Plethora of evidence suggest that he risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and complications of COVID-19 in patients increases with pre-existing digestive and has posed a great concern since infection of the gastrointestinal tract was first reported in March, 2020. The increased risk with pre-existing digestive diseases is attributed to immune dysfunction. The current review studied the implications of COVID-19 for patients with pre-existing digestive diseases.

A study included 88 747 patients tested for SARS-CoV-2 before May 15, 2020, and showed that there was similarity in susceptibility of testing positive for SARS-CoV-2 between those with and without a diagnosis of cirrhosis. Two international registries were formed to obtain data from COVID-19 cases in patients with chronic liver diseases and liver transplant recipients. The outcome from an evaluation of 745 patients with chronic liver diseases with SARS-CoV-2 infection revealed that baseline liver disease stage and alcohol-related liver disease were independent risk factors for mortality from COVID-19.Data shows no conclusive evidence in relation to infection risk in solid organ transplant recipients in contrast to patients without a transplant. 

For liver transplant recipients, most societies, such as The American Association for the Study of Liver Diseases and European Association for the Study of the Liver, recommendes not to reduce immunosuppressive therapy to prevent SARS-CoV-2 infection. However, its reduction should only be considered under special conditions, such as medication-induced lymphopenia, or bacterial or fungal superinfection in case of severe COVID-19, after consultation with specialists. 

There is dearth of data that can establish a relationship between pre-existing non-alcoholic fatty liver disease (NAFLD) with SARS-CoV-2 infection. A retrospective analysis of 61·4 million adults showed that the cumulative incidence of COVID-19 was higher in patients with a primary diagnosis of metabolic syndrome (0.10% vs 0·01) in comparison to in patients without metabolic syndrome. Furthermore, NAFLD was independently associated with COVID-19 progression.

Source: Mao R, Liang J, Shen J, Ghosh S, Zhu LR, Yang H, Wu KC, Chen MH; Chinese Society of IBD, Chinese Elite IBD Union; Chinese IBD Quality Care Evaluation Center Committee. Implications of COVID-19 for patients with pre-existing digestive diseases. Lancet Gastroenterol Hepatol. 2020 May;5(5):425-427.