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Revista colombiana de Gastroenterología
versión impresa ISSN 0120-9957versión On-line ISSN 2500-7440
Rev. colomb. Gastroenterol. vol.35 no.2 Bogotá abr./jun. 2020
https://doi.org/10.22516/25007440.553
Letter
COVID-19: A new perspective in gastroenterology
1 Gastroenterology Service, Hospital III de Emergencias Grau EsSalud in Lima, Peru
Since its appearance in Wuhan, Hubei province, in central China, and due to its rapid spread and severity, the Coronavirus disease (COVID-19) has been declared a “public health emergency of international importance” by the World Health Organization (WHO). It is worth mentioning that this is the sixth time that the WHO has made a pronouncement of such magnitude since the approval of International Health Regulations in 2005. 1
This disease is transmitted from person to person through aerosols generated by coughs or sneezes. In its most critical stage, severe acute respiratory syndrome (SARS) develops. SARS is a condition requires mechanical ventilation for a large percentage of patients. Nevertheless several already-published studies and several others that are in-publication also report gastrointestinal symptoms in infected patients. In these patients, the presence of diarrhea stands out (Table 1). 2-6
COVID-19 uses angiotensin-converting enzyme 2 to enter the cell. This enzyme is not only found in the lungs but is also expressed in cells of the digestive tract, and in cholangiocytes and hepatocytes which could explain the reports of gastrointestinal manifestations. 7,8 In turn, this would support the possibility of fecal-oral transmission of the disease. 7 This context automatically turns endoscopic centers into high-risk sites.
A number of medical societies have published their recommendations and guidelines for endoscopic procedures and outpatient follow-up. The American Association of Gastroenterology (AGA) recommends correct use of personal protective equipment and the use of negative pressure rooms during the endoscopy of patients with a confirmed COVID-19 diagnoses as well as for those suspected of having COVID-19. 9
For its part, the European Association for the Study of the Liver (EASL) suggests using telemedicine to reduce exposure of vulnerable patients to COVID -19 through outpatient appointments. 10 Daily clinical practice will undergo changes in the coming months and will depend on our ability to adapt so that we can continue offering the same standards of care to our patients.
From another point of view, this is an opportunity for development of research into manifestations of COVID-19 in the digestive tract, as well as its impacts on patients with chronic gastrointestinal diseases. To gain a better understanding of the behavior of this disease in our region.
Despite difficulties in determining the real impact of this epidemic, new opportunities have been created for development of skills and tools that will set the course for patient care
Referencias
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2. Majeed MB, Majeed MB, Agrawal R, Wang Y, Attar B, Patel P, et al. Prevalence of gastrointestinal symptoms in COVID-19 patients and impact of medical resources on disease transmission. Available-at SSRN. 3572865(2020). https://doi.org/10.2139/ssrn.3572865 [ Links ]
3. Garg S, Kim L, Whitaker M, O’Halloran A, Cummings C, Holstein R, et al. Hospitalization Rates and Characteristics of Patients Hospitalized with Laboratory-Confirmed Coronavirus Disease 2019 - COVID-NET, 14 States, March 1-30, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(15):458-64. https://doi.org/10.15585/mmwr.mm6915e3 [ Links ]
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6. Escalera-antezana JP, Lizon-ferrufino NF, Maldonado-alanoca A, Alarcón-de-la-vega G, Alvarado-arnez LE, Balderrama-saavedra MA, et al. Clinical features of the first cases and a cluster of Coronavirus Disease 2019 (COVID-19) in Bolivia imported from Italy and Spain. Travel Med Infect Dis [Internet]. 2020;(March):101653. Available from: https://doi.org/10.1016/j.tmaid.2020.101653 [ Links ]
7. Xiao F, Tang M, Zheng X, Liu Y, Shan H. Evidence for Gastrointestinal Infection of SARS-CoV-2. Gastroenterology . 2020;S0016-5085. https://doi.org/10.1053/j.gastro.2020.02.055 [ Links ]
8. Chai X, Hu L, Zhang Y, Han W, Lu Z, Ke A. Specific ACE2 Expression in Cholangiocytes May Cause Liver Damage After 2019-nCoV Infection. bioRxiv [Internet]. 2020;2020.02.03.931766. Available from: http://biorxiv.org/content/early/2020/02/04/2020.02.03.931766.abstract [ Links ]
9. Sultan S, Lim JK, Altayar O, Davitkov P, Joseph D, Siddique SM, et al. AGA Institute Rapid Recommendations for Gastrointestinal Procedures During the COVID-19 Pandemic. Gastroenterology [Internet]. 2020; Available from: https://doi.org/10.1053/j.gastro.2020.03.072 [ Links ]
10. Boettler T, Newsome PN, Mondelli MU, Maticic M, Cordero E. Care of patients with liver disease during the COVID-19 pandemic: EASL-ESCMID Position Paper. JHEP Reports [Internet]. 2020;2(3):100113. Available from: www.sciencedirect.com/science/article/pii/S2589555920300471 https://doi.org/10.1016/j.jhepr.2020.100113 [ Links ]
Received: April 29, 2020; Accepted: May 12, 2020