Coronavirus Disease-2019: Implications for the Gastroenterologist

Mohammad Bilal; Mandeep S. Sawhney; Joseph D. Feuerstein

Disclosures

Curr Opin Gastroenterol. 2020;37(1):23-29. 

In This Article

Abstract and Introduction

Abstract

Purpose of Review: The COVID-19 pandemic has impacted the practicing gastroenterologist in several ways. Although majority of COVID-19 patients present with respiratory symptoms, gastrointestinal symptoms are also seen. COVID-19 has also disrupted gastrointestinal endoscopy services in numerous ways. There are also concerns regarding the impact of these changes on gastrointestinal cancer screening and management of chronic gastrointestinal diseases. The purpose of this review is to provide an overview of the implications of COVID-19 for the practicing gastroenterologist.

Recent Findings: COVID-19 patients can have gastrointestinal symptoms including diarrhea, nausea and vomiting, abdominal pain and anorexia. Separate from the management of COVID-19 patients, there has been a reduction in endoscopy volume worldwide. This has also resulted in reduction/cessation of in-person clinic visits and an increasing use of telemedicine services. In addition, patients with certain chronic diseases like chronic liver disease or inflammatory bowel disease may have worse outcomes during the COVID-19 pandemic.

Summary: Gastroenterologists need to rapidly adapt to the challenges being faced and need to make both systems and practice-based changes to the endoscopy unit and outpatient clinic practices. Gastroenterologists should stay up-to-date with the rapidly evolving literature regarding gastrointestinal symptoms in COVID-19 patients as well as its impact on chronic gastrointestinal illnesses.

Introduction

The WHO declared the coronavirus disease-2019 (COVID-19) a global pandemic in March, 2020. COVID-19 is caused by infection with the novel coronavirus called SARS-CoV-2. The first case was reported in Wuhan, China. The most common presenting symptoms were initially thought to be fevers, cough, shortness of breath and body aches.[1] Subsequent reports, however, showed that gastrointestinal manifestations are also common in COVID-19 patients.[2] Interestingly, the first patient with COVID-19 in the United States had abdominal pain, diarrhea and a positive rRT-PCR for 2019-nCoV in the stool.[3] Since then, the Centers for Disease Control and Prevention (CDC) has added gastrointestinal symptoms to the list of COVID-19 symptoms.[4] This has led to several implications for the practicing gastroenterologists and it is imperative that gastroenterologists stay up-to-date on the common gastrointestinal manifestations of this disease. In addition to managing the disease itself, the pandemic has resulted in significant changes to endoscopy flow[5–8] as well as a reduction in in-person clinic visits and increased adoption of telemedicine in patient care. There are also concerns regarding the impact of COVID-19 in patients with chronic gastrointestinal diseases, such as inflammatory bowel disease (IBD) and chronic liver disease. In this review, we aim to provide a brief overview of the implications of COVID-19 for the practicing gastroenterologist.

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