The worldwide pandemic of COVID-19, known to be caused by the SARS-CoV-2 virus, is progressing at a rapid pace across the globe. Updated information is becoming available about the incidence of digestive symptoms as well as abnormal liver-associated enzymes in infected patients with each passing day.

These alterations seem to be related to the viruss use of ACE-2 receptors present on certain intestinal cells, cholangiocytes, and hepatocytes. A brief review by Agarwal et al has summarized the limited data available on digestive manifestations of COVID-19.

A large number of COVID-19 patients can present at the outset with only digestive complaints, the most common symptoms being anorexia, nausea, vomiting, and diarrhea. Liver-related transaminases have been shown to be elevated in a considerable proportion of patients, though they may be only mildly elevated.

There is still no sturdy evidence to suggest that severity of digestive symptoms corresponds to severity of COVID-19 clinical course; however, more severe alterations in liver enzymes may correspond to worse clinical course.

With the use of antiviral and antibacterial drugs in sicker patients, drug-induced liver injury cannot be excluded in these cases. While viral RNA can be detected in stool, it is still not clearly known whether fecal-oral transmission is possible.

Source: Agarwal A, Chen A, Ravindran N, et al. Gastrointestinal and Liver Manifestations of COVID-19. Journal of Clinical and Experimental Hepatology April 1, 2020.