COVID-19 in gastroenterology & hepatology

The gastrointestinal tract is involved in COVID-19, gastrointestinal symptoms can occur and marked changes in the gut microbiota have been observed. This Perspective highlights interactions between the gut microbiota and SARS-CoV-2 infection and increasing interest in the gut–lung axis.

In this Review, Neurath discusses the implications of COVID-19 on immunosuppressive and biologic therapies as well as those of vaccination in gastrointestinal contexts such as inflammatory bowel disease, autoimmune hepatitis and liver transplantation.

This Review provides mechanistic and clinical insights into COVID-19 in the context of liver disease, discussing the potential underlying biology and clinical features of SARS-CoV-2 infection in patients with pre-existing liver conditions. The management of these patients is also discussed, including SARS-CoV-2 vaccination strategies.

Although COVID-19 is a respiratory disease and its causative agent, SARS-CoV-2, principally infects the respiratory tract, extrapulmonary manifestations are observed. This Perspective explores the gastrointestinal symptoms associated with COVID-19 and the putative underlying mechanisms, discussing experimental evidence on SARS-COV-2 gastrointestinal infection and the potential for faecal–oral transmission.

The COVID-19 pandemic has resulted in changes to the management of patients with inflammatory bowel disease, including major disruptions to endoscopy. This Perspective provides a guide and recommendations for inflammatory bowel disease endoscopy during a global health emergency based on expert experience in Italy and France.

The definition of gastrointestinal involvement in post-acute COVID-19 syndrome, its frequency and its pathophysiology are still not completely understood. Here, we discuss the emerging evidence supporting immunological signatures and the unique nature of the gastrointestinal tract in this syndrome.

Patients with end-stage liver disease and COVID-19 are at a higher risk of hospitalization, ventilation and death than those without chronic liver disease. Whether the aetiology of liver disease also affects the natural history of COVID-19 in cirrhosis is debated. Effective and universal vaccination is paramount to combat SARS-CoV-2 infection.

Data on the efficacy and safety of SARS-CoV-2 vaccines are now available, but evidence for these vaccines in those who are immunocompromised (including patients with inflammatory bowel diseases) are lacking. As vaccination begins, questions on advantages and disadvantages can be partially addressed using the experience from other vaccines or immune-mediated inflammatory disorders.

Case reports and retrospective cohort studies have reported an association between acute pancreatitis and COVID-19. As SARS-CoV-2 (the causative agent of COVID-19) receptors are expressed in the pancreas and endothelial damage can occur, this association is plausible. However, this hypothesis has many biases and needs further investigation.

The effect of coronavirus disease 2019 (COVID-19) on liver transplantation programmes and recipients is still not completely understood but overall involves the risk of donor-derived transmission, the reliability of diagnostic tests, health-care resource utilization and the effect of immunosuppression. This Comment reviews the effect of COVID-19 on liver transplantation and summarizes recommendations for donor and recipient management.

The gastrointestinal tract represents a target organ for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), warranting a thorough discussion on the consequences, particularly regarding inflammatory bowel diseases. Here, aspects of gastrointestinal involvement with SARS-CoV-2, the role of viruses as modulators of mucosal immunity and as treatment-related safety hazards, and the current clinical evidence will be discussed.

Greater than the coronavirus disease 2019 (COVID-19) crisis, systemic inequity in social determinants of health is the pandemic that has long fostered vulnerability to disease and poor health outcomes in the USA. Our response has major implications for the health of our nations.

Coronavirus disease 2019 (COVID-19) itself and/or the use of hepatotoxic drugs might negatively affect the course and management of patients with pre-existing chronic liver diseases. However, the greatest effect of COVID-19 on liver diseases will be indirect and delayed, resulting from the impending global economic crisis.

The outbreak of coronavirus disease 2019 has undeniably affected modalities of medical and gastroenterology training in all endemic areas. Indeed, the adoption of various distance-learning techniques has been mandatory to facilitate education and enhance skills such as problem-solving, self-directed learning, open communication and also holistic non-cognitive attributes such as adaptability and collaboration.

During the coronavirus disease 2019 (COVID-19) pandemic, inflammatory bowel disease (IBD) practices have been disrupted. This Comment summarizes the key strategies that should be implemented for both patients and IBD specialists to provide optimal care while avoiding new outbreaks for the first 6–12 months after the peak of the COVID-19 pandemic.

The coronavirus disease 2019 (COVID-19) pandemic is affecting and changing the daily practice of gastrointestinal endoscopy worldwide. To protect patients and endoscopy unit personnel, endoscopy units have had to postpone a large proportion of endoscopic procedures. These delays might have an effect on the screening for and surveillance of digestive cancers.

The coronavirus disease (COVID-19) worldwide outbreak has led to a dramatic challenge for all healthcare systems, including inflammatory bowel disease (IBD) centres. Here, we describe the fast changes and clinical issues that IBD specialists could face during this SARS-CoV-2 infection pandemic, highlighting the potential rearrangements of care and resetting of clinical priorities.

The repercussions of the COVID-19 pandemic go far beyond the disease itself, and cannot be overlooked. The gastroenterology and hepatology community has adapted quickly, but resilience and collaboration will be key to address future uncertainty.