Síntomas gastrointestinales en la enfermedad por COVID-19 y sus implicaciones en enfermedad inflamatoria intestinal
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https://doi.org/10.22516/25007440.532Palabras clave:
SARS virus, enfermedad inflamatoria intestinal, covid 19, inmunosupresión, heces, tracto gastrointestinalResumen
La pandemia por SARS-Cov-2, ha tomado gran relevancia por su impacto en los diversos sistemas de salud en el mundo. Inicialmente solo se contemplaba la importancia de los síntomas respiratorios y la fiebre; sin embargo, a diario tenemos más reportes y publicaciones sobre la relevancia que está teniendo en el sistema digestivo, ya que algunos pacientes informan síntomas gastrointestinales como diarrea, vómito y dolor abdominal. Los estudios han identificado el ARN del SARS-CoV-2 en muestras de heces de pacientes infectados, en las que se encontró que su receptor que es el de la enzima convertidora de angiotensina 2 (ECA2) se expresaba altamente en las células epiteliales gastrointestinales. Esto sugiere que el SARS-CoV-2 puede infectar activamente y replicarse en el tracto gastrointestinal. Esto tiene implicaciones importantes para el tratamiento de la enfermedad, la transmisión y el control de infecciones. En pacientes con patologías crónicas como la enfermedad inflamatoria intestinal (EII), se han generado gran cantidad de preguntas e incertidumbres ante la presencia de COVID-19 junto con las implicaciones que pueden tener tanto en la severidad de los síntomas, como en la descompensación de la patología de base y en la continuidad del tratamiento inmunosupresor.
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Referencias bibliográficas
WHO [Internet]. WHO; 2020. [acceso 31 de marzo de 2020]. Director-General’s opening remarks at the media briefing on COVID-19 - 11 March 2020. Disponible en: https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020
Johns Hopkins Coronavirus Resource Center [Internet]. [citado 1 de abril de 2020]. COVID-19 Map. Disponible en: https://coronavirus.jhu.edu/map.html
Guan W-J, Ni Z-Y, Hu Y, Liang W-H, Ou C-Q, He J-X, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. [28 de febrero de 2020; actualizado 6 de marzo de 2020]. https://doi.org/10.1056/NEJMoa2002032
Gu J, Han B, Wang J. COVID-19: Gastrointestinal Manifestations and Potential Fecal-Oral Transmission. Gastroenterology. 2020. pii: S0016-5085(20)30281-X. https://doi.org/10.1053/j.gastro.2020.02.054
Xiao F, Tang M, Zheng X, Liu Y, Li X, Shan H. Evidence for Gastrointestinal Infection of SARS-CoV-2. Gastroenterology. 2020. pii: S0016-5085(20)30282-1. https://doi.org/10.1053/j.gastro.2020.02.055
Zou X, Chen K, Zou J, Han P, Hao J, Han Z. Single-cell RNA-seq data analysis on the receptor ACE2 expression reveals the potential risk of different human organs vulnerable to 2019-nCoV infection. Front Med. 2020. https://doi.org/10.1007/s11684-020-0754-0
Hindson J. COVID-19: faecal-oral transmission? Nat Rev Gastroenterol Hepatol. 2020. https://doi.org/10.1038/s41575-020-0295-7
Xu K, Cai H, Shen Y, Ni Q, Chen Y, Hu S, et al. [Management of corona virus disease-19 (COVID-19): the Zhejiang experience]. Zhejiang Da Xue Xue Bao Yi Xue Ban. 2020;49(1):0.
