Gastroenterological features of COVID-19 and the role of the United European Gastroenterology Journal

The United European Gastroenterology Journal likes to keep up with the clinical developments and provide guidelines, ¹ position papers ² , ³ and reviews^3–6 to help you to provide better digestive care.

This year, we have been confronted with the widespread consequences of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) responsible for coronavirus disease 2019 (COVID-19). This virus had not been recognised before, although coronaviruses have been responsible for regional outbreaks of Middle East respiratory syndrome (MERS) and SARS.

COVID-19 is a systemic disease, and the main symptoms include fever, cough, fatigue, muscle pain, sore throat, loss of smell and dyspnea. While the majority of patients develop only a mild disease, some progress to viral pneumonitis and develop acute respiratory distress syndrome. These patients are in need for mechanical ventilation, and this clinical situation is associated with high mortality.

COVID-19 is playing out on a global scale, and the speed and extent of viral transmission has impacted virtually every civilian and every nation. The effect on our personal lives cannot be overestimated as social distancing and lockdown have become accepted tools to combat viral transmission. The wave of COVID-19 patients has surprised us, and most health-care organisations have been forced to adapt to the new reality within a very short period of time. Everywhere, hospitals have converted from serving all-comers to facilities that almost exclusively treat COVID-19 patients. This has led to the creation of COVID-19-only wards and the ballooning of intensive care units with a need to funnel all available resources to these wards. Medical resources have been diverted, forcing additional efforts by all health workers and moving medical attention away from everyday care.

For gastroenterologists, this has meant that we have had to change our outpatient services rapidly and move to virtual-based care and more elaborate use of (distant) point-of-care testing. Endoscopy activities have been scaled down rapidly, and in some cases, gastroenterologists have been assigned to care for COVID-19 patients instead of providing dedicated gastrointestinal (GI) care. These events reverberate through our society, and the learnings from this pandemic and its aftershocks will be highly relevant from a medical and health perspective.

That is why we as the Editorial Board of the UEG journal have decided to devote space to the COVID-19 pandemic and the effects on the organisation of the digestive health-care system. In the upcoming issues this year, we will publish a series of articles that deal with the daily impact of the pandemic on gastroenterology. ⁷

We have decided to focus on the practical aspects of the impressive adaptation that the GI health-care service has had to make under the pressure of this pandemic. It is important to understand how the different European gastroenterology departments have dealt with the abrupt cut in care. The series will answer questions such as how to deal with endoscopies, infusion units and immunosuppressed patients, how to prioritise, how to maintain patients in regular schedules in clinical trials, how to restructure units, how to protect health workers with personal protective equipment and finally how to manage your shortcomings.

The health-care community quickly realised that COVID-19 is a systemic disease with extra-pulmonary features. ⁸ COVID-19 patients also suffer from GI symptoms such as diarrhoea, nausea and vomiting. Indeed, the virus may be retrieved from faeces long after oropharyngeal shedding of SARS-CoV-2 has ceased, and detection of SARS-CoV-2 in intestinal mucosa has been demonstrated. COVID-19 may also come with hepatological features, and a large minority of patients will display transient elevation of transaminases. ⁹

In order to give practicing gastroenterologists a better handle on this pandemic, the UEG journal will consider papers that offer original data on GI features of COVID-19 that come with scientific implications for digestive health.