Points of Interest Regarding COVID-19 For Gastroenterologists
- Coronavirus Disease 2019 (COVID-19) is a respiratory illness caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
- Most cases of COVID-19 appear to be mild with the most common symptoms being fever, cough, myalgia/fatigue, and shortness of breath but can result in more severe disease
- Risk factors for more severe disease included older age and underlying chronic medical conditions such as cardiovascular or lung disease.
- Potential gastrointestinal manifestations of COVID-19 have been reported including nausea, vomiting, diarrhea, and abnormal liver function tests. SARS-CoV-2 has been detected in patient stool though unclear if there is a fecal-oral route of infection.
- There are currently no data on impact of immunosuppression on susceptibility or disease course. Patients on immunosuppression should be counseled to not stop medications for preventative reasons but should follow general precautions recommended for at risk groups by the CDC.
- Patients who potentially have COVID-19 should be isolated in a separate room and asked to wear a surgical mask. Local health authorities should be notified of possible cases.
- This is a rapidly evolving area and it is important to keep up to date with information from national and international health organizations.
Recap: In a special article published online March 17 in Clinical Gastroenterology and Hepatology, key information is presented about coronavirus disease 2019 (COVID-19) and the field of gastroenterology.
Based on currently available information, Ryan C. Ungaro, M.D., from the Icahn School of Medicine at Mount Sinai in New York City, and colleagues provide a brief overview of COVID-19 for the gastroenterology community.
The authors note that COVID-19 patients may complain of gastrointestinal symptoms, including nausea or diarrhea. Among COVID-19 patients, the reported frequency of diarrhea varied from 2 to 33 percent and was one of the prominent symptoms reported by the first U.S. case. SARS-CoV-2 has been detected in stool from COVID-19 patients, indicating that the gastrointestinal tract is a potential route of infection; this highlights the importance of personal protective equipment during endoscopy. Liver function test abnormalities have also been described in COVID-19 patients. For patients on immunosuppression, such as those with inflammatory bowel disease (IBD), there are currently no specific recommendations. IBD patients or others on immunosuppression should not be advised to stop medications, as the risk for disease flare outweighs the likelihood of contracting SARS-CoV-2. Patients on immunosuppression should be encouraged to limit travel and avoid crowds in accordance with the U.S. Centers for Disease Control and Prevention guidelines for at-risk populations.
“While COVID-19 is a significant global public health concern, it is important to keep its risks in perspective and stay up-to-date on current research and recommendations in order to provide our patients with the most accurate advice,” the authors write.
Several authors disclosed financial ties to the pharmaceutical industry.
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