Addressing multiple gastroenterological aspects of coronavirus disease 2019

The outbreak of the coronavirus disease 2019 ( COVID-19) pandemic has become the biggest challenge for the whole human community since many years. It seems that the proper identification of all people infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the best strategy to limit the transmission. However, in a significant proportion of patients, there are no clinical manifestations of the disease, and symptoms may be very mild or atypical. There is a growing body of evidence that digestive manifestations of COVID-19 are frequently reported and may precede typical respiratory symptoms. Moreover, SARS-CoV-2 particles were found in the gastrointestinal epithelial cells, and viral RNA was detected in the feces of patients with COVID-19. These data suggest that gastrointestinal symptoms in COVID-19 are not accidental findings and they may result from direct digestive involvement. Patients with new-onset diarrhea, abdominal pain, nausea, and vomiting without any other evident etiological factors should be tested for SARS-CoV-2 infection. Gastroenterologists and members of other medical specialties should also remember that the current epidemiological situation has changed diagnostic and therapeutic algorithms in the management of several gastrointestinal and liver disorders. This review article summarizes the currently available data on multiple gastroenterological aspects of COVID-19 and provides information on practical recommendations and position statements of the most prominent associations in the field of gastroenterology, which appeared in response to the emergence of the pandemic.