Lippi G, Simundic A-M, Plebani M. Potential preanalytical and analytical vulnerabilities in the laboratory diagnosis of coronavirus disease 2019 (COVID-19). Clin Chem Lab Med. 2020. https://doi.org/10.1515/cclm-2020-0285
LIANG PT. [Internet]. 2020 [citado 31 de marzo de 2020]. Manual de Prevención y Tratamiento de COVID-19 (traducción). Disponible en: https://figshare.com/articles/Manual_de_Prevenci_n_y_Tratamiento_de_COVID-19_Traducci_n_/12032154
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet Lond Engl. 2020;395(10223):497-506. https://doi.org/10.1016/S0140-6736(20)30183-5
Kotfis K, Skonieczna-Żydecka K. COVID-19: gastrointestinal symptoms and potential sources of 2019-nCoV transmission. Anaesthesiol Intensive Ther. 2020. https://doi.org/10.5114/ait.2020.93867
Yu ITS, Li Y, Wong TW, Tam W, Chan AT, Lee JHW, et al. Evidence of airborne transmission of the severe acute respiratory syndrome virus. N Engl J Med. 2004;350(17):1731-9. https://doi.org/10.1056/NEJMoa032867
Repici A, Maselli R, Colombo M, Gabbiadini R, Spadaccini M, Anderloni A, et al. Coronavirus (COVID-19) outbreak: what the department of endoscopy should know. Gastrointest Endosc. 2020. https://doi.org/10.1016/j.gie.2020.03.019
Leung WK, To K-F, Chan PKS, Chan HLY, Wu AKL, Lee N, et al. Enteric involvement of severe acute respiratory syndrome-associated coronavirus infection. Gastroenterology. 2003;125(4):1011-7. https://doi.org/10.1016/S0016-5085(03)01215-0
Liu C-L, Lu Y-T, Peng M-J, Chen P-J, Lin R-L, Wu C-L, et al. Clinical and laboratory features of severe acute respiratory syndrome vis-a-vis onset of fever. Chest. 2004;126(2):509-17. https://doi.org/10.1378/chest.126.2.509
Chan JFW, Lau SKP, To KKW, Cheng VCC, Woo PCY, Yuen K-Y. Middle East respiratory syndrome coronavirus: another zoonotic betacoronavirus causing SARS-like disease. Clin Microbiol Rev. 2015;28(2):465-522. https://doi.org/10.1128/CMR.00102-14
Wong SH, Lui RN, Sung JJ. Covid-19 and the Digestive System. J Gastroenterol Hepatol. 2020. https://doi.org/10.1111/jgh.15047
Jin X, Lian J-S, Hu J-H, Gao J, Zheng L, Zhang Y-M, et al. Epidemiological, clinical and virological characteristics of 74 cases of coronavirus-infected disease 2019 (COVID-19) with gastrointestinal symptoms. Gut. 2020. https://doi.org/10.1136/gutjnl-2020-320926
Holshue ML, DeBolt C, Lindquist S, Lofy KH, Wiesman J, Bruce H, et al. First Case of 2019 Novel Coronavirus in the United States. N Engl J Med. 2020;382(10):929-36. https://doi.org/10.1056/NEJMoa2001191
Chan JF-W, Yuan S, Kok K-H, To KK-W, Chu H, Yang J, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet Lond Engl. 2020;395(10223):514-23. https://doi.org/10.1016/S0140-6736(20)30154-9
Lu X, Zhang L, Du H, Zhang J, Li YY, Qu J, et al. SARS-CoV-2 Infection in Children. N Engl J Med. 2020. https://doi.org/10.1056/NEJMc2005073
Zheng F, Liao C, Fan Q-H, Chen H-B, Zhao X-G, Xie Z-G, et al. Clinical Characteristics of Children with Coronavirus Disease 2019 in Hubei, China. Curr Med Sci. 2020. https://doi.org/10.1007/s11596-020-2172-6
Deng Y, Liu W, Liu K, Fang Y-Y, Shang J, Zhou L, et al. Clinical characteristics of fatal and recovered cases of coronavirus disease 2019 (COVID-19) in Wuhan, China: a retrospective study. Chin Med J (Engl). 2020. https://doi.org/10.1097/CM9.0000000000000824
Song Y, Liu P, Shi XL, Chu YL, Zhang J, Xia J, et al. SARS-CoV-2 induced diarrhoea as onset symptom in patient with COVID-19. Gut. 2020. https://doi.org/10.1136/gutjnl-2020-320891
