Clinical and laboratory aspects of gastrointestinal tract damage in COVID-19
The new coronavirus infection is a disease with a complex pathogenetic mechanism manifestating in the defeat of almost all organs and systems. In the context of the COVID-19 pandemic, along with the study of the respiratory manifestations most typical for this infection, studies to assess the incidence and clinical significance of extrapulmonary lesions, as well as to study the dynamics of a number of laboratory parameters are relevant. The aim is to study the clinical manifestations of gastrointestinal tract lesions in patients with COVID-19 and to assess the dynamics of individual laboratory parameters in different forms of the disease. Materials and methods. The observation group consisted of 366 medical workers who had recovered from a new coronavirus infection in 2020. During the acute period of the disease, they underwent laboratory examination, it including an assessment of biochemical parameters characterizing damage to the liver and biliary tract (AST, ALT, total bilirubin, alkaline phosphatase), damage to the pancreas (amylase), kidney (creatinine, urea), impaired protein metabolism (total protein), lipid metabolism (cholesterol), carbohydrate metabolism (glucose), damage to muscle tissue and various internal organs (creatinine phosphokinase, lactate dehydrogenase), systemic inflammatory response (C-reactive protein). The online questionnaire developed by the authors was used to clarify the clinical manifestations of the disease. Results and discussion. In the majority of patients (281 out of 366, or 76.8%), the disease proceeded in the form of acute respiratory viral infections of mild or moderate severity, in 85 (23.2%) - in the form of interstitial pneumonia. Most respondents complained of weakness, fever, anosmia, difficulty in nasal breathing and serous-mucous nasal discharge, muscle pain, joints, headache, cough, mostly dry. Of the damage. The most observed symptoms associated with gastrointestinal tract were loss or distortion of taste sensations, abdominal pain, especially in the epigastric region, and dyspeptic manifestations such as diarrhea, nausea or vomiting. From laboratory parameters in persons with interstitial pneumonia, there were significant deviations in indicators characterizing damage to internal organs (AST, ALT, creatinine phosphokinase, lactic dehydrogenase, total protein, urea, bilirubin, creatinine, CRP), indicating the presence of cytolysis syndrome and systemic inflammatory response corresponding to research by other authors. The most likely pathogenetic mechanism of the disease is the direct cytopathic effect of the SARS-CoV-2 virus on the liver, pancreas, gallbladder, kidneys, heart, muscle tissue, being enhanced by the reaction of the sympathoadrenal system to the fact of virus intervention, as well as the cytokine "storm" within the systemic inflammatory response and drug-induced liver damage due to the use of drugs with potential hepatotoxic effects to treat infection. Conclusion. Based on the results of the study, the data were obtained on the incidence of extrapulmonary manifestations of coronavirus infection, their severity in various forms of the disease, with a separate emphasis on the symptoms of gastrointestinal tract lesions, all these should be considered for the diagnosis of COVID-19. The main laboratory markers associated with the most severe clinical forms of coronavirus infection have been determined, they can be used in the formation of treatment protocols within the framework of the formulary system.