nogrЭкспериментальная и клиническая гастроэнтерологияExperimental and Clinical Gastroenterology1682-8658«Global Media Technologies»10.31146/1682-8658-ecg-186-2-20-26nogr-1557Research ArticleCOVID-19COVID-19Клиника и семиотика поражения органов пищеварения при новой коронавирусной инфекции (COVID-19)Clinic and semiotics of digestive lesions with coronavirus SARS-CoV-2https://orcid.org/0000-0002-7152-0615КучеренкоН. Г.KucherenkoN. G.noemail@neicon.ruhttps://orcid.org/0000-0003-3279-6448РатниковаА. К.RatnikovaA. K.noemail@neicon.ruhttps://orcid.org/0000-0002-1095-8787ГриневичВ. Б.GrinevichV. B.noemail@neicon.ruhttps://orcid.org/0000-0002-8858-5642ТкаченкоЕ. И.TkachenkoE. I.noemail@neicon.ruhttps://orcid.org/0000-0001-8347-0531КравчукЮ. А.KravchukYu. A.kravchuk2003@mail.ruФГБУ «Северо-западный окружной научно-клинический центр им. Л. Г. Соколова ФМБА России»РоссияFGBU “Northwest District Research and Clinical Center by L. G. Sokolov FMBA of Russia”Russian FederationФГБУ «Северо-западный окружной научно-клинический центр им. Л. Г. Соколова ФМБА России»; ФГБВОУ ВО «Военно-медицинская академия имени С. М. Кирова» МО РФРоссияFGBU “Northwest District Research and Clinical Center by L. G. Sokolov FMBA of Russia”; Military Medical Academy named after S. M. KirovRussian FederationФГБВОУ ВО «Военно-медицинская академия имени С. М. Кирова» МО РФРоссияMilitary Medical Academy named after S. M. KirovRussian Federation202107042021022026Copyright © Кучеренко Н.Г., Ратникова А.К., Гриневич В.Б., Ткаченко Е.И., Кравчук Ю.А., 20212021Кучеренко Н.Г., Ратникова А.К., Гриневич В.Б., Ткаченко Е.И., Кравчук Ю.А.Kucherenko N.G., Ratnikova A.K., Grinevich V.B., Tkachenko E.I., Kravchuk Y.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.nogr.org/jour/article/view/1557

В статье представлены результаты анализа клинических особенностей гастроэнтерологических проявлений новой коронавирусной инфекции (COVID-19), вызванной возбудителем SARS-CoV-2. С учетом этапной системной оценки опыта лечения 1180 пациентов в условиях многопрофильного стационара, трансформированного в инфекционный госпиталь, описаны наиболее характерные клинические проявления поражения органов пищеварения коронавирусом SARS-CoV-2. В статье особое внимание уделено верификации изменений со стороны органов пищеварения, как на этапе первичного обследования, так и в ходе проведения этиотропной (в комбинации гидроксихлорохина и азитромицина, препаратов интерферона-альфа), патогенетической (в комбинации глюкокортикоидов, препаратов гепарина, по показаниям - ингибитора интерлейкина-6) и симптоматической (антипиретики, противорвотные и противокашлевые препараты) терапии, проведенной в соответствии с Временными методическими рекомендациями Минздрава России «Профилактика, диагностика и лечение новой коронавирусной инфекции COVID-19». Обоснованы направления для разработки алгоритмов клинико-лабораторной, инструментальной и лучевой диагностики изменений органов пищеварения у пациентов с COVID-19.

The article presents the results of the analysis of clinical features of gastroenterological manifestations of a new coronavirus infection (COVID-19) caused by the pathogen SARS-CoV-2. Taking into account the stage-by-stage system assessment of the experience of treating 1,180 patients in a multi-specialty hospital transformed into an infectious hospital, the most characteristic clinical manifestations of digestive damage by SARS-CoV-2 coronavirus are described. The article focuses on verification of changes in the digestive system, both at the stage of primary examination, and during etiotropic (in combination with hydroxychloroquine and azithromycin, interferon-alpha drugs), pathogenetic (in combination with corticosteroids, heparin drugs, according to indications - an interleukin-6 inhibitor) and symptomatic (antipyretics, antiemetics and antitussive drugs) therapy, carried out in accordance with Temporary guidelines of the Ministry of health of the Russian Federation “Prevention, diagnosis and treatment of new coronavirus infection Covid-19”. Directions for the development of algorithms for clinical and laboratory, instrumental and radiological diagnostics of changes in the digestive system in patients with COVID-19 are justified.

