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World J Gastrointest Surg. Jun 27, 2021; 13(6): 548-562
Published online Jun 27, 2021. doi: 10.4240/wjgs.v13.i6.548
Association between acute pancreatitis and COVID-19 infection: What do we know?
Beata Jabłońska, Marek Olakowski, Sławomir Mrowiec
Beata Jabłońska, Marek Olakowski, Sławomir Mrowiec, Department of Digestive Tract Surgery, Medical University of Silesia, Katowice 40-752, Poland
Author contributions: Jabłońska B wrote this paper; Olakowski M and Mrowiec S revised this paper; all authors have read and approved the final manuscript.
Conflict-of-interest statement: No conflict of interest exists.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Beata Jabłońska, MD, PhD, Adjunct Professor, Department of Digestive Tract Surgery, Medical University of Silesia, Medyków 14, Katowice 40-752, Poland. bjablonska@poczta.onet.pl
Received: February 14, 2021
Peer-review started: February 14, 2021
First decision: March 16, 2021
Revised: March 25, 2021
Accepted: May 8, 2021
Article in press: May 8, 2021
Published online: June 27, 2021
Processing time: 123 Days and 16.7 Hours
Abstract

The disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also called coronavirus disease 2019 (COVID-19), first originated in Wuhan, China, displaying atypical pneumonia-like respiratory symptoms in affected patients. SARS-CoV-2 primarily attacks the respiratory system, and the most common symptoms include cough, shortness of breath, and fever. However, its impact on the digestive system has been shown, and various clinical gastrointestinal manifestations of this disease have been recognized. Some reports have shown acute pancreatitis (AP) as the initial symptom in patients with COVID-19. AP may be a consequence of direct pancreatic damage by the virus because pancreatic acinar cells contain angiotensin-converting enzyme 2 receptor proteins, and SARS-CoV-2 can bind to these receptors, causing pancreatic injury. Moreover, AP may be a secondary indicator of cytokine storms and altered inflammatory responses. Our review of the literature shows that SARS-CoV-2 appears to be a new etiological infectious factor related to AP. In this manuscript, a comprehensive review of case reports and case series of patients with AP and COVID-19 is presented. All reports on COVID-19-associated AP are summarized. All cases are thoroughly analyzed and discussed in-depth.

Keywords: SARS-CoV-2; COVID-19; Acute pancreatitis; Angiotensin-converting enzyme 2

Core Tip: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) appears to be a new etiological infectious factor of acute pancreatitis (AP). AP in coronavirus disease 2019 (COVID-19) patients may be caused by direct attack of SARS-CoV-2 to pancreatic acinar cells or indirect, uncontrollable systemic inflammatory response from cytokine storm syndrome leading to multi-organ dysfunction including pancreatic injury or locoregional vasculitis and thrombotic microangiopathy from COVID-19. To our knowledge, there is no such comprehensive review with a detailed description of various articles on this topic including case reports and cohort studies.