New Delhi: Critically ill Covid-19 patients may develop gastrointestinal complications during their hospital stay, a new study in the peer-reviewed Journal of the American Medical Association has suggested.
The complications include bowel ischemia, transaminitis, gastrointestinal bleeding, pancreatitis, Ogilvie syndrome, and severe blockage of food material in intestines.
Intestinal Ischemia or bowel ischemia is a condition where blood flow through major arteries to intestines slows or stops, causing pain. Ogilvie syndrome leads to acute dilation of the colon.
Mesenteric ischemia is a medical condition in which injury to the small intestine occurs due to lack of blood supply. Transaminitis is the condition when the liver produces too many enzymes which then move into one’s blood stream.
“This study found a higher rate of gastrointestinal complications, including mesenteric ischemia, in critically ill patients with COVID-19 compared with propensity score-matched patients without COVID-19, suggesting a distinct phenotype (characteristics) for COVID-19 compared with conventional ARDS,” said the study.
Acute respiratory distress syndrome (ARDS) is failure of respiratory function when fluid builds up in the lungs, leading to the inflammation of lungs.
Titled Gastrointestinal Complications in Critically Ill Patients With and Without COVID-19, the study by seven researchers at Massachusetts General Hospital in US’ Boston was published on 23 September.
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Lining in gut may act as SARS-CoV-2 host cell receptor
The researchers compared the incidence of gastrointestinal complications in critically ill patients with Covid-induced ARDS against patients with non-Covid ARDS.
They quoted a Chinese study — ‘Single cell RNA sequencing of 13 human tissues identify cell types and receptors of human coronaviruses’ — to link the connection between Covid and gastrointestinal complications.
According to the study, high expression of angiotensin-converting enzyme 2 receptors along the epithelial lining of the gut could explain involvement of abdominal organs. The enzyme receptors act as host-cell receptors for SARS-CoV-2.
How the study was performed
Under the new study, 486 patients were selected, of which 244 had non-Covid ARDS and 242 had Covid ARDS.
The median age of patients in the study was 60.5 years for patients with Covid and 62 years for patients without Covid.
“Patients with COVID-19 were more likely to develop gastrointestinal complications compared with those without COVID-19. The difference in incidence was more evident after the third day of critical illness,” the study concluded.
“Specifically, patients with COVID-19 developed more transaminitis, severe ileus (food blockage) and bowel ischemia… Three of the four patients with COVID-19 and bowel ischemia were taken to the operating room and had intraoperative findings…,” it added.
More research needed
The researchers said the “limitations of this study include the single center and the unavailability of inflammatory markers to use for matching”.
They also said “further translational studies are warranted to examine the pathophysiology of these findings”.
“Whether the high incidence of gastrointestinal complications is a manifestation of critical illness in general or is specific to COVID-19 remains unclear,” they said.
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