Pathogenesis of diarrhea in patients with COVID-19 and approaches to therapy
https://doi.org/10.51793/OS.2022.25.6.014
Abstract
Diarrhea is observed in a significant proportion of patients with SARS-CoV-2 infection, both in the acute phase and in the post-COVID period. The purpose of the review is to present current data on the epidemiology and pathogenesis of diarrhea in patients with COVID-19, SARS-CoV-2, on therapeutic and preventive measures in patients during the acute phase and the post-COVID period. Intestinal injury associated with COVID-19 is often multifactorial and may be due to direct cytopathic effects on the gastrointestinal epithelium, immune-mediated injury, ischemic/hypoxic injury, as well as disruption of the gut microbial landscape or the development of C. difficile-associated colitis, a side effect of some drugs used to treat COVID-19. Given that one of the leading causes of diarrhea in patients with COVID 19 is the secretory genesis of diarrhea, rehydration therapy, sorbents and cytoprotectors are used in the treatment. In patients with C. difficile-associated colitis, metronidazole and vancomycin are the drugs of choice. Prevention of C. difficile-associated colitis includes the use of probiotics Saccharomyces boulardii, Lactobacillus rhamnosus and others, as well as probiotic mixtures. One of the therapeutic measures is the prevention of the development of severe toxicosis, sorption and elimination of toxic compounds from the intestines. Phytosorbents, herbal preparations (dietary fibers), the main properties of which are their solubility and fermentability by intestinal bacteria, demonstrated a high ability to enterosorption. Thanks to this polyfractional structure, psyllium has a complex effect not only on the intestines, but also on the body as a whole. The main effects of psyllium (detoxification, antidiarrheal, anti-inflammatory, cytoprotective restoration of the intestinal microbiota) make it possible to use it as a pathogenetic agent in patients with COVID-19, both in the acute phase and in the post-COVID period.
About the Author
E. A. Lyalyukova
Federal State Budgetary Educational Institution of Higher Education Omsk State Medical University of the Ministry of Health of the Russian Federation
Россия
Россия
Elena A. Lyalyukova, Dr. of Sci. (Med.), Professor, Professor of the Department of Internal Medicine and Family Medicine of the Faculty of Additional Professional Education
5 Petr Nekrasov str., Omsk, 644037
References
1. Megyeri K., Dernovics Á., Al-Luhaibi Z. I. I., Rosztóczy A. COVID-19-associated diarrhea // World J Gastroenterol. 2021; 27(23): 3208-3222. DOI: 10.3748/wjg.v27.i23.3208.
2. Effenberger M., Grabherr F., Mayr L., et al. Faecal calprotectin indicates intestinal inflammation in COVID-19 // Gut. 2020; 69 (8): 1543-1544. DOI: 10.1136/gutjnl-2020-321388.
3. Garrigues E., Janvier P., Kherabi Y., Le Bot A., Hamon A., Gouze H., Doucet L., Berkani S., Oliosi E., Mallart E., Corre F., Zarrouk V., Moyer J. D., Galy A., Honsel V., Fantin B., Nguyen Y. Post-discharge persistent symptoms and health-related quality of life after hospitalization for COVID-19 // J Infect. 2020; 81 (6): e4-e6. DOI: 10.1016/j.jinf.2020.08.029.
4. Drapkina O. M., Mayev I. V., Bakulin I. G., Nikonov Ye. L., Chulanov V. P., Belousova Ye. A., Veselov A. V., Sayganov S. A., Simanenkov V. I., Bakulina N. V., Avaluyeva Ye. B., Oganezova I. A., Skalinskaya M. I., Skazyvayeva Ye. V., Kashin S. V., Kuvayev R. O. Temporary guidelines: «Diseases of the digestive system in the context of a pandemic of a new coronavirus infection (COVID-19)» // Profilakticheskaya meditsina. 2020; 23 (3): 2120-2152.
5. Zhong P., Xu J., Yang D., Shen Y., Wang L., Feng Y., Du C., Song Y., Wu C., Hu X., Sun Y. COVID-19-associated gastrointestinal and liver injury: clinical features and potential mechanisms // Signal Transduct Target Ther. 2020; 5 (1): 256. DOI: 10.1038/s41392-020-00373-7.
6. Zou X., Chen K., Zou J., Han P., Hao J., Han Z. Single-cell RNA-seq data analysis on the receptor ACE2 expression reveals the potential risk of different human organs vulnerable to 2019-nCoV infection // Front Med. 2020; 14 (2): 185-192. DOI: 10.1007/s11684-020-0754-0.
7. Zhang H., Kang Z., Gong H., et al. Digestive system is a potential route of COVID-19: an analysis of single-cell coexpression pattern of key proteins in viral entry process // Gut. 2020; 69 (6): 1010-1018. DOI: 10.1136/gutjnl-2020-320953.
8. Zhang L., Han C., Zhang S., Duan C., Shang H., Bai T., Hou X. Diarrhea and altered inflammatory cytokine pattern in severe coronavirus disease 2019: Impact on disease course and in-hospital mortality // J Gastroenterol Hepatol. 2021; 36: 421-429.
