The thrilling journey of sars-cov-2 into the intestine: From pathogenesis to future clinical implications

Franco Scaldaferri, Gianluca Ianiro, Giuseppe Privitera, Loris Riccardo Lopetuso, Lorenzo Maria Vetrone, Valentina Petito, Daniela Pugliese, Matteo Neri, Giovanni Cammarota, Yehuda Ringel, Guido Costamagna, Antonio Gasbarrini, Ivo Boskoski, Alessandro Armuzzi

Research output: Contribution to journalArticlepeer-review

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has a direct impact on the gastrointestinal system, as up to 50% of fecal samples from coronavirus disease 2019 (COVID-19) patients contain detectable viral RNA despite a negative rhino-pharyngeal swab. This finding, together with an intestinal expression of angiotensin conversion enzyme 2 protein, suggests a possible fecal-oral transmission for SARSCoV-2. Furthermore, gastrointestinal (GI) symptoms are common in COVID-19 patients including watery diarrhea, vomiting particularly in children nausea, and abdominal pain. Pathogenesis of SARS-CoV-2 infection presents significant similarities to those of some immune-mediated diseases, such as inflammatory bowel diseases or rheumatoid arthritis, leading to the hypothesis that targeted therapies used for the treatment of immune-mediated disease could be effective to treat (and possibly prevent) the main complications of COVID-19. In this review, we synthesize the present and future impact of SARS-CoV-2 infection on the gastrointestinal system and on gastroenterology practice, hypothesizing a potential role of the "gut-lung axis" and perhaps of the gut and lung microbiota into the interindividual differential susceptibility to COVID-19 19 disease. Finally, we speculate on the reorganization of outpatient gastroenterology services, which need to consider, among other factors, the major psychological impact of strict lockdown measures on the whole population.

Original languageEnglish
Pages (from-to)1306-1314
Number of pages9
JournalInflammatory Bowel Diseases
Volume26
Issue number9
DOIs
Publication statusPublished - Sep 1 2020

Keywords

  • immune-mediated disease
  • immunomodulators
  • lung-gut axis
  • microbiota

ASJC Scopus subject areas

  • Immunology and Allergy
  • Gastroenterology

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