Gastrointestinal, Hepatic Manifestations Affect Many with COVID-19

Although COVID-19 is predominantly a respiratory illness, a significant number of patients experience gastrointestinal and hepatobiliary manifestations, advises a review article published in Human Pathology.

“These manifestations are often mild and transient, but they can be severe and consequential,” wrote Angela R. Shih, MD, of Harvard Medical School, Boston, Massachusetts, and Joseph Misdraji, MD, of Yale University, New Haven, Connecticut.

Ischemic enterocolitis is the most common and significant gastrointestinal manifestation of COVID-19. Hepatic manifestations can include steatosis, hepatitis, and post-COVID-19 cholangiopathy. The mechanisms of gastrointestinal and hepatobiliary injuries are likely multifactorial and could include direct viral infection, systemic inflammatory and immune-mediated effects, and vascular changes that lead to ischemia, the authors explained.

“In the liver, the reported pathologic findings may often be related to consequences of severe systemic viral infection, but reports of hepatitis presumed to be due to SARS-CoV-2 suggest that direct viral infection of the liver may be a rare complication of COVID-19,” they wrote.

Agents used to prevent or treat COVID-19, such as lopinavir-ritonavir combination therapy, oseltamivir, remdesivir, and antimicrobials, may also cause gastrointestinal or hepatic injury. Some of the more controversial agents — chloroquine and hydroxychloroquine, for example, and ivermectin — can lead to gastrointestinal effects.

“Preexisting gastrointestinal or hepatic disease may affect the disease course of COVID-19, and may alter the outcome of the viral illness,” the authors continued. “As we begin to understand more about the long-term effects of COVID-19, the long-term gastrointestinal and hepatic manifestations of this viral illness will become increasingly defined.”

—Jolynn Tumolo

Reference:
Shih AR, Misdraji J. COVID-19: gastrointestinal and hepatobiliary manifestations. Hum Pathol. 2023;132:39-55. doi:10.1016/j.humpa