Gastrointestinal and Hepatobiliary Manifestations of COVID-19

The world in 2020 has witnessed the spread of a novel coronavirus, the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), which typically involves the respiratory tract causing symptoms like fever, cough and shortness of breath and, in severe cases leading to the development of acute respiratory distress syndrome (ARDS). As the disease has evolved across the globe, a large number of patients are being recognised with atypical symptoms, including abdominal pain, nausea, vomiting and diarrhea. Involvement of liver in form of elevated aminotransferases and association of increased severity of coronavirus disease of 2019 (COVID-19) with pre-existing chronic liver disease has also been noted. The detection of virus in saliva and faeces of patients has unveiled the possibility of faecal-oral transmission of the virus and the risk of transmission during endoscopic procedures. Liver transplant recipients or patients undergoing liver transplant also need specialised care during this pandemic because of the possible interplay of immunosuppression and SARS-CoV-2. Various drugs used in the treatment of COVID-19 can also cause gastrointestinal symptoms or drug induced liver injury (DILI). This review will focus on the symptomatology, mechanism and pathological findings of SARS-CoV-2 in the liver and gastrointestinal tract. We will also highlight safe endoscopy practices to curtail the spread of COVID-19 and implications of the disease in liver transplant recipients.

Keywords: ACE2, Acute on chronic liver failure, Acute respiratory distress syndrome, Chronic liver disease, COVID-19, Diarrhea, Endoscopy, Fecal-oral transmission, Gastrointestinal symptoms, Hepatocytes, Liver, Liver injury, Liver transplant, nCOV-2, Novel Coronavirus, Raised transaminases, RT-PCR, SARSCoV- 2.