Diarrhea syndrome: new accents of patient curation during COVID-19 pandemic
DOI: 10.32364/2587-6821-2021-5-6-446-452
O.V. Gaus, M.A. Livzan
Omsk State Medical University, Omsk, Russian Federation
The digestive tract, like the respiratory organs, is the entrance gate for SARS-CoV-2. At the same time, diarrhea is one of the most common gastrointestinal symptoms among infected people. As the debut of COVID-19 clinical manifestations, diarrhea can be associated both with the direct cytopathic effect of the virus on the intestinal mucosal epithelium and with the gut microbiota modulation. During the period of the expanded clinical picture of COVID-19, diarrhea syndrome is commonly associated with the adverse event of drug therapy, primarily antibiotics, nonsteroidal anti-inflammatory drugs, antiviral agents, antiplatelet agents and anticoagulants, as well as with possible involvement in the pathological process of the liver and pancreas with a violation of their functional activity. Finally, after the infection, the repeated occurrence of diarrhea requires the exclusion of antibiotic-associated diarrhea, including those caused by Clostridium difficile, as well as ischemic colitis and post-infectious irritable bowel syndrome. Besides, despite the pandemic, it should not be forgotten about the possible debut of gastrointestinal disorder or an exacerbation of already existing chronic pathology. The article presents a brief algorithm for the differential diagnosis of diarrhea in the conditions of the COVID-19 pandemic.
Keywords: diarrhea, COVID-19 pandemic, antibiotic-associated diarrhea, ischemic colitis, post-infectious irritable bowel syndrome.
For citation: Gaus O.V., Livzan M.A. Diarrhea syndrome: new accents of patient curation during COVID-19 pandemic. Russian Medical Inquiry. 2021;5(6):446–452 (in Russ.). DOI: 10.32364/2587-6821-2021-5-6-446-452.
About the authors:
Olga V. Gaus — C. Sc. (Med.), Associate Professor of the Department of Faculty Therapy, Department of Occupational Diseases, Head of the Department for the Development of Regional Healthcare and Medical Activities, Omsk State Medical University; 12, Lenin str., Omsk, 644099, Russian Federation; ORCID iD 0000-0001-9370-4768.
Maria A. Livzan — Dr. Sc. (Med.), Professor, Head of the Department of Faculty Therapy and Gastroenterology, Rector, Omsk state Medical University; 12, Lenin str., Omsk, 644099, Russian Federation; ORCID iD 0000-0002-6581-7017.
Contact information: Olga V. Gaus, e-mail: gaus_olga@bk.ru.
Financial Disclosure: no authors have a financial or property interest in any material or method mentioned.
There is no conflict of interests.
Received 27.05.2021.
Revised 22.06.2021.
Accepted 15.07.2021.
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19. Yeoh Y.K., Zuo T., Lui G.C. et al. Gut microbiota composition reflects disease severity and dysfunctional immune responses in patients with COVID-19. 2021;70(4):698–706. DOI: 10.1136/gutjnl-2020-323020.
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21. Zuo T., Liu Q., Zhang F. et al. Depicting SARS-CoV-2 faecal viral activity in association with gut microbiota composition in patients with COVID-19. Gut. 2021;70(2):276–284. DOI: 10.1136/gutjnl-2020-322294.
22. Effenberger M., Grabherr F., Mayr L. et al. Faecal calprotectin indicates intestinal inflammation in COVID-19. Gut. 2020;69(8):1543–1544. DOI: 10.1136/gutjnl-2020-321388.
23. Penninger J.M., Grant M.B., Sung J.J.Y. The Role of Angiotensin Converting Enzyme 2 in Modulating Gut Microbiota, Intestinal Inflammation, and Coronavirus Infection. Gastroenterology. 2021;160(1):39–46. DOI: 10.1053/j.gastro.2020.07.067.
24. Höglund E., Øverli Ø., Winberg S. Tryptophan metabolic pathways and brain serotonergic activity: a comparative review. Front Endocrinol (Lausanne). 2019;10:158. DOI: 10.3389/fendo.2019.00158.
25. Bian X., Patel B., Dai X. et al. High mucosal serotonin availability in neonatal guinea pig ileum is associated with low serotonin transporter expression. Gastroenterology. 2007;132(7):2438–2447. DOI: 10.1053/j.gastro.2007.03.103.
26. Heredia D.J., Gershon M.D., Koh S.D. et al. Important role of mucosal serotonin in colonic propulsion and peristaltic reflexes: in vitro analyses in mice lacking tryptophan hydroxylase 1. J Physiol. 2013;591(23):5939–5957. DOI: 10.1113/jphysiol.2013.256230.
