key: cord-0964746-wc40gouw
authors: Wilson, M.P.; Katlariwala, P.; Low, G.
title: Potential implications of novel coronavirus disease (COVID-19) related gastrointestinal symptoms for abdominal imaging
date: 2020-05-01
journal: Radiography (Lond)
DOI: 10.1016/j.radi.2020.04.016
sha: a761f4e4afaab0a83f66f9be05cf1a3888529023
doc_id: 964746
cord_uid: wc40gouw

nan

The number of cases of novel coronavirus disease (COVID-19) has risen dramatically across the world in recent weeks. The most frequently reported symptoms in a recent meta-analysis of 46,248 infected patients include fever (91%), cough (67%), fatigue (51%), and dyspnea (30%). 1 However, a recent review has demonstrated that gastrointestinal symptoms including anorexia (40e50%), diarrhea (2e50%), vomiting (4e67%), nausea (1e29%), abdominal pain (2e6%) and gastrointestinal bleeding (4e14%) may also occur in patients with COVID-19. 2 In some cases, gastrointestinal symptoms may be the only presenting findings. 3 Studies have shown that the ACE2 receptor, the host cell receptor responsible for mediating infection by COVID-19, is highly expressed in absorptive enterocytes of the bowel, in addition to the lungs. 4 The presence of COVID-19 in the gastrointestinal system is supported by fecal RT-PCR positivity in some patients. 5 The rise in reporting of gastrointestinal symptoms related to COVID-19 has important potential implications for radiographers. Firstly, it's necessary to recognize that while uncommon, gastrointestinal symptoms may be the presenting finding of COVID-19 in some patients. This highlights the need for stringent cleanliness and strict adherence to regional public health recommendations in radiology departments, regardless of respiratory-related patient symptomatology. Secondly, radiographers should be prepared that the number of requests for COVID-19 related abdominal imaging may increase. For instance, exclusion of secondary causes for abdominal pain may be requested in patients with suspected or known COVID-19 disease. Abdominal organs with high concentrations of ACE2 expression may be theoretically vulnerable to COVID-19 related infections. These sites notably include the esophagus, ileum, kidneys, and bladder. 6 In particular, the ileum contains approximately 30% ACE2-positive epithelial cells. At the present time, there are no known imaging reports of COVID-19 related inflammatory changes in these abdominal organs. Finally, imaging requests to evaluate the cause of gastrointestinal bleeding may increase as the number of suspected or confirmed COVID-19 cases continue to rise. This may be especially true if these patient demonstrates bright red blood per rectum, declining hemoglobin, and/or hemodynamic instability.

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None to declare.

Prevalence of comorbidities in the novel Wuhan coronavirus (COVID-19) infection a systematic review and meta-analysis

Gastrointestinal features in COVID-19 and the possibility of fecal transmission

Clinical features of 2019 novel coronavirus pneumonia presented gastrointestinal symptoms but without fever onset

The digestive system is a potential route of 2019-nCov infection: a bioinformatics analysis based on single-cell transcriptomes

COVID-19: faecal-oral transmission? Nat Rev Gastroenterol Hepatol 2020. Epub ahead of print

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 Times

Low Department of Radiology and Diagnostic Imaging

None.