новая коронавирусная инфекция (COVID-19)SARS-CoV-2гастроэнтерологические симптомыnew coronavirus infection (COVID-19)SARS-CoV-2gastroenterological symptomsReferencesCha M.H., Regueiro M., Sandhu D. S. Gastrointestinal and hepatic manifestations of COVID-19: A comprehensive review. World J. Gastroenterol. 2020; 26 (19): 2323-2332.Cha M.H., Regueiro M., Sandhu D. S. Gastrointestinal and hepatic manifestations of COVID-19: A comprehensive review. World J. Gastroenterol. 2020; 26 (19): 2323-2332.Temporary guidelines of the Ministry of Health of the Russian Federation. Prevention, diagnosis and treatmentof new coronavirus infection (COVID-19). Moscow. Version 10 (08/02/2021), 261 p.Temporary guidelines of the Ministry of Health of the Russian Federation. Prevention, diagnosis and treatmentof new coronavirus infection (COVID-19). Moscow. Version 10 (08/02/2021), 261 p.Cavalli G., De Luca G., Campochiaro C. et al. Interleukin-1 blockade with high-dose anakinra in patients with COVID-19, acute respiratory distress syndrome, and hyperinflammation: a retrospective cohort study. Lancet Rheumatol. 2020; 2(6): e325-e331.Cavalli G., De Luca G., Campochiaro C. et al. Interleukin-1 blockade with high-dose anakinra in patients with COVID-19, acute respiratory distress syndrome, and hyperinflammation: a retrospective cohort study. Lancet Rheumatol. 2020; 2(6): e325-e331.Rapid Expert Consultations on the COVID-19 Pandemic: March 14, 2020-April 8, 2020 National Academies of sciences, engineering, and medicine Washington (DC): National Academies Press (US); 2020 Apr 30.Rapid Expert Consultations on the COVID-19 Pandemic: March 14, 2020-April 8, 2020 National Academies of sciences, engineering, and medicine Washington (DC): National Academies Press (US); 2020 Apr 30.Mao R., Qiu Y., He J-S., et al. Manifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19: a systematic review and meta-analysis. Lancet Gastroenterol. Hepatol. 2020: S2468-1253(20)30126-6.Mao R., Qiu Y., He J-S., et al. Manifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19: a systematic review and meta-analysis. Lancet Gastroenterol. Hepatol. 2020: S2468-1253(20)30126-6.Ivashkin V.T., Sheptulin A. A., Zolnikova O. Yu. et al. New coronavirus infection (COVID-19) and digestive system. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2020; 30(3): 7-13. (In Russ.) https://doi.org/10.22416/1382-4376-2020-30-3-7Ivashkin V.T., Sheptulin A. A., Zolnikova O. Yu. et al. New coronavirus infection (COVID-19) and digestive system. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2020; 30(3): 7-13. (In Russ.) https://doi.org/10.22416/1382-4376-2020-30-3-7Grinevich V.B., Gubonina I. V., Doshchitsin V. L. et al. Management of patients with comorbidity during novel coronavirus (COVID-19) pandemic. National Consensus Statement 2020. Cardiovascular Therapy and Prevention. 2020; 19 (4): 2630. (In Russ.) https://doi.org/10.15829/1728-8800-2020-2630Grinevich V.B., Gubonina I. V., Doshchitsin V. L. et al. Management of patients with comorbidity during novel coronavirus (COVID-19) pandemic. National Consensus Statement 2020. Cardiovascular Therapy and Prevention. 2020; 19 (4): 2630. (In Russ.) https://doi.org/10.15829/1728-8800-2020-2630Grinevich V.B., KravchukYu.A., Ped V. I. et al. Management of patients with digestive diseases during the COVID-19 pandemic: clinical practice guidelines by the Gastroenterological scientific society of Russia. Experimental and Clinical Gastroenterology. 2020; (7): 4-51. (In Russ.) https://doi.org/10.31146/1682-8658-ecg-179-7-4-51Grinevich V.B., KravchukYu.A., Ped V. I. et al. Management of patients with digestive diseases during the COVID-19 pandemic: clinical practice guidelines by the Gastroenterological scientific society of Russia. Experimental and Clinical Gastroenterology. 2020; (7): 4-51. (In Russ.) https://doi.org/10.31146/1682-8658-ecg-179-7-4-51Klyushin D. A., Petunin Yu. I. Evidence-based medicine. Application of statistical methods. Moscow. LLC “I. D. Williams” Publ., 2017, 316 p.@@ Клюшин Д.А., Петунин Ю. И. Доказательная медицина. Применение статистических методов. - М.: ООО «И. Д. Вильямс», 2017-316 с.Klyushin D. A., Petunin Yu. I. Evidence-based medicine. Application of statistical methods. Moscow. LLC “I. D. Williams” Publ., 2017, 316 p.@@ Клюшин Д.А., Петунин Ю. И. Доказательная медицина. Применение статистических методов. - М.: ООО «И. Д. Вильямс», 2017-316 с.Cascella M., RajnikM., CuomoA. et al. Features, evaluation and treatment of coronavirus (COVID-19). In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020.Cascella M., RajnikM., CuomoA. et al. Features, evaluation and treatment of coronavirus (COVID-19). In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020.Ma C., Cong Y., Zhang H. COVID-19 and the digestive system. Am. J. Gastroenterol. 