MEDIX, God. 28 Br. 153/154  •  Pregledni članak  •  Gastroenterologija HR ENG

Crijevna sluznica i COVID-19Gut mucosa and COVID-19

Sanda Mustapić, Ida Tješić-Drinković, Biljana Knežević, Žarko Babić, Marko Banić

SARS CoV-2, koji izaziva bolest COVID-19 (engl. CoronaVirus Disease 2019) u organizam ulazi putem ACE2 receptora i TMPRSS2 na stanicama dišnoga i gastrointestinalnoga sustava i uzrokuje gastrointestinalne simptome u do 53% bolesnika. Prema učestalosti simptoma najzastupljeniji su: gubitak apetita, proljev, mučnina i povraćanje te bol u trbuhu. Prisutnost simptoma u gastrointestinalnome sustavu, posebno bolova u trbuhu upućuje na teži tijek bolesti s mogućnošću razvoja akutnoga respiratornoga distresnoga sindroma (ARDS). Postoje dvije teorije dospijevanja virusa u gastrointestinalni sustav, jedna je oralno-fekalni put prijenosa virusa dok je druga krvožilnim putem. Oralno-fekalni put nije potvrđen jer infektivni oblik virusa nije izoliran iz stolice već samo iz intestinalnoga tkiva. Detekcija virusa RNK u stolici ne znači i širenje infektivnoga virusa i izazivanje bolesti. Od značenja je da se virus u crijevu zadržava još neko vrijeme nakon negativnoga obriska iz nosa. Produljeno izlučivanje virusnoga RNK u stolici u odnosu na uzorke iz respiratornoga sustava zabilježeno je u 70,3% bolesnika. SARS CoV-2 djeluje na mikrobiom narušujući biološku raznolikost uz porast oportunističkih te reduciran broj komenzalnih bakterija. Dio simptoma COVID-a 19 kao što je proljev objašnjava se narušenom funkcijom ACE2-receptora te posljedičnom disregulacijom crijevnih ionskih transportera i prodorom virusa u submukozu

Ključne riječi:
mikrobiota; SARS CoV-2; sluznica probavnoga sustava

Članak u cijelosti pročitajte u tiskanom izdanju MEDIX, God. 28 Br. 153/154
narudžba izdanja

SARS CoV-2 which causes COVID-19 enters the organism using ACE2 receptors and TMPRSS2. The receptors are found on the cells of the respiratory and gastrointestinal system, causing gastrointestinal symptoms in up to 53% of patients. The most common gastrointestinal symptoms are: loss of appetite, diarrhea, nausea, vomiting and abdominal pain. Gastrointestinal symptoms, especially the abdominal pain, indicate a worse clinical outcome with a higher possibility of acute respiratory distress syndrome (ARDS) development. There are two theories on how the virus enters the gastrointestinal system: the oral-fecal route, and through the vascular system. The oral-fecal route has not been confirmed since the virus has only been found in the gastrointestinal tissue and not in the stool. Detection of RNA virus in the stool dose not mean the spread of the infectious virus and causing the disease. Prolonged excretion of RNA virus in stool has been recorded in 70.3% of the patients in comparison to samples from the respiratory tract. SARS CoV-2 influences the microbiom by disrupting the normal bio-diversity with increase in opportunistic bacteria and reduction of comensal bacteria. One part of COVID-19 symptoms, like diarrhea, are explained by disturbed function of ACE2 receptor and consequent dysregulation of intestinal ion transporters and the penetration of the virus into the submucosa

Key words:
gastrointestinal mucosa; microbiota; SARS CoV-2