Russian Military Medical Academy ReportsRussian Military Medical Academy Reports2713-23152713-2323Eco-Vector7626910.17816/rmmar76269Research ArticleDiseases of the digestive organs and COVID-19GrinevichVladimir B.<p>M.D., D.Sc. (Medicine), Professor</p>grinevich_vb@mail.ruhttps://orcid.org/0000-0002-1095-8787KravchukYuriy A.<p>M.D., D.Sc. (Medicine), Associate Professor</p>kravchuk2003@mail.ruhttps://orcid.org/0000-0001-8347-0531S.M. Kirov Military Medical Academy0209202140339441907202127072021Copyright © 2021, Grinevich V.B., Kravchuk Y.A.2021<p>With a new coronavirus infection (COVID-19), gastroenterological symptoms are often detected, which is due to both the damage to the digestive organs by the SARS-CoV-2 coronavirus and the exacerbation of chronic diseases, as well as aggressive multicomponent therapy. The severity of gastroenterological manifestations, primarily impaired liver function, is associated with a more severe and complicated course of COVID-19 infection. Numerous mechanisms of damage to the digestive organs in COVID-19 have been identified: direct damage by the virus due to resuscitation and multicomponent therapy, impaired central and peripheral nervous regulation, immunothrombotic syndrome, virus persistence in the gastrointestinal tract, induction of autoimmune reactions by the virus, humoral disorders (changes in serotonin levels, bradykinin, activation of mast cells). Violation of the microbial-tissue complex of the intestine and the permeability of the intestinal barrier, induced by the SARS-CoV-2 virus, ensures the formation and progression of chronic systemic inflammation, cytokine aggression, insulin resistance, endothelial dysfunction, which affect the severity of the infection. Therapy for patients with COVID-19 should include therapeutic approaches aimed at correcting disorders of the intestinal microbiota, intestinal barrier permeability, and relief of gastroenterological manifestations (bibliography: 20 refs).</p>gastroenterological manifestationsintestinal barrier permeabilitymicrobiotanovel coronavirus infectionгастроэнтерологические проявлениямикробиотановая коронавирусная инфекцияпроницаемость барьера кишечника[Grinevich VB, Kravchuk YuA, Ped’ VI, et al. Management of patients with diseases of the digestive system during the COVID-19 pandemic. Clinical guidelines of the Russian Scientific Medical Society of Physicians and the Scientific Society of Gastroenterologists of Russia (2nd edition). Experimental and Clinical Gastroenterology. 2021;187(3):5–82. DOI: https://doi.org/10.31146/1682-8658-ecg-187-3-5-82][Grinevich VB, Gubonina IV, Doshchitsin VL, et al. Features of management of comorbid patients during a pandemic of a new coronavirus infection (COVID-19). National Consensus 2020. Cardiovascular Therapy and Prevention. 2020;19(4):135–172. DOI: 10.15829/1728-8800-2020-2630 (In Russ.)][Mao R, Qiu Y, He JS, et al. Manifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2020;5(7):667–678. DOI: 10.1016/S2468-1253(20)30126-6][Kumar A, Arora A, Sharma P, et al. Gastrointestinal and hepatic manifestations of Corona Virus Disease-19 and their relationship to severe clinical course: A systematic review and meta-analysis. Indian J Gastroenterol. 2020;39(3):268–284. DOI: 10.1007/s12664-020-01058-3][Elshazli RM, Kline A, Elgaml A, et al. Gastroenterology manifestations and COVID-19 outcomes: A meta-analysis of 25,252 cohorts among the first and second waves. J Med Virol. 2021;93(5): 2740–2768. DOI: 10.1002/jmv.26836][Press release of RGA and ROPIP. New disease, new symptoms, new therapeutic options. 2021. Available from: https://www.rsls.ru/files/Prz2.pdf (accessed: 07.05.2021). (In Russ.)][Kucherenko NG, Ratnikova AK, Grinevich VB, et al. Clinic and semiotics of lesions of the digestive system in a new coronavirus infection (COVID-19). Experimental and Clinical Gastroenterology. 2021; 186(2):20–26. DOI: 10.31146/1682-8658-ecg-186-2-20-26 (In Russ.)][Yong SJ. Long-Haul COVID-19: Putative Pathophysiology, Risk Factors, and Treatments. Preprints.org. 2020:2020120242. DOI: 10.20944/preprints202012.0242.v1][Lopez-Leon S, Wegman-Ostrosky T, Perelman C, et al. More than 50 Long-term effects of COVID-19: a systematic review and meta-analysis. medRxiv. 2021 Jan 30. Preprint. DOI: 10.1101/2021.01.27.21250617][Salabei JK, Fishman TJ, Asnake ZT, Ali A, Iyer UG. COVID-19 Coagulopathy: Current knowledge and guidelines on anticoagulation. Heart Lung. 2021;50(2):357–360. DOI: 10.1016/j.hrtlng.2021.01.011][Deidda S, Tora L, Firinu D, et al. Gastrointestinal coronavirus disease 2019: epidemiology, clinical features, pathogenesis, prevention, and management. Expert Rev Gastroenterol Hepatol. 2021;15(1): 41–50. DOI: 10.1080/17474124.2020.1821653][Choi B, Choudhary MC, Regan J, et al. Persistence and Evolution of SARS-CoV-2 in an Immunocompromised Host. N Engl J Med. 2020;383(23):2291–2293. DOI: 10.1056/NEJMc2031364][Hu F, Chen F, Ou Z, et al. A compromised specific humoral immune response against the SARS-CoV-2 receptor-binding domain is related to viral persistence and periodic shedding in the gastrointestinal tract. Cell Mol Immunol. 2020;17:1119–1125. DOI: 10.1038/s41423-020-00550-2][Kumar V. How could we forget immunometabolism in SARS-CoV2 infection or COVID-19? Int Rev Immunol. 2021;40 (1–2):72–107. DOI: 10.1080/08830185.2020.1840567][Garvin MR, Alvarez C, Miller JI, et al. A mechanistic model and therapeutic interventions for COVID-19 involving a RAS-mediated bradykinin storm. Elife. 2020;9: e59177. DOI: 10.7554/eLife.59177][Afrin LB, Weinstock LB, Molderings GJ. Covid-19 hyperinflammation and post-Covid-19 illness may be rooted in mast cell activation syndrome. Int J Infect Dis. 2020;100:327–332. DOI: 10.1016/j.ijid.2020.09.016][Mönkemüller K, Fry L, Rickes S. COVID-19, coronavirus, SARS-CoV-2 and the small bowel. Rev Esp Enferm Dig. 2020;112(5): 383–388. DOI: 10.17235/reed.2020.7137/2020][Sencio V, Machado MG, Trottein F. The lung-gut axis during viral respiratory infections: the impact of gut dysbiosis on secondary disease outcomes. Mucosal Immunol. 2021;14(2):296–304. DOI: 10.1038/s41385-020-00361-8][Giron LB, Dweep H, Yin X, et al. Severe COVID-19 Is Fueled by Disrupted Gut Barrier Integrity. medRxiv. 2020. Preprint. DOI: 10.1101/2020.11.13.20231209][Yan C, Chen Y, Sun C., et al. Will Proton Pump Inhibitors Lead to a Higher Risk of COVID-19 Infection and Progression to Severe Disease? A Meta-analysis. Jpn J Infect Dis. 2021. DOI: 10.7883/yoken.JJID.2021.074]