2020: 00:1-4.Ma C., Cong Y., Zhang H. COVID-19 and the digestive system. Am. J. Gastroenterol. 2020: 00:1-4.Xiao F., Tang M., Zheng X. et al. Evidence for gastrointestinal infection of SARS-CoV-2. Gastroenterology. 2020; 158: 1831-1833.Xiao F., Tang M., Zheng X. et al. Evidence for gastrointestinal infection of SARS-CoV-2. Gastroenterology. 2020; 158: 1831-1833.Tariq R., Saha S., Furqan F. et al. Prevalence and mortality of COVID-19 patients with gastrointestinal symptoms: a systematic review and meta-analysis. Mayo Clin Proc. 2020; 95(8): 1632-1648. doi:10.1016/j.mayocp.2020.06.003Tariq R., Saha S., Furqan F. et al. Prevalence and mortality of COVID-19 patients with gastrointestinal symptoms: a systematic review and meta-analysis. Mayo Clin Proc. 2020; 95(8): 1632-1648. doi:10.1016/j.mayocp.2020.06.003Li M.Y., Li L., Zhang Y., Wang X. S. Expression of the SARS-CoV-2 cell receptor gene ACE2 in a wide variety of human tissues. Infect. Dis. Poverty. 2020; 28: 9 (1): 45.Li M.Y., Li L., Zhang Y., Wang X. S. Expression of the SARS-CoV-2 cell receptor gene ACE2 in a wide variety of human tissues. Infect. Dis. Poverty. 2020; 28: 9 (1): 45.Hoffmann M., Kleine-Weber H., Schroeder S. et al. SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell. 2020; 16: 181 (2): 271-280.Hoffmann M., Kleine-Weber H., Schroeder S. et al. SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell. 2020; 16: 181 (2): 271-280.Parasa S., Desai M., Thoguluva Chandrasekar V. et al. Prevalence of gastrointestinal symptoms and fecal viral shedding in patients with coronavirus disease 2019: A systematic review and meta-analysis. JAMA Netw. Open. 2020; 3(6): e2011335.Parasa S., Desai M., Thoguluva Chandrasekar V. et al. Prevalence of gastrointestinal symptoms and fecal viral shedding in patients with coronavirus disease 2019: A systematic review and meta-analysis. JAMA Netw. Open. 2020; 3(6): e2011335.Zhang C., Shi L., Wang F.-S. Liver injury in COVID-19: management and challenges. Lancet Gastroenterol. Hepatol. 2020; 5(5): 428-430.Zhang C., Shi L., Wang F.-S. Liver injury in COVID-19: management and challenges. Lancet Gastroenterol. Hepatol. 2020; 5(5): 428-430.Scaldaferri F., Ianiro G., Privitera G. et al. The thrilling journey of SARS-CoV-2 into the intestine: from pathogenesis to future clinical implications. Inflamm. Bowel Dis. 2020; 26 (9): 1306-1314. doi: 10.1093/ibd/izaa181. PMID: 32720978; PMCID: PMC7454647.Scaldaferri F., Ianiro G., Privitera G. et al. The thrilling journey of SARS-CoV-2 into the intestine: from pathogenesis to future clinical implications. Inflamm. Bowel Dis. 2020; 26 (9): 1306-1314. doi: 10.1093/ibd/izaa181. PMID: 32720978; PMCID: PMC7454647.Hui D.S.C., Zumla A. Severe acute respiratory syndrome: historical, epidemiologic, and clinical features. Infect. Dis. Clin. North Am. 2019; 33(4): 869-889.Hui D.S.C., Zumla A. Severe acute respiratory syndrome: historical, epidemiologic, and clinical features. Infect. Dis. Clin. North Am. 2019; 33(4): 869-889.Clark A., Jit M., Warren-Gash C. et al. Centre for the Mathematical Modelling of Infectious Diseases COVID-19 working group. Global, regional, and national estimates of the population at increased risk of severe COVID-19 due to underlying health conditions in 2020: a modelling study. Lancet Glob. Health. 2020; 8(8): e1003-e1017.Clark A., Jit M., Warren-Gash C. et al. Centre for the Mathematical Modelling of Infectious Diseases COVID-19 working group. Global, regional, and national estimates of the population at increased risk of severe COVID-19 due to underlying health conditions in 2020: a modelling study. Lancet Glob. Health. 2020; 8(8): e1003-e1017.Bimonte S., Crispo A., Amore A. et al. Potential antiviral drugs for SARS-Cov-2 treatment: preclinical findings and ongoing clinical research. In Vivo. 2020; 34 (3 Suppl): 1597-1602.Bimonte S., Crispo A., Amore A. et al. Potential antiviral drugs for SARS-Cov-2 treatment: preclinical findings and ongoing clinical research. In Vivo. 2020; 34 (3 Suppl): 1597-1602.Anand S., Mande S. S. Diet, microbiota and gut-lung connection. Front. Microbiol. 2018; 9: 2147.Anand S., Mande S. S. Diet, microbiota and gut-lung connection. Front. Microbiol. 2018; 9: 2147.Ahlawat S.A., Sharma K. K. Immunological co-ordination between gut and lungs in SARS-CoV-2 infection. Virus Res. 2020; 286: 198103. doi:10.1016/j.virusres.2020.198103.Ahlawat S.A., Sharma K. K. Immunological co-ordination between gut and lungs in SARS-CoV-2 infection. Virus Res. 2020; 286: 198103. doi:10.1016/j.virusres.2020.198103.

The authors declare that there are no conflicts of interest present.