The outbreak of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has emerged in China, in December, 2019, which has now affected the global population. The management of COVID-19 becomes a challenge along with pre-existing digestive diseases. It has been observed that the presence and number of comorbidities is correlated to adverse clinical outcome in patients with COVID-19. A study of 1099 patients with COVID-19, showed that 261 (23·7%) patients had at least one comorbidity, with hypertension, diabetes, and coronary heart disease being the most frequent. The authors also reported that 23 (2·1%) patients had hepatitis B infection; it was not related to severe course of COVID-19. However, abnormal liver function tests, including elevated aspartate aminotransferase, alanine aminotransferase, and total bilirubin were recorded. Liver abnormalities in patients with COVID-19 might be attributed to viral infection in liver cells or other causes such as drug toxicity and systemic inflammation. Furthermore, it has been suggested that liver injury is more prevalent in severe cases in contrast to mild cases of COVID-19.

As shown in the previous SARS epidemic, liver transplantation can also involve a risk of transmission of viral infection from donor to recipient and hence, donor screening and testing is mandatory. Patients with cancer in general are more at increased risk of infection due to their immunocompromised status caused by the malignancy and anticancer treatments. However, studies evaluating whether patients with gastrointestinal cancers have more likelihood to be infected with SARS-CoV-2 than healthy counterparts are scarce.

Another gastrointestinal disorder, inflammatory bowel disease (IBD) has raised few concerns in regard to its susceptibility to COVID-19 infection because of the use of biologics and immunosuppressive agents. However, no patients with IBD is seen to be infected with SARS-CoV-2. Various management approaches have been used to minimise the potential risk of SARS-CoV-2 infection in patients with IBD since the outbreak of COVID-19.

The Chinese IBD Society issued official guidelines for managing patients with IBD in early February 2020, which is as follows:

Potential risk factors for SARS-CoV-2 infection

• Patients with inflammatory bowel disease (IBD) on immunosuppressive agents
• Patients with active-stage IBD with malnutrition
• Elderly patients with IBD
• Patients with IBD frequently visiting medical clinic
• Patients with IBD with underlying health conditions, such as hypertension and diabetes
• Patients with IBD who are pregnant

Source: Mao R, Liang J, Shen J, et al. Implications of COVID-19 for patients with pre-existing digestive diseases [published correction appears in Lancet Gastroenterol Hepatol. 2020 Jul;5(7):e6]. Lancet Gastroenterol Hepatol. 2020;5(5):425-427.