- The incidence of diarrhea is varying from 2% to 33% and may be underestimated in clinical publications
- ACE2, a known receptor used by SARS-CoV2 to enter cells, is more expressed in proximal and distal enterocytes
- SARS-CoV2 appears to invade mucosal cells of the stomach, small intestine and colon where it multiplies and creates virions.2
- SARS-CoV is completely inactivated by acidic pH, so for SARS-CoV2 to invade the stomach, the pH must be neutral.2
- Conditions resulting in increased pH (atrophic gastritis, gastrointestinal metaplasia, the use of proton pump inhibitors or potassium-competitive acid blockers) may promote the entry of SARS-CoV2 into stomach epithelial cells.2
This data comes from 2 studies. Liang W. et al. did a postscript letter based on three publications who studied the incidence of SARS-CoV2 symptoms. Among these symptoms, they studied the incidence of diarrhea and its relationship with COVID-19. Uno Y. et al. performed gastrointestinal endoscopy and biopsy on patient with positive stool samples.
- Liang W., Feng Z., Rao S., et al (February 26, 2020). Diarrhoea may be underestimated: A missing link in 2019 novel coronavirus. Gut. https://doi.org/10.1136/gutjnl-2020-320832
- Uno Y (April 2, 2020). Why does SARS-CoV-2 invade the gastrointestinal epithelium?, Gastroenterology. https://doi.org/10.1053/j.gastro.2020.04.006