Coronavirus disease 2019 (COVID-19) and its 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 symptoms often bring the patients to medical attention, clinical manifestations on the gastrointestinal tract and hepatobiliary system have also been cautiously observed. It has been reported that approximately 1-5% of cases developed diarrhea and nausea or vomiting, sometimes preceding the respiratory symptoms. As hemorrhagic colitis was reported in one case with SARS-CoV-2, detected in stool, there is a possibility of fecal-oral transmission of the virus is possible in humans. Thus, it is widely recommended that non-urgent and low prior endoscopic procedures be postponed. For patients requiring urgent endoscopic procedures, SARS-CoV-2 nucleic acid testing from the throat swabs is used as a screening test within 48 hours prior. Minimal personnel, infection control training, and usage of negative pressure rooms are recommended. Abnormal liver function tests have been commonly reported. Patients infected with SARS-CoV-2 can have a true liver injury, which is however mild. The abnormal liver function test values may be caused, at least partially, by muscle injury or hemolysis. Nevertheless drugs with hepatotoxicity should be used with increased caution.