27. Atkinson W., Lockhart S., Whorwell P.J. et al. Altered 5-hydroxytryptamine signaling in patients with constipation- and diarrhea-predominant irritable bowel syndrome. Gastroenterology. 2006;130(1):34–43. DOI: 10.1053/j.gastro.2005.09.031.
28. Ha S., Jin B., Clemmensen B. et al. Serotonin is elevated in COVID-19-associated diarrhoea. Gut. 2021:gutjnl-2020–323542. DOI: 10.1136/gutjnl-2020-323542.
29. Jin B., Singh R., Ha S.E. et al. Pathophysiological mechanisms underlying gastrointestinal symptoms in patients with COVID-19. World J Gastroenterol. 2021;27(19):2341–2352. DOI: 10.3748/wjg.v27.i19.2341.
30. Ливзан М.А., Осипенко М.Ф., Лялюкова Е.А. Поражение органов пищеварения у пациентов, принимающих нестероидные противовоспалительные препараты: факторы риска, тактика ведения. Лечащий врач. 2013;7:27–30. [Livzan M.A., Osipenko M.F., Lyalyukova E.A. Damage to the digestive organs in patients taking non-steroidal anti-inflammatory drugs: risk factors, management tactics. Lechaschii Vrach. 2013;07:27–30 (in Russ.)].
31. Zhang F.C., Yin Z.B., Tang X.P. Clinical analysis of 260 cases of SARS in Guangzhou. Chinese J Infect. 2003;21:84–88.
32. Leung W.K., To K.F., Chan P.K. et al. Enteric involvement of severe acute respiratory syndrome-associated coronavirus infection. Gastroenterology. 2003;125(4):1011–1017. DOI: 10.1016/s0016-5085(03)01215-0.
33. Kociolek L.K., Gerding D.N. Breakthroughs in the treatment and prevention of Clostridium difficile infection. Nat Rev Gastroenterol Hepatol. 2016;13(3):150–160. DOI: 10.1038/nrgastro.2015.220.
34. Ливзан М.А., Гаус О.В., Николаев Н.А. Колит, ассоциированный с приемом лекарственных средств. Фарматека. 2020;27(2):16–22. DOI: 10.18565/pharmateca.2020.2.16-22. [Livzan M.A., Gaus O.V., Nikolaev N.A. Colitis associated with taking medications. Pharmateca. 2020;27(2):16–22 (in Russ.)]. DOI: 10.18565/pharmateca.2020.2.16-22.
35. Fang D., Ma J.-D., Guan J.-L. et al. A single-center, descriptive study on the digestive system of COVID-19 inpatients in Wuhan. Chinese J Digest. 2020;40:E005–E005.
36. Cheung S., Quiwa J.C., Pillai A. et al. Superior mesenteric artery thrombosis and acute intestinal ischemia as a consequence of COVID-19 infection. Am J Case Rep. 2020;21:e925753. DOI: 10.12659/AJCR.925753.
37. Parry A.H., Wani A.H., Yaseen M. Acute mesenteric ischemia in severe Coronavirus-19 (COVID-19): possible mechanisms and diagnostic pathway. Acad Radiol. 2020;27(8):1190. DOI: 10.1016/j.acra.2020.05.016.
38. Varga Z., Flammer A.J., Steiger P. et al. Endothelial cell infection and endotheliitis in COVID-19. Lancet. 2020;395(10234):1417–1418. DOI: 10.1016/S0140-6736(20)30937-5.
39. Keshavarz P., Rafiee F., Kavandi H. et al. Ischemic gastrointestinal complications of COVID-19: a systematic review on imaging presentation. Clin Imaging. 2021;73:86–95. DOI: 10.1016/j.clinimag.2020.11.054.
40. Manolis A.S., Manolis T.A., Manolis A.A. et al. COVID-19 infection: viral macro- and micro-vascular coagulopathy and thromboembolism/prophylactic and therapeutic management. J Cardiovasc Pharmacol Ther. 2021;26(1):12–24. DOI: 10.1177/1074248420958973.
41. Barbara G., Grover M., Bercik P. et al. Rome Foundation Working Team Report on Post-Infection Irritable Bowel Syndrome. Gastroenterology. 2019;156(1):46–58.e7. DOI: 10.1053/j.gastro.2018.07.011.
42. Гаус О.В., Ливзан М.А. СРК: что мы знаем о симптомах сегодня? Consilium Medicum. 2019;21(8):42–48. DOI: 10.26442/20751753.2019.8.190512. [Gaus O.V., Livzan M.A. IBS: what do we know about the symptoms today? Consilium Medicum. 2019;21(8):42–48 (in Russ.)]. DOI: 10.26442/20751753.2019.8.190512.
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