Documented gastrointestinal manifestations in coronavirus disease 2019 (COVID-19) patients include anorexia, nausea, vomiting, abdominal pain, and diarrhea. These gastrointestinal manifestations may predate more commonly described signs and respiratory symptoms, such as cough and fever, by several days (de Souza et al., Song et al., Wang et al.).
The prevalence of gastrointestinal symptoms in COVID-19 patients at the time of initial presentation for medical evaluation ranges between 1% to 17% (Chen et al., de Souza et al., Gu et al., Guan et al., Huang et al., Jin et al., Luo et al., Ng & Tilg, Young et al.). Table 1 profiles the relative prevalence of gastrointestinal symptoms and average transaminase values in 183 patients that initially presented with gastrointestinal symptoms only and were subsequently diagnosed with COVID-19 infection.
Importantly, up to 16% of patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may present primarily with gastrointestinal symptoms and not initially exhibit fever or respiratory manifestations (Luo et al.). Mild-to-moderate elevations in serum transaminases (AST and ALT) were noted upon initial hospitalization (Chen et al., Huang et al., Luo et al., Parohan et al., Wang et al.). SARS-CoV-2 is the presumed pathogen causing these symptoms. Angiotensin-converting enzyme 2 (ACE2) receptors have been identified as the attachment site for the spike protein of the SARS-CoV-2 virus and facilitate cell entry. ACE2 receptors have been identified in the upper and stratified epithelial cells of the esophagus as well as the absorptive enterocytes of the ileum (Zhang et al.).
The pathophysiology and transmission routes of COVID-19–induced gastrointestinal disease is under active investigation. COVID-19 patients have been found to shed SARS-CoV-2 in throat swabs and stool samples for up to 2 to 3 weeks (respectively) following initial diagnosis (Gu et al., Ng & Tilg, Tan et al., Young et al.).
To date, characteristic gastrointestinal ultrasound findings in COVID-19-infected patients have not been described. An important application of ultrasound in COVID-positive or rule-out COVID patients presenting with gastrointestinal symptoms is to identify alternative etiologies for these symptoms (e.g., small bowel obstruction).
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