PracticeUpdate [Internet]. [citado 1 de abril de 2020]. Clinical Characteristics of COVID-19 Patients With Digestive Symptoms in Hubei, China. Disponible en: https://www.practiceupdate.com/content/clinical-characteristics-of-covid-19-patients-with-digestive-symptoms-in-hubei-china/98000
Zhang C, Shi L, Wang F-S. Liver injury in COVID-19: management and challenges. Lancet Gastroenterol Hepatol. 2020. https://doi.org/10.1016/S2468-1253(20)30057-1
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet Lond Engl. 2020. https://doi.org/10.1016/S0140-6736(20)30566-3
Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med. 2020. https://doi.org/10.1016/S2213-2600(20)30076-X
Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet Lond Engl. 2020;395(10223):507-13. https://doi.org/10.1016/S0140-6736(20)30211-7
Chau T-N, Lee K-C, Yao H, Tsang T-Y, Chow T-C, Yeung Y-C, et al. SARS-associated viral hepatitis caused by a novel coronavirus: report of three cases. Hepatol Baltim Md. 2004;39(2):302-10. https://doi.org/10.1002/hep.20111
Yao XH, Li TY, He ZC, Ping YF, Liu HW, Yu SC, et al. [A pathological report of three COVID-19 cases by minimally invasive autopsies]. Zhonghua Bing Li Xue Za Zhi. 2020;49(0):E009. https://doi.org/10.3760/cma.j.cn112151-20200312-00193
Abraham C, Cho JH. Inflammatory bowel disease. N Engl J Med. 2009;361(21):2066-78. https://doi.org/10.1056/NEJMra0804647
Baumgart DC, Sandborn WJ. Inflammatory bowel disease: clinical aspects and established and evolving therapies. Lancet Lond Engl. 2007;369(9573):1641-57. https://doi.org/10.1016/S0140-6736(07)60751-X
Juliao Baños F, Ruiz Vélez MH, Flórez Arango JF, Donado Gómez JH, Marín Zuluaga JI, Monsalve Arango C, et al. Phenotypes and natural history of Inflammatory Bowel Disease (IBD) in a referral population in Medellín, Colombia. Rev Colomb Gastroenterol. 2010;25(3):240-51.
Yepes Barreto I de J, Carmona R, Díaz F, Marín-Jiménez I. Prevalencia y características demográficas de la enfermedad inflamatoria intestinal en Cartagena, Colombia. Rev Colomb Gastroenterol. 2010;25(2):107-11.
Reyes M GA, Gil P FL, Carvajal P GD, Sánchez L CB, Aponte M DM, González S CA, et al. Enfermedad inflamatoria intestinal: características de fenotipo y tratamiento en un hospital universitario de Bogotá, Colombia. Rev Colomb Gastroenterol. 2018;33(2):117-26. https://doi.org/10.22516/25007440.196
Fabian J, Omar C. Prevalence of Crohn’s Disease and Ulcerative Colitis in Colombia: Analysis of the Integral Information System of Social Protection (Sispro): P-034. Am J Gastroenterol. 2018;113:S9. https://doi.org/10.14309/00000434-201802001-00034
Yamamoto-Furusho J-K, Parra-Holguín N, Grupo-Colombiano E, Bosques Padilla FJ, Veitia-Velásquez G, Torres E, et al. P749 Epidemiological and clinical characterisation of inflammatory bowel disease (IBD) in Latin America and the Caribbean: The EPI-LATAM IBD study from the Pan American Crohn’s colitis organisation. J Crohns Colitis. 2020;14:S599-600. https://doi.org/10.1093/ecco-jcc/jjz203.877
Guan W-J, Zhong N-S. Clinical Characteristics of Covid-19 in China. Reply. N Engl J Med. 2020;382. https://doi.org/10.1056/NEJMc2005203
Hoffmann M, Kleine-Weber H, Schroeder S, Krüger N, Herrler T, Erichsen S, et al. SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor. Cell. 2020. https://doi.org/10.1016/j.cell.2020.02.052
Harmer D, Gilbert M, Borman R, Clark KL. Quantitative mRNA expression profiling of ACE 2, a novel homologue of angiotensin converting enzyme. FEBS Lett. 2002;532(1-2):107-10. https://doi.org/10.1016/S0014-5793(02)03640-2
