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A round up on COVID-19 and the Digestive System.

When COVID-19 appeared on the scene a lot of strange, interesting, and terrible things happened in the world. Of particular interest to me was how many companies in the MedTech space pivoted their technology to meet some aspect of the pandemic. As one of the most niche companies out there, we at Motilent kept our heads down and focused on not going out of business as everything shut down around us.As a friend said at the time: “Until Covid starts presenting with GI symptoms there’s not much we can do” (The friend said it less diplomatically but I’ll leave that to your imagination!) 

 

 

The months and now years rolled on and many companies in our space now have a new respiratory side-gig but, being ever late to the party, I thought now was a good time to flick through the literature and see what, if anything was going on with digestive disease. Could we now (a year later) roll up our sleeves and get stuck in? 

 

Here’s what I found on pubmed (via Twitter). I do not claim this is comprehensive.

 

1) Biological mechanisms of COVID-19. It was news to me when I read about it but apparently there’s a receptor called ACE2 that plays a role in intestinal homeostasis and is found along the GI tract. The SARS-CoV-2 virus binds directly to this receptor to enter the cell meaning that the GI tract can serve as an infection site for the virus. Potentially, people with underlying GI disease especially with leaky gut or influence low-grade inflammation along the gut potentially increasing susceptibility to infection by this route. Already, we’re getting into a place that is not that well characterised in the literature compounded by my relative ignorance around mucosal immunology but suffice to say, there seems to be a ‘back door’ for infection in our GI tract through this receptor. More can be read here.

2) Digestive symptoms and COVID-19. This is a more complex topic and there’s been a couple of nice little articles out that point towards the post-viral implications of COVID-19 on the GI tract.

 

Cooney et al. examined acute chronic GI symptoms post COVID infection over a 6 month follow up period in 48 patients using a web-survey. They found that at 6 months 43.8% reported new GI symptoms (83.3% reported no GI symptoms before COVID) and led to them asking if this could be a new type of post-COVID-19 IBS. The main symptoms reported were pain (29.2%) and diarrhoea (19%). The authors acknowledge the usual weaknesses of such studies (self-reported symptoms, uptake bias, small numbers etc) but the presence of post-infective, new GI symptoms is interesting and this study may well power future investigations.

 

A case study by Courtney et al. walks us through an episode of post-viral gastroparesis in a 16-year old who underwent scintigraphy and was found to have delayed gastric emptying. This was resolved with a spot of decompression and erythromycin to get things moving again which led to the situation improving. While it’s difficult to take a lot away from case studies, it did produce some nice images (which I’m all about) and plants a flag for those seeing evidence of gastroparesis in COVID patients. To the group which published the work: can you please do a cine MR next time so we can see those contractions?  Looking at the stills, I’d bet this subject was hyper-contractile with a difficult pylorus.

 

 

Oshima et al. found that people with functional dyspepsia and IBS  experienced worsening symptoms  likely as a result of the stress caused  by the pandemic.  Although these findings are perhaps not super unexpected (and I see very few areas where our particular approach to digestive disease can particularly help), they serve as a reminder that when life’s stresses weigh on us mentally, their impacts can be manifested physically through our digestive system. In fact,  I’m surprised with all the uncertainty over the last few years that a lot more people have not yet shown up with IBS (or maybe they’re out there, but undiagnosed due to being fairly low down on most hospitals’ priorities right now).

 

So in summary, Motilent’s not about to pivot its business. GI complaints remain a constant – but largely de-prioritised – side effect of the general distress caused by the pandemic, and there are some interesting biochemical mechanisms related to GI and Covid to explore. But Motilent  will remain focused on helping healthcare systems play catchup with all