9. Effenberger M., Grabherr F., Mayr L., Schwaerzler J., Nairz M., Seifert M., Hilbe R., Seiwald S., Scholl-Buergi S., Fritsche G., Bellmann-Weiler R., Weiss G., Müller T., Adolph T. E., Tilg H. Faecal calprotectin indicates intestinal inflammation in COVID-19 // Gut. 2020; 69 (8): 1543-1544. DOI: 10.1136/gutjnl-2020-321388.
10. Mandal S., Barnett J., Brill S. E., Brown J. S., Denneny E. K., Hare S. S., Heightman M., Hillman T. E., Jacob J., Jarvis H. C., Lipman M. C. I., Naidu S. B., Nair A., Porter J. C., Tomlinson G. S., Hurst J. R. ARC Study Group. 'Long-COVID': a cross-sectional study of persisting symptoms, biomarker and imaging abnormalities following hospitalisation for COVID-19 // Thorax. 2021; 76 (4): 396-398. DOI: 10.1136/thoraxjnl-2020-215818.
11. Li J. J., Lu Z. L., Kou W. R., Chen Z., Wu Y. F., Yu X. H., Zhao Y. C. Chinese Coronary Secondary Prevention Study CCSPS) Group. Long-term effects of Xuezhikang on blood pressure in hypertensive patients with previous myocardial infarction: data from the Chinese Coronary Secondary Prevention Study (CCSPS) // Clin Exp Hypertens. 2010; 32 (8): 491-498. DOI: 10.3109/10641961003686427.
12. Zuo T., Zhang F., Lui G. C. Y., Yeoh Y. K., Li A. Y. L., Zhan H., Wan Y., Chung A. C. K., Cheung C. P., Chen N., Lai C. K. C., Chen Z., Tso E. Y. K., Fung K. S. C., Chan V., Ling L., Joynt G., Hui D. S. C., Chan F. K. L., Chan P. K. S., Ng S. C. Alterations in Gut Microbiota of Patients With COVID-19 During Time of Hospitalization // Gastroenterology. 2020; 159 (3): 944-955. DOI: 10.1053/j.gastro.2020.05.048.
13. Mifsud E. J., Hayden F. G., Hurt A. C. Antivirals targeting the polymerase complex of influenza viruses // Antiviral Res. 2019; 169: 104545. DOI: 10.1016/j.antiviral.2019.104545.
14. Granata G., Bartoloni A., Codeluppi M., Contadini I., Cristini F., Fantoni M., Ferraresi A., Fornabaio C., Grasselli S., Lagi F., Masucci L., Puoti M., Raimondi A., Taddei E., Trapani F. F., Viale P., Johnson S., Petrosillo N. On Behalf Of The CloVid Study Group. The Burden of Clostridioides Difficile Infection during the COVID-19 Pandemic: A Retrospective Case-Control Study in Italian Hospitals (CloVid) // J Clin Med. 2020; 9: E3855. DOI: 10.3390/jcm9123855.
15. Hanna R., Dalvi S., Sălăgean T., Pop I. D., Bordea I. R., Benedicenti S. Understanding COVID-19 Pandemic: Molecular Mechanisms and Potential Therapeutic Strategies. An Evidence-Based Review // J Inflamm Res. 2021; 14: 13-56. DOI: 10.2147/JIR.S282213.
16. Ivashkin V. T., Yushchuk N. D., Mayev I. V., Lapina T. L., Poluektova Ye. A., Shifrin O. S., Tertychnyy A. S., Trukhmanov A. S., Sheptulin A. A., Baranskaya Ye. K., Lyashenko O. S., Ivashkin K. V. Recommendations of the Russian Gastroenterological Association for the diagnosis and treatment of Clostridium difficile-associated disease // Ros. zhurn. gastroenterol., gepatol., koloproktol. 2016; 26 (5): 56-65.
17. Shelygin Yu. A., Aloshkin V. A., Sukhina M. A. i dr. Clinical guidelines of the National Association of Infection Control Specialists associated with the provision of medical care and the All-Russian public non-profit organization «Association of Coloproctologists of Russia» on the diagnosis, treatment and prevention of Clostridium diffi cileassociated diarrhea (CDI) // Koloproktologiya. 2018; 3 (65): 7-23. DOI: 10.33878/2073-7556-2018-0-3-7-23.
18. Zakharenko S. M. Enterosorption in the practice of an infectious disease specialist // Glavvrach Yuga Rossii. 2011; 2 (25). URL: https: // cyberleninka.ru/article/n/enterosorbtsiya-v-praktike-infektsionista-1 (data obrashcheniya: 08.03.2022).
19. http: //www.mucofalk.ru/.
20. Polevaya Ye. V., Vakhitov T. YA., Sitkin S. I. Enterosorption properties of psyllium (Mukofalk®) and possible mechanisms of its action in intestinal infections // Klinicheskiye perspektivy gastroenterologii, gepatologii. 2012; 2: 35-39.
21. Chashchina S. Ye., Startseva Ye. V. Experience in the use of Mucofalk in the pathogenetic therapy of infectious enterocolitis in young children // Klinicheskiye perspektivy gastroenterologii, gepatologii. 2012 (4): 36-41.
Review
For citations:
Lyalyukova E.A. Pathogenesis of diarrhea in patients with COVID-19 and approaches to therapy. Lechaschi Vrach. 2022;(5-6):77-83. (In Russ.) https://doi.org/10.51793/OS.2022.25.6.014
Views:
191
JATS XML
Email this article 