Garg M, Royce SG, Tikellis C, Shallue C, Batu D, Velkoska E, et al. Imbalance of the renin-angiotensin system may contribute to inflammation and fibrosis in IBD: a novel therapeutic target? Gut. 2019. https://doi.org/10.1136/gutjnl-2019-318512
Ning L, Shan G, Sun Z, Zhang F, Xu C, Lou X, et al. Quantitative Proteomic Analysis Reveals the Deregulation of Nicotinamide Adenine Dinucleotide Metabolism and CD38 in Inflammatory Bowel Disease. BioMed Res Int. 2019;2019:3950628. https://doi.org/10.1155/2019/3950628
Ibrahim IM, Abdelmalek DH, Elshahat ME, Elfiky AA. COVID-19 spike-host cell receptor GRP78 binding site prediction. J Infect. 2020;80(5):554-562. https://doi.org/10.21203/rs.2.24599/v1
Zhang H, Kang Z, Gong H, Xu D, Wang J, Li Z, et al. The digestive system is a potential route of 2019-nCov infection: a bioinformatics analysis based on single-cell transcriptomes. bioRxiv. 2020. https://doi.org/10.1101/2020.01.30.927806
Vergnolle N. Protease inhibition as new therapeutic strategy for GI diseases. Gut. 2016;65(7):1215-24. https://doi.org/10.1136/gutjnl-2015-309147
Li G, Fan Y, Lai Y, Han T, Li Z, Zhou P, et al. Coronavirus infections and immune responses. J Med Virol. 2020;92(4):424-32. https://doi.org/10.1002/jmv.25685
Sarzi-Puttini P, Giorgi V, Sirotti S, Marotto D, Ardizzone S, Rizzardini G, et al. COVID-19, cytokines and immunosuppression: what can we learn from severe acute respiratory syndrome? Clin Exp Rheumatol. 2020;38(2):337-42.
Qin C, Zhou L, Hu Z, Zhang S, Yang S, Tao Y, et al. Dysregulation of immune response in patients with COVID-19 in Wuhan, China. Clin Infect Dis Off Publ Infect Dis Soc Am. 2020. https://doi.org/10.1093/cid/ciaa248
Maude SL, Barrett D, Teachey DT, Grupp SA. Managing cytokine release syndrome associated with novel T cell-engaging therapies. Cancer J Sudbury Mass. 2014;20(2):119-22. https://doi.org/10.1097/PPO.0000000000000035
Chen C, Zhang XR, Ju ZY, He WF. [Advances in the research of cytokine storm mechanism induced by Corona Virus Disease 2019 and the corresponding immunotherapies]. Zhonghua Shao Shang Za Zhi Zhonghua Shaoshang Zazhi Chin J Burns. 2020;36(0):E005. https://doi.org/10.3760/cma.j.cn501120-20200224-00088
Monteleone G, Pallone F, MacDonald TT. Emerging immunological targets in inflammatory bowel disease. Curr Opin Pharmacol. 2011;11(6):640-5. https://doi.org/10.1016/j.coph.2011.09.013
Govani SM, Higgins PDR. Combination of thiopurines and allopurinol: adverse events and clinical benefit in IBD. J Crohns Colitis. 2010;4(4):444-9. https://doi.org/10.1016/j.crohns.2010.02.009
Lai C-C, Liu YH, Wang C-Y, Wang Y-H, Hsueh S-C, Yen M-Y, et al. Asymptomatic carrier state, acute respiratory disease, and pneumonia due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): Facts and myths. J Microbiol Immunol Infect Wei Mian Yu Gan Ran Za Zhi. 2020. https://doi.org/10.1016/j.jmii.2020.02.012
D’Antiga L. Coronaviruses and immunosuppressed patients. The facts during the third epidemic. Liver Transplant Off Publ Am Assoc Study Liver Dis Int Liver Transplant Soc. 2020. https://doi.org/10.1002/lt.25756
An P, Ji M, Ren H, Su J, Kang J, Yin A, et al. Protection of 318 Inflammatory Bowel Disease Patients from the Outbreak and Rapid Spread of COVID-19 Infection in Wuhan, China. Social Science Research Network. 2020. https://doi.org/10.2139/ssrn.3543590
Secure-IBD Database [Internet]. [citado 1 de abril de 2020]. Coronavirus and IBD Reporting Database. Disponible en: https://covidibd.org/
