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      COVID-19 aus der Sicht der Gastroenterologie Translated title: COVID-19 du point de vue de la gastro-entérologie Translated title: COVID-19 dal punto di vista della gastroenterologia

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          Abstract

          Das „severe acute respiratory syndrome coronavirus 2“ (SARS-CoV-2) verursacht die Coronaviruserkrankung (COVID-19), die aktuell pandemisch ist und sich mit einer infektiösen Pneumonie manifestiert. Neben den typischen Symptomen, wie Fieber, Husten und Dyspnoe, entwickeln einige Patienten auch gastrointestinale und hepatische Manifestationen, die sich meist als Diarrhö, Nausea, Erbrechen und Abdominalschmerzen bemerkbar machen. Von hepatischer Seite können erhöhte Leberenzyme beobachtet werden. SARS-CoV‑2 kann den Gastrointestinaltrakt via den Rezeptor „angiotensin converting enzyme 2“ infizieren, der auf den Enterozyten des Ileums und Kolons exprimiert wird. Virale RNA wurde im Stuhl vom COVID-19-Patienten isoliert, was die Möglichkeit offenlässt, dass SARS-CoV‑2 neben der Tröpfcheninfektion auch mittels fäkal-oraler Transmission übertragen werden kann. Der Einfluss von SARS-CoV‑2 auf zugrunde liegende Erkrankungen des Gastrointestinaltrakts und des hepatobiliären Systems wird aktuell ausführlich untersucht. Dieser Artikel soll einen kurzen Überblick verschaffen bezüglich gastroenterologischer und hepatologischer Manifestationen von COVID-19 sowie des Einflusses von COVID-19 auf zugrunde liegende, chronische gastroenterologische Erkrankungen.

          Résumé

          Le «severe acute respiratory syndrome coronavirus 2» (SARS-CoV-2) provoque une maladie à coronavirus (COVID-19), qui est actuellement pandémique et se manifeste par une pneumonie infectieuse. En plus des symptômes typiques, tels que la fièvre, la toux et la dyspnée, certains patients développent également des manifestations gastro-intestinales et hépatiques, qui se manifestent généralement par la diarrhée, la nausée, le vomissement et les douleurs abdominales. Une augmentation des enzymes hépatiques peut être observée du côté hépatique. Le SARS-CoV‑2 peut infecter le tractus gastro-intestinal via le récepteur «angiotensin converting enzyme 2», qui est exprimé sur les entérocytes de lʼiléon et du côlon. LʼARN viral a été isolé dans les selles du patient atteint de COVID-19, ce qui laisse la possibilité que le SARS-CoV‑2 puisse être transmis par voie fécale-orale en plus de lʼinfection par les gouttelettes. Lʼinfluence du SARS-CoV‑2 sur les maladies sous-jacentes du tractus gastro-intestinal et du système hépatobiliaire est actuellement étudiée en détail. Cet article vise à donner un bref aperçu des manifestations gastro-entérologiques et hépatologiques de COVID-19 et de lʼinfluence de COVID-19 sur les maladies gastro-entérologiques chroniques sous-jacentes.

          Riassunto

          La „severe acute respiratory syndrome coronavirus 2“ (SARS-CoV-2) causa la malattia coronavirus (COVID-19), che è attualmente una pandemia e si manifesta con una polmonite infettiva. Oltre ai sintomi tipici, come febbre, tosse e dispnea, alcuni pazienti sviluppano anche manifestazioni gastrointestinali ed epatiche, che di solito si manifestano con diarrea, nausea, vomito e dolori addominali. Lʼaumento degli enzimi epatici può essere osservato dal lato epatico. La SARS-CoV‑2 può infettare il tratto gastrointestinale attraverso il recettore „angiotensin converting enzyme 2“, che si esprime sugli enterociti dellʼileo e del colon. LʼRNA virale è stato isolato nelle feci dei pazienti affetti da COVID-19, il che lascia aperta la possibilità che la SARS-CoV‑2 possa essere trasmessa tramite trasmissione orale e fecale oltre allʼinfezione da goccioline. Lʼinfluenza della SARS-CoV‑2 sulle malattie sottostanti del tratto gastrointestinale e del sistema epatobiliare è attualmente oggetto di unʼindagine approfondita. Questo articolo intende fornire una breve panoramica delle manifestazioni gastroenterologiche ed epatologiche di COVID-19 e dellʼinfluenza di COVID-19 sulle malattie gastroenterologiche croniche sottostanti.

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          Most cited references14

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          Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

          Summary Background A recent cluster of pneumonia cases in Wuhan, China, was caused by a novel betacoronavirus, the 2019 novel coronavirus (2019-nCoV). We report the epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of these patients. Methods All patients with suspected 2019-nCoV were admitted to a designated hospital in Wuhan. We prospectively collected and analysed data on patients with laboratory-confirmed 2019-nCoV infection by real-time RT-PCR and next-generation sequencing. Data were obtained with standardised data collection forms shared by WHO and the International Severe Acute Respiratory and Emerging Infection Consortium from electronic medical records. Researchers also directly communicated with patients or their families to ascertain epidemiological and symptom data. Outcomes were also compared between patients who had been admitted to the intensive care unit (ICU) and those who had not. Findings By Jan 2, 2020, 41 admitted hospital patients had been identified as having laboratory-confirmed 2019-nCoV infection. Most of the infected patients were men (30 [73%] of 41); less than half had underlying diseases (13 [32%]), including diabetes (eight [20%]), hypertension (six [15%]), and cardiovascular disease (six [15%]). Median age was 49·0 years (IQR 41·0–58·0). 27 (66%) of 41 patients had been exposed to Huanan seafood market. One family cluster was found. Common symptoms at onset of illness were fever (40 [98%] of 41 patients), cough (31 [76%]), and myalgia or fatigue (18 [44%]); less common symptoms were sputum production (11 [28%] of 39), headache (three [8%] of 38), haemoptysis (two [5%] of 39), and diarrhoea (one [3%] of 38). Dyspnoea developed in 22 (55%) of 40 patients (median time from illness onset to dyspnoea 8·0 days [IQR 5·0–13·0]). 26 (63%) of 41 patients had lymphopenia. All 41 patients had pneumonia with abnormal findings on chest CT. Complications included acute respiratory distress syndrome (12 [29%]), RNAaemia (six [15%]), acute cardiac injury (five [12%]) and secondary infection (four [10%]). 13 (32%) patients were admitted to an ICU and six (15%) died. Compared with non-ICU patients, ICU patients had higher plasma levels of IL2, IL7, IL10, GSCF, IP10, MCP1, MIP1A, and TNFα. Interpretation The 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality. Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies. Funding Ministry of Science and Technology, Chinese Academy of Medical Sciences, National Natural Science Foundation of China, and Beijing Municipal Science and Technology Commission.
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            Clinical Characteristics of Coronavirus Disease 2019 in China

            Abstract Background Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients. Methods We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in mainland China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Results The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission. Conclusions During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.)
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              SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor

              Summary The recent emergence of the novel, pathogenic SARS-coronavirus 2 (SARS-CoV-2) in China and its rapid national and international spread pose a global health emergency. Cell entry of coronaviruses depends on binding of the viral spike (S) proteins to cellular receptors and on S protein priming by host cell proteases. Unravelling which cellular factors are used by SARS-CoV-2 for entry might provide insights into viral transmission and reveal therapeutic targets. Here, we demonstrate that SARS-CoV-2 uses the SARS-CoV receptor ACE2 for entry and the serine protease TMPRSS2 for S protein priming. A TMPRSS2 inhibitor approved for clinical use blocked entry and might constitute a treatment option. Finally, we show that the sera from convalescent SARS patients cross-neutralized SARS-2-S-driven entry. Our results reveal important commonalities between SARS-CoV-2 and SARS-CoV infection and identify a potential target for antiviral intervention.
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                Author and article information

                Contributors
                alain.schoepfer@chuv.ch
                michael.scharl@usz.ch
                Journal
                Schweiz. Gastroenterol.
                Schweizer Gastroenterologie
                Springer Vienna (Vienna )
                2662-7140
                2662-7159
                13 July 2020
                : 1-3
                Affiliations
                [1 ]GRID grid.8515.9, ISNI 0000 0001 0423 4662, Division de Gastroentérologie et d’hépatologie, , Centre Hospitalier Universitaire Vaudois (CHUV) et Université de Lausanne, ; Rue de Bugnon 44, 07/2425, 1011 Lausanne, Schweiz
                [2 ]GRID grid.412004.3, ISNI 0000 0004 0478 9977, Department für Gastroenterologie und Hepatologie, , Universitätsspital Zürich, ; Rämistrasse 100, 8091 Zürich, Schweiz
                Article
                16
                10.1007/s43472-020-00016-w
                7375696
                77587fb2-b892-4a4e-b8f4-7a3d4c2931c7
                © Springer-Verlag GmbH Austria, ein Teil von Springer Nature 2020

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

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                sars-cov-2,gastroenterologie,hepatologie,chronisch entzündliche darmerkrankungen,lungenversagen,gastro-entérologie,hépatologie,maladies gastro-entérologiques chroniques,insuffisance pulmonaire,gastroenterologia,epatologia,malattie gastroenterologiche croniche,insufficienza polmonare

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