Potential Severe Coronavirus Complications for GI Patients

Those with Barrett’s esophagus and other gastrointestinal tract problems could be at higher risk for developing or experiencing more severe complications from the novel coronavirus (COVID-19), according to a paper published in Gastroenterology.

The study authors, from Washington University in St. Louis said that as gastrointestinal symptoms are prominent in COVID-19, and live virus can be detected in the tract and stool, they wanted to determine if individuals with GI tract problems would have increased potential for severe disease and symptoms. They suggested that intestinal metaplasia could present a novel and/or unappreciated route of viral entry for individuals with these types of disorders.

Investigators collected human tissue blocks from 30 Barrett’s esophagus patients and used an ex vivo model to test if Barrett’s was susceptible to COVID-19. They learned that all of the samples had receptors for the SARS-CoV-2 virus, which are lacking in normal esophageal cells. The virus was able to infect the organoids from the Barrett’s esophagus patients. Additionally, the cultured organoid resembled an intestine, the investigators noted, and more virus bound to that culture.

“There is no evidence yet that people with Barrett’s esophagus have higher rates of COVID-19 or are at any greater risk, but part of the reason is because that hasn’t been studied,” senior investigator Jason C. Mills, MD, PhD said in a press release. “Now that we’ve connected these dots, it may be worthwhile to look and see whether people with Barrett’s have higher rates of infection.”

Ultimately, the study authors said that their results may serve as a novel in vivo niche for COVID-19 and that viral entry may increase with “increasing intestinalization.”

“The worry would be that, particularly for Barrett’s patients, there even may be a susceptibility to infection from foods containing viral particles,” Mills said. “This study provides data to indicate that we need to take a closer look to investigate whether a substantial portion of the population may be susceptible to infection through what they swallow.”

Patients with Barrett’s esophagus are almost always treated with proton pump inhibitors, the study authors also noted. Those with other gastric intestinal metaplasia almost always have loss of acid secreting parietal cells. These factors combined, the study authors posited, leads to a decreased ability for the stomach to produce acid and therefore may contribute epidemiologically, alongside age and male sex, to being susceptible to COVID-19.

Further studies should focus on any additional risk posed by ectopic proximal expression and include an infection of a broader panel of organoids that vary in their intestinal differentiation, the study authors said. And eventually large-scale studies should be conducted retrospectively and correlate with autopsy series to analyze COVID-19 outcome compared to viral load and the extent of the deceased’s metaplasia.

As early as March, Contagion® has reported on the idea that gastrointestinal symptoms could be a focus for coronavirus diagnosis. In 2 papers, investigators from China detailed how COVID-19 patients had gastrointestinal symptoms including diarrhea, nausea, vomiting and abdominal discomfort, as well as occasional loose bowel movements. These papers also noted that mild to moderate liver injury present in early COVID-19 patients.