Monteleone G, Ardizzone S. Are patients with inflammatory bowel disease at increased risk for Covid-19 infection? J Crohns Colitis. 2020. https://doi.org/10.1093/ecco-jcc/jjaa061
Wisniewski A, Kirchgesner J, Seksik P, Landman C, Bourrier A, Nion-Larmurier I, et al. Increased incidence of systemic serious viral infections in patients with inflammatory bowel disease associates with active disease and use of thiopurines. SAGE journal. 2020;8(3):303-313. https://doi.org/10.1177/2050640619889763
Danese S, Cecconi M, Spinelli A. Management of IBD during the COVID-19 outbreak: resetting clinical priorities. Nat Rev Gastroenterol Hepatol. 2020. https://doi.org/10.1038/s41575-020-0294-8
IOIBD [Internet]. IOIBD; 2020 [citado 31 de marzo de 2020]. IOIBD Update on COVID19 for Patients with Crohn’s Disease and Ulcerative Colitis. Disponible en: https://www.ioibd.org/ioibd-update-on-covid19-for-patients-with-crohns-disease-and-ulcerative-colitis/
Crohn’s & Colitis Foundation [Internet]. [citado 31 de marzo de 2020]. What IBD patients should know about the 2019 novel coronavirus (COVID-19). Disponible en: https://www.crohnscolitisfoundation.org/what-ibd-patients-should-know-about-2019-novel-coronavirus-covid-19
Crohn’s & Colitis UK [Internet]. [citado 31 de marzo de 2020]. Coronavirus (COVID-19): FAQs for people with Crohn’s and Colitis. Disponible en: https://www.crohnsandcolitis.org.uk/news/coronavirus-covid-19-advice
Humberto C, Trujillo S, Gutiérrez A, Rodríguez-Morales A, Javier A, Mejía N, et al. Consenso colombiano de atención, diagnóstico y manejo de la infección por SARS-COV-2/COVID-19 en establecimientos de atención de la salud - Recomendaciones basadas en consenso de expertos e informadas en la evidencia. Infectio. 2020;24:1-102. https://doi.org/10.22354/in.v24i3.851
Mao R, Liang J, Shen J, Ghosh S, Zhu L-R, Yang H, et al. Implications of COVID-19 for patients with pre-existing digestive diseases. Lancet Gastroenterol Hepatol. 2020. https://doi.org/10.1016/S2468-1253(20)30076-5
European Crohn’s and Colitis Organisation [Internet]. ECCO; 2020. [citado 31 de marzo de 2020]. ECCO Information on COVID-19. Disponible en: https://www.ecco-ibd.eu/publications/covid-19.html
Nature Medicine [Internet]. [citado 31 de marzo de 2020]. Characteristics of pediatric SARS-CoV-2 infection and potential evidence for persistent fecal viral shedding. Disponible en: https://www.nature.com/articles/s41591-020-0817-4
Ling Y, Xu S-B, Lin Y-X, Tian D, Zhu Z-Q, Dai F-H, et al. Persistence and clearance of viral RNA in 2019 novel coronavirus disease rehabilitation patients. Chin Med J (Engl). 2020. https://doi.org/10.1097/CM9.0000000000000774
Wang W, Xu Y, Gao R, Lu R, Han K, Wu G, et al. Detection of SARS-CoV-2 in Different Types of Clinical Specimens. JAMA. 2020. https://doi.org/10.1001/jama.2020.3786
Xie X, Li F, Chen J-W, Wang J. Risk of tuberculosis infection in anti-TNF-α biological therapy: from bench to bedside. J Microbiol Immunol Infect Wei Mian Yu Gan Ran Za Zhi. 2014;47(4):268-74. https://doi.org/10.1016/j.jmii.2013.03.005
Zingone F, Savarino EV. Viral screening before initiation of biologics in patients with inflammatory bowel disease during the COVID-19 outbreak. Lancet Gastroenterol Hepatol. 2020. https://doi.org/10.1016/S2468-1253(20)30085-6
Regino WO, Zuleta MAG, Arango LAA, Morales OFR, Fernández HM, Riveros J, et al. Procedimientos endoscópicos y pandemia COVID19. Consideraciones básicas. Rev Colomb Gastroenterol. 2020;35(1):65-75. https://doi.org/10.22516/25007440.526
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