Intestinal ischemic manifestations of SARS-CoV-2: Results from the ABDOCOVID multicentre study

doi:10.3748/wjg.v27.i32.5448

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World Journal of Gastroenterology

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World J Gastroenterol. Aug 28, 2021; 27(32): 5448-5459
Published online Aug 28, 2021. doi: 10.3748/wjg.v27.i32.5448

Intestinal ischemic manifestations of SARS-CoV-2: Results from the ABDOCOVID multicentre study

Lorenzo Norsa, Pietro Andrea Bonaffini, Maja Caldato, Cristiana Bonifacio, Aurelio Sonzogni, Amedeo Indriolo, Clarissa Valle, Federica Furfaro, Alice Bonanomi, Paolo Niccolò Franco, Mauro Gori, Veronica Smania, Lucia Scaramella, Laura Forzenigo, Maurizio Vecchi, Monica Solbiati, Giorgio Costantino, Silvio Danese, Lorenzo D'Antiga, Sandro Sironi, Luca Elli

Lorenzo Norsa, Lorenzo D'Antiga, Department of Pediatric Gastroenterology Hepatology and Transplantation, ASST Papa Giovanni XXIII, Bergamo 24127, Italy

Pietro Andrea Bonaffini, Clarissa Valle, Sandro Sironi, Department of Radiology Papa Giovanni XXIII Bergamo, University of Milano-Bicocca, Milan 20126, Italy

Maja Caldato, Fondazione IRCCS Ca’ Granda, Department of Emergency Medicine, Ospedale Maggiore Policlinico, Milano 20122, Italy

Cristiana Bonifacio, Department of Radiology, Humanitas Clinical and Research Center, IRCCS, Rozzano 20089, Italy

Aurelio Sonzogni, Department of Pathology, ASST Papa Giovanni XXIII, Bergamo 24127, Italy

Amedeo Indriolo, Department of Gastroenterology and Endoscopy, ASST Papa Giovanni XXIII, Bergamo 24127, Italy

Federica Furfaro, Silvio Danese, IBD Center, Humanitas Clinical and Research Center IRCCS, Humanitas University, Rozzano 20089, Italy

Alice Bonanomi, Paolo Niccolò Franco, Sandro Sironi, Post-Graduate School of Diagnostic Radiology, University of Milano-Bicocca, Milano 20126, Italy

Mauro Gori, Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo 24127, Italy

Veronica Smania, Lucia Scaramella, Maurizio Vecchi, Luca Elli, Department of Gastroenterology and Endoscopy, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano 20122, Italy

Veronica Smania, Lucia Scaramella, Maurizio Vecchi, Luca Elli, Department of Pathophysiology and Transplantation, University of Milan, Milano 20122, Italy

Laura Forzenigo, Department of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano 20122, Italy

Monica Solbiati, Giorgio Costantino, Fondazione IRCCS Ca’ Granda, Department of Emergency Medicine, Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Milano 20122, Italy

Author contributions: Caldato M, Bonifacio C, Valle C, Furfaro F, Gori M, Smania V and Scaramella L did data acquisition; Norsa L, Bonaffini PA, Sonzogni A and Indriolo A drafted the manuscript; Norsa L, Bonanomi A and Franco PN did the figures selection and production; Forzenigo L, Vecchi M, Solbiati M, Costantino G, Danese S, D’Antiga L, Sironi S and Elli L critically reviewed the paper.

Institutional review board statement: The study was reviewed and approved by the ASST Papa Giovanni XXIII Institutional Review Board, No. 2020-0096.

Informed consent statement: Informed consent from patients was waived because of the retrospective nature of the study.

Conflict-of-interest statement: The authors declare no conflict of interest and no financial support for this study.

Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at lnorsa@asst-pg23.it.

STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.

Corresponding author: Lorenzo Norsa, PhD, Doctor, Department of Pediatric Gastroenterology Hepatology and Transplantation, ASST Papa Giovanni XXIII, Piazza OMS 1, Bergamo 24127, Italy. lnorsa@asst-pg23.it

Received: March 26, 2021
Peer-review started: March 26, 2021
First decision: April 29, 2021
Revised: April 30, 2021
Accepted: July 23, 2021
Article in press: July 23, 2021
Published online: August 28, 2021
Processing time: 151 Days and 19.4 Hours

ARTICLE HIGHLIGHTS

Research background

Clinical manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus are heterogenous and can affect different organs, including the gastrointestinal tract. Angiotensin converting enzyme 2 receptor, which mediates SARS-CoV-2 infection, is abundantly present in the intestinal mucosa.

Research motivation

Since the cytokine storm mediated by SARS-CoV-2 in coronavirus disease 19 (COVID-19) seems to determine a vascular damage which could explain hypercoagulability and pulmonary embolism, intestinal ischemic events in SARS-CoV-2 positive patients may be linked to the same pathogenic mechanism.

Research objectives

The aim of the present study is to collect and analyse the intestinal ischemic events in SARS-CoV-2 positive patients in order to calculate the incidence and determine the prognosis of affected subjects.

Research methods

The study was designed as a retrospective observational multicentre collection involving three among the largest COVID hospitals in Lombardy.

Research results

Intestinal ischemia is a rare but fatal manifestation of SARS-CoV-2 infection. The condition should be suspected in case of severe abdominal pain. In order to define localization and extent of intestinal ischemia, abdominal computed tomography scan and possibly endoscopy should be carried out. Intestinal biopsies main finding is endotheliitis.

Research conclusions

Severe endotheliitis in the intestinal mucosa could mediate intestinal ischemic manifestations in the gastrointestinal tract. Such manifestations are rare but frequently fatal, thus they should be ruled out in SARS-CoV-2 positive patients with gastrointestinal symptoms.

Research perspectives

One of the possible mechanisms of ischemic intestinal manifestations of SARS-CoV-2 could be mediated by mannan-binding lectin-associated serine protease-2 which is also a possible target for future therapy of COVID-19.