Professor ZHU Shu from the Chinese University of Science and Technology (USTC) of CAS and Professor Richard A. Flavell from Yale University were recently invited to publish a review article in Nature Reviews Gastroenterology and Hepatology. They systematically summarized the gastrointestinal manifestations in patients with COVID-19 and investigated the possible mechanisms of intestinal symptoms caused by COVID-19 disease.
Although the clinical symptoms of COVID-19 are primarily fever, cough, and lung imaging, gastrointestinal symptoms have also been reported. Approximately 50% of COVID-19 patients have shown visible SARS-CoV-2 RNA in their faecal samples. Evidence for SARS-CoV-2 infectious disease has also been reported based on several in vitro and in vivo animal studies.
The available evidence on infectious disease was summarized in COVID-19. Intestinal sensitivity of SARS-CoV-2 receptor and serine protease remains at a very high level. Virus grafts and intestinal inflammation were detected at autopsy and biopsy of the patient’s abdomen. Intestinal cell lines and intestinal organs have been identified as susceptible to SARS-CoV-2. The mouse, hamster, ferret, rhesus monkey and other animal models that can be used to study intestinal SARS-CoV-2 infection were also summarized.
The potential risk of oral SARS-CoV-2 oral transmission was discussed. A strict and systematic determination of whether the virus titer in faecal fomites can exceed the minimum infectious dose is necessary to accurately measure the true risk of SARS-CoV-2 transmission through the oral route.
This work led to a deeper understanding of the gastrointestinal manifestations of COVID-19 and suggests a possible link between infectious diseases and depth of disease. It is important to understand the mechanism of pathogenicity and transmission of the virus and to develop scientific prevention and control strategies.
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