clinics/2020/e1983. eCollection  2020.
30. Oyelade T, Alqahtani J, Canciani G. Prognosis of COVID-19 in patients with Liver and Kidney diseases.: an early systematic review and metaanalysis. Trop Mesed Infect Dis 2020; 5 (2): 80. doi: 10.3390/tropicalmed5020080.
31. Elens L, Langman LJ, Hesselink DA et al. Pharmacologic Treatment of Transplant Recipients Infected With SARS-CoV-2: Considerations Regarding Therapeutic Drug Monitoring and Drug-Drug Interactions. Ther Drug Monit 2020; 42 (3): 360–368. doi: 10.1097/FTD.0000000000000761.
32. El Kassas M, Alborale M, Balakosy AA et al. Liver transplantation in the era of COVID-19. Arab J Gastroenterol 2020; 21 (2): 69–75. doi: 10.10168j.ajg.2020.04.019.
33. Boyarsky BJ, Po-Yu Chiang T, Werbel WA et al. Early impact of COVID-19 on transplant center practices and policies in the United States. Am J Transplant 2020; 20 (7): 1809–1818. doi: 10.1111/ajt.15915.
34. Sahin TT, Akbulut S, Yimaz S. COVID-19 pandemic: its impact on liver disease and liver transplantation. World J Gastroenterol 2020; 26 (22):  2987–2999. doi: 10.3748/wjg.v26.i22.2987.
35. Mao R, Qiu Y, He JS et all. Manifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2020; 5 (7): 667–678. doi: 10.1016/S2468-1253 (20) 30126-6.
36. Fix OK, Hameed B, Fontana RJ et al. Clinical Best Practice Advice for Hepatology and Liver Transplant Providers During the COVID-19 Pandemic: AASLD Expert Panel Consensus Statement. Hepatology 2020; 72 (1): 287–304. doi: 10.1002/hep.31281.
37. Boettler T, Newsome PN, Mondelli MU et al. Care of patients with liver disease during the COVID-19 pandemic: EASL-ESCMID position paper. JHEP Rep 2020; 2 (3): 100113. doi: 10.1016/j.jhepr.2020.100113.
38. Dhar D, Mohanty A. Gut microbio­ta  a COVID-19 – possible link and implications. Virus Res 2020; 285: 198018. doi: 10.1016/ j.virusres.2020.198018.
 

Kreditovaný autodidaktický test