Coronavirus Disease 2019 (COVID-19) and It’s Gastrointestinal and Hepatic Manifestations

Coronavirus disease 2019 (COVID-19) is a severe respiratory disease caused by the virus SARS-CoV-2 that became classified as a pandemic on March 11, 2020. COVID-19 is known to produce similar clinical manifestations to SARS of the last decade. Fever, dry cough, fatigue, myalgia, dyspnea, and sore throat are some of the most common symptoms and the median incubation period is around 4 days. While the respiratory manifestations have been widely reported, clinical manifestations on the gastrointestinal and hepatic side have often been overlooked. Diarrhea and nausea or vomiting have been reported in approximately 1-5% of cases and sometimes they precede respiratory symptoms. COVID-19 has also been reported to cause hemorrhagic colitis in one case Live SARS-CoV-2 have been detected in stool so, there is a possibility of fecal-oral transmission thus it recommended that non-urgent and low prior endoscopies be postponed. For endoscopies that cannot be postponed, SARS-CoV-2 screening of patients, minimal personnel, infection control training, and usage of negative pressure rooms are recommended. Evidence of abnormal liver-associated biomarker values have been commonly reported, however, there is evidence of extrahepatic causes those abnormal biomarker values. The evidence suggest that COVID-19 patients can have true liver injury, however, it is mild and the abnormal liver-associated biomarker values may be caused, at least partially, but muscle injury. Drugs with hepatotoxicity should be used with increased caution in COVID-19 patients.