1/7 Important #COVID19 Updates (please share): We know that Covid19 is principally a respiratory illness. But people are starting to wonder if it presents in other ways, namely as a gastrointestinal (GI) illness. If so, that’s critical to know, because current testing requires…
2/7 …respiratory symptoms. Moreover, absence of diarrhea is being used by some doctors to distinguish #COVID19 from flu. However, several reports now indicate that COVID19 is detected in stool. A forthcoming report, available here (gastrojournal.org/article/S0016-…), shows that 53.4%...
3/7 …of confirmed cases tested +ive for viral RNA in stool. Importantly, 23% had +ive stool but *negative* respiratory samples. Endoscopy in 1 pt showed extensive damage & even bleeding in GI system. In another unpublished report I received, roughly half of COVID19 patients...
4/7 …in Wuhan had GI symptoms, and those fared worse. Additionally, it appears #COVID19 gains entry into cells using the “ACE2” receptor, which is highly expressed in the GI tract, suggesting it gains a foothold through the GI system. Emerging theory is COVID19 may spread...
5/7 …in part, through fecal-oral route. Recommendations emerging to test stool of all #COVID19 pts, even after respiratory symptoms subside. Less clear how often COVID19 presents with GI first, respiratory second. Of note, 1st pt confirmed in US reported nausea, vomiting...
6/7 …and loose stool. Another forthcoming article, here, (gastrojournal.org/article/S0016-…), suggests #COVID19 may infect salivary glands and serve as source of infection. Could then hang out in the mouth and shed into lungs, GI tract, or both. Might explain variable presentations.
7/7 This all emphasizes new data that GI tract may be serve as reservoir for viral replication of #COVID19 and spread, and challenges us to re-think how to test for virus and what symptoms to monitor as this pandemic unfolds.
Update: The American Gastroenterological Association has posted similar conclusions on their official website, here: gastro.org/press-release/…. I am aware that the American College of Gastroenterology will be putting out guidance on this shortly as well.
