key: cord-0778209-2fb4z0dr
authors: Gao, Qin Yan; Chen, Ying Xuan; Fang, Jing Yuan
title: 2019 Novel coronavirus infection and gastrointestinal tract
date: 2020-03-10
journal: J Dig Dis
DOI: 10.1111/1751-2980.12851
sha: cc3398af0d3d1293112892056560a65b9b7e88d7
doc_id: 778209
cord_uid: 2fb4z0dr

Since end of December 2019, a cluster of patients with pneumonia of unknown origin was reported from Wuhan, Hubei province, China. As of Feb 17th, 2020, statistical data show that the outbreak constitutes an epidemic threat in China, where the exponential increase in patients has reached 75114 confirmed cases, with 2239 deaths. Different from SARS-CoV (severe acute respiratory syndrome coronavirus) and MERS-CoV (Middle East respiratory syndrome coronavirus) infection, the initial presentations or the chief complain of some patients with the 2019 novel coronavirus (COVID-19) were gastrointestinal symptoms. So we call upon all the first-line medical staff to be cautious and pay more attention to those untypical patients especially from the epidemic area. Besides, as the viral nucleic acids could be found in the fecal samples and anal swabs of some patients with COVID-19 infection, the possibility of fecal-oral transmission need to be took into account. Based on the previously and recently studies, we speculate that COVID-19 may have some relationship with the gut microbiota through angiotensin-converting enzyme 2 (ACE2) receptor, thus targeting gut microbiota might be a new therapeutic option for the treatment of virus-related pneumonia. This article is protected by copyright. All rights reserved.

However, the connection between the lung and the gastrointestinal tract is not completely understood. It is well known that the respiratory tract houses its own microbiota, but patients with respiratory infections generally have gut dysfunction or secondary gut dysfunction complications, which are related to a more severe clinical course of the disease, thus indicating gut-lung crosstalk. This phenomenon can also be observed in the patients with COVID-19.

Numerous studies have shown that modulating gut microbiota can reduce enteritis and ventilator-associated pneumonia, and it can reverse certain side effects of antibiotics to avoid early influenza virus replication in lung epithelia. 8 Currently, there is no direct clinical evidence that the modulation of gut microbiota plays the therapeutic role in the treatment of COVID-19, but we speculate that targeting gut microbiota may be a new therapeutic option or at least an adjuvant therapeutic choice. In early February, the guidance (ver- Huge efforts from the Chinese government and accelerated related research have been done over this period. Although no specific antiviral treatment has been recommended to date, we speculate that probiotics may modulate the gut microbiota to alter the gastrointestinal symptoms favorably and may also protect the respiratory system. Further studies may focus on this point. It would be interesting to investigate whether the benefits of ACE2 on pulmonary disease may be mediated via modulation of gut and/or lung microbiota. Finally, we call upon all first-line medical staffs to be cautious and pay more attention to atypical patients with an initial presentation of gastrointestinal symptoms, espe-

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