Research Article
Volume 8 Issue 3 - 2021
Hepatic and Gastrointestinal Manifestation of COVID-19
Kamlesh Kumar Sharma1, Sudhir Maharshi2*, Shyam Sunder Sharma3, Bharat Sapra3 and Sandeep Nijhawan3
1Assistant Professor, Department of Gastroenterology, SMS Medical College and Hospitals, Jaipur, India
2Associate Professor, Department of Gastroenterology, SMS Medical College and Hospitals, Jaipur, India
3Senior Professor, Department of Gastroenterology, SMS Medical College and Hospitals, Jaipur, India
*Corresponding Author: Sudhir Maharshi, Assistant Professor, Department of Gastroenterology, SMS Medical College and Hospitals, Jaipur, India.
Received: December 31, 2020; Published: February 10, 2021


Coronavirus disease of 2019 (COVID-19) is a disease resultant of a novel coronavirus, severe acute respiratory syndrome coronavirus 2. It emerged at the end of 2019 and spread almost in all the countries. Because of high infectivity rate, it was declared as pandemic in March 2020. The leading method of spreading is through airway droplets with a median incubation period is 5.1 days. Spectrum of illness varies from mild to severe with majority suffering with mild symptoms. Coronavirus disease of 2019 involves mainly the respiratory system but other organs like heart, kidney, liver, intestine may also be affected. Major hepatic and gastrointestinal manifestations include elevation of liver enzymes, nausea, vomiting and diarrhoea. Pathophysiology of these symptoms is explained by presence of the ACE-2 receptors in the biliary tree and intestinal mucosa. This virus has been isolated from the stool specimens of COVID-19 patients. Based on its disease extent and involvement of hepatic and gastrointestinal systems, COVID-19 poses a high risk for gastroenterologist and precautions during endoscopic procedures are required.

Keywords: SARS-CoV-2; COVID 19; Pandemic; Gastrointestinal; Manifestation


  1. Su S., et al. “Epidemiology, genetic recombination, and pathogenesis of coronaviruses”. Trends in Microbiology 24 (2016): 490‐502.
  2. Peiris J., et al. “Coronavirus as a possible cause of severe acute respiratory syndrome”. Lancet 361 (2003): 1319‐1325.
  3. Kupferschmidt K. “Researchers scramble to understand camel connection to MERS”. Science 341 (2013): 702.
  4. Zhu N., et al. “A novel coronavirus from patients with pneumonia in China, 2019”. The New England Journal of Medicine 382 (2020): 727‐733.
  5. Wu D., et al. “The SARS-CoV-2 outbreak: what we know”. International Journal of Infectious Diseases 94 (2020): 44-48.
  6. Lauer SA., et al. “The incubation period of coronavirus disease 2019”. Annals of Internal Medicine 172 (2020): 577-582.
  7. Guo YR., et al. “The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-2019) outbreak- an update on the status”. Military Medical Research 7 (2020): 11.
  8. Chau TN., et al. “SARS-associated viral hepatitis caused by a novel coronavirus: report of three cases”. Hepatology 39 (2004): 302-310.
  9. Alsaad KO., et al. “Histopathology of Middle East respiratory syndrome coronovirus (MERS-CoV) infection-clinicopathological and ultrastructural study”. Histopathology 72 (2018): 516-524.
  10. Guan W., et al. “Clinical characteristics of novel coronavirus infection in China”. The New England Journal of Medicine 382 (2020): 1708-1720.
  11. Cai Q., et al. “COVID-19 in a Designated Infectious Diseases Hospital Outside Hubei Province, China”. Allergy 75 (2020): 1742-1752.
  12. Fan Z., et al. “Clinical features of COVID-19-related liver damage functional abnormality”. Clinical Gastroenterology and Hepatology 18 (2020): 1561-1566.
  13. Wang D., et al. “Clinical characteristics of 138 hospitalised patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China”. The Journal of the American Medical Association 323 (2020): 1061-1069.
  14. Chen N., et al. “Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study”. Lancet 395 (2020): 507-513.
  15. Lu Li., et al. “Risk factors related to hepatic injury in patients with corona virus disease 2019”. Med Rxiv (2020).
  16. Shi H., et al. “Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study”. The Lancet Infectious Diseases 20 (2020): 425-434.
  17. Xu X-W., et al. “Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: retrospective case series”. British Medical Journal on JSTOR 368 (2020): m606.
  18. Yang X., et al. “Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study”. The Lancet Respiratory Medicine 8 (2020): 475-481.
  19. Huang C., et al. “Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China”. Lancet 395 (2020): 497-506.
  20. Zhang B., et al. “Clinical characteristics of 82 death cases with COVID-19”. PLoS One 15 (2020): e0235458.
  21. Huang Y., et al. “Clinical characteristics of 36 non-survivors with COVID-19 in Wuhan, China”. Med Rxiv (2020).
  22. Chai X., et al. “Specific ACE2 expression in cholangiocytes may cause liver damage after 2019-nCoV infection”. Bio Rxiv (2020).
  23. Xu Z., et al. “Pathological findings of COVID-19 associated with acute respiratory distress syndrome”. The Lancet Respiratory Medicine 8 (2020): 420-422.
  24. Zhang C., et al. “Liver injury in COVID-19: management and challenges”. The Lancet Gastroenterology and Hepatology 5 (2020): 428-430.
  25. Chien JY., et al. “Temporal changes in cytokine/chemokine profiles and pulmonary involvement in severe acute respiratory syndrome”. Respirology 11 (2006): 715-722.
  26. Liu J., et al. “Longitudinal characteristics of lymphocyte responses and cytokine profiles in the peripheral blood of SARS-CoV-2 infected patients”. EBio Medicine 55 (2020): 102763.
  27. Li L., et al. “Risk factors related to hepatic injury in patients with corona virus disease 2019”. Med Rxiv Preprint (2020).
  28. Bangash MN., et al. “COVID-19 and the liver: little cause for concern”. The Lancet Gastroenterology and Hepatology 5 (2020): 529-530.
  29. Fan Z., et al. “Clinical Features of COVID-19-Related Liver Damage”. Bio Rxiv (2020).
  30. Kujawski SA., et al. “First 12 patients with coronavirus disease 2019 (COVID-19) in the United States”. Med Rxiv Preprint (2020).
  31. Huang Y and Gao Z. “Study of the relationship SARS and hepatitis virus B”. Journal of Clinical and Experimental Hepatology 06 (2003): 342-343.
  32. Xiao Y., et al. “Prevention of SARSCoV-2 infection in patients with decompensated cirrhosis”. The Lancet Gastroenterology and Hepatology 5 (2020): 528-529.
  33. Kumar D., et al. “Severe acute respiratory syndrome (SARS) in a liver transplant recipient and guidelines for donor SARS screening”. American Journal of Transplantation 3 (2003): 977-981.
  34. Michaels MG., et al. “Coronavirus Disease 2019: Implications of Emerging Infections for Transplantation”. American Journal of Transplantation 20 (2020): 1768-1772.
  35. Gori A., et al. “Coronavirus disease 2019 and transplantation: a view from the inside”. American Journal of Transplantation 20 (2020): 1939-1940.
  36. Yeo C., et al. “Enteric involvement of coronaviruses: is faecal–oral transmission of SARS-CoV-2 possible?” The Lancet Gastroenterology and Hepatology 5 (2020): 335-337.
  37. Holshue ML., et al. “First case of 2019 novel corona virus in the united states”. The New England Journal of Medicine 382 (2020): 929-936.
  38. Pan L., et al. “Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: a descriptive, cross-sectional, multicenter study”. The American Journal of Gastroenterology 115 (2020): 766-773.
  39. Leung WK., et al. “Enteric involvement of severe acute respiratory syndrome associated coronavirus infection”. Gastroenterology 125 (2003): 1011-1017.
  40. Zhang H., et al. “The digestive system is a potential route of 2019-nCov infection: a bioinformatics analysis based on single-cell transcriptomes”. Bio Rxiv (2020).
  41. Liang W., et al. “Diarrhoea may be underestimated: a missing link in 2019 novel coronavirus”. Gut 69 (2020): 1141-1143.
  42. Liu Q., et al. “Gross examination report of a COVID-19 death autopsy”. Fa Yi Xue Za Zhi 36 (2020): 21-23.
  43. Wu Y., et al. “Prolonged presence of SARS-CoV-2 viral RNA in faecal samples”. The Lancet Gastroenterology and Hepatology 5 (2020): 434-435.
  44. Mao R., et al. “Implications of COVID-19 for patients with preexisting digestive diseases”. The Lancet Gastroenterology and Hepatology 5 (2020): 425-427.
  45. An P., et al. “Prevention of COVID-19 in patients with inflammatory bowel disease in Wuhan, China”. The Lancet Gastroenterology and Hepatology 5 (2020): 525-527.
  46. Danese S., et al. “Managing of IBD during the COVID19 outbreak: resetting clinical priorities”. Nature Reviews Gastroenterology and Hepatology 25 (2020): 1-3.
  47. The Lancet. “COVID-19: protecting health-care workers”. Lancet 395 (2020): 922.
  48. Wang C., et al. “A novel coronavirus outbreak of global health concern”. Lancet 395 (2020): 470-473.
  49. Gu J., et al. “COVID-19: Gastrointestinal manifestations and potential fecal-oral transmission”. Gastroenterology 158 (2020): 1518-1519.
  50. Repici A., et al. “Coronavirus (COVID-19) outbreak: what the department of endoscopy should know”. Gastrointestinal Endoscopy 92 (2020): 192-197.
  51. Rees CJ., et al. “Restarting gastrointestinal endoscopy in the deceleration and early recovery phases of COVID-19 pandemic: Guidance from the British Society of Gastroenterology”. Clinical Medical 20 (2020): 352-358.
  52. Gralnek IM., et al. “ESGE and ESGENA Position Statement on gastrointestinal endoscopy and the COVID-19 pandemic”. Endoscopy 52 (2020): 483-490.
  53. Park SH. “Personal protective equipment for health care workers during COVID-19 pandemic”. Infect Chemother 52 (2020): 165-182.
  54. Geller C., et al. “Human coronaviruses: insights into environmental resistance and its influence on the development of new antiseptic strategies”. Viruses 11 (2012): 3044-3068.
  55. Calderwood AH., et al. “Infection control during GI endoscopy”. Gastrointestinal Endoscopy 87 (2018): 1167-1179.
Citation: Sudhir Maharshi., et al. “Hepatic and Gastrointestinal Manifestation of COVID-19”. EC Gastroenterology and Digestive System 8.3 (2021): 69-77.

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