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There is an incidence of digestive symptoms as well as abnormal liver-associated enzymes in infected patients.
These are postulated to be related to the virus's use of ACE-2 receptors located on certain intestinal cells, cholangiocytes, and hepatocytes.
During Endoscopies, Infiltrate of occasional lymphocytes was observed in the esophageal squamous epithelium.
In lamina propria of the stomach, duodenum, and rectum, numerous infiltrating plasma cells and lymphocytes with interstitial edema were seen.
SARS-CoV-2 was detected in the peritoneal fluid at a higher concentration than in the respiratory tract.
A considerable proportion of COVID-19 patients can present initially with only digestive complaints.
The most common digestive symptoms are anorexia, nausea, vomiting, and diarrhea. Anorexia could be a symptom resulting due to loss of taste primarily present in the majority of COVID-19 positive patients.
Liver-related transaminases (SGOT, SGPT) are elevated in a substantial proportion of patients, although generally only mildly elevated. This short elevation is seen in a very short span of time.
SARS CoV2 virus RNA was also detected in the stools of infected individuals, however, how long the viral shedding continues- is still under research.
Researchers are also looking into the possibility of feco-oral transmission of COVID-19 infection. Endoscopies performed in COVID-19 positive patients showed no significant damage to the mucosal epithelium of esophagus, stomach, duodenum or even rectum.
In more than 20% of patients with SARS-CoV-2, it was observed that the test result for viral RNA remained positive in feces, even after test results for viral RNA in the respiratory tract converted to negative, indicating that the viral gastrointestinal infection and potential fecal-oral transmission can last even after viral clearance in the respiratory tract.