Double trouble: COVID-19 in gastroenterology and hepatology
Gastroenterology and hepatology are two areas most people will not associate with COVID-19. However, many individuals who suffered from COVID-19 have reported gastrointestinal and liver-related issues before and after recovering from the disease.
Despite being a predominantly respiratory illness, COVID-19 has been observed to affect other parts of the human body, including the stomach, intestines, and even the gallbladder, if the conditions are right.
It has been estimated that at least 53% of all hospitalised COVID-19 patients have experienced at least one gastrointestinal problem while suffering from the illness.
This article will explore the impact COVID-19 may have on the digestive system and the liver, and how gastroenterology and hepatology are intertwined with this illness.
How does COVID-19 affect the liver?
Liver-related illnesses may have serious effects on a patient’s health, especially after they have recovered from COVID-19.
The liver is a vital part of the digestive system and plays a key role in purifying blood and producing bile, which digests fats.
Some patients with COVID-19 had recorded high levels of certain liver enzymes like alanine aminotransferase (ALT), which may mean the patient has suffered a degree of liver damage.
Further studies have found that individuals with pre-existing liver conditions like cirrhosis may have a higher risk of dying from COVID-19 than those who never had any liver-related illnesses. People who suffer from hepatitis B or C had more serious cases of COVID-19.
At the moment, the true extent of COVID-19’s impact on the liver is not understood. The number of liver-related problems in former and current COVID-19 patients, however, is significant enough to warrant more research into the link.
COVID-19’s effect on the gastrointestinal system
Many COVID-19 patients have experienced gastrointestinal problems and symptoms both during and after COVID-19; the most common symptoms were diarrhoea, vomiting and abdominal cramps.
Just like the liver, the rest of the gastrointestinal system may get infected with COVID-19. This may be due to the angiotensin-converting enzyme 2 (ACE-2), a protein found in the intestinal cells, that is used as a receptor by the virus to enter the cells.
Once the virus has entered the intestinal cells, it triggers the production of cytokines, which are protein molecules that cause inflammation, making the linings of the intestines very sensitive. Inflamed intestinal linings may be prone to damage and the formation of ulcers.
COVID-19 has also been reported to cause an imbalance in the gut microbiome.
The gut microbiome is a collection of trillions of microorganisms living in the gut. These microorganisms are essential for the digestion of food and help keep the gut healthy. Stool samples from patients with COVID-19 indicated that the number of microorganisms in their gut was significantly lower than that of a healthy patient — this means the patient has a condition called Dysbiosis.
Dysbiosis is when there is an imbalance in the microbial colonies in the gut microbiome. It is believed that when COVID-19 enters the gut, it causes an immune response which may lead to existing gut microorganisms being killed off.
Because of how COVID-19 impacts the gut microbiome, giving COVID-19 patients antibiotics may worsen the condition as it may kill off more important gut bacteria.
It’s important to note that not every patient suffering from COVID-19 will have serious gastrointestinal or liver problems, and most may experience only mild gastrointestinal symptoms or no symptoms at all.
Are people with chronic gastrointestinal and liver problems at risk?
People suffering from chronic liver diseases like cirrhosis and hepatitis may experience COVID-19 more seriously; this could apply to other gastrointestinal diseases.
Patients suffering from inflammatory bowel disease and Crohn’s disease may experience worsened gastrointestinal symptoms of COVID-19. Since most chronic gastrointestinal diseases involve the inflammation of the gastrointestinal linings, the body’s production of cytokines as a response to the virus may worsen the inflammation.
There is still a lot of research that needs to be done in the fields of gastroenterology and hepatology to find more links between liver and gastrointestinal health and COVID-19.
Gastroenterology and hepatology specialists may be able to help
COVID-19 primarily affects the respiratory system but some of the symptoms of COVID-19 may be gastrointestinal, and these symptoms may last long after a patient recovers from COVID-19.
Fortunately, gastrointestinal and hepatology specialists can help patients, so that their recovery goes smoothly and whatever gastrointestinal or liver issues they have, are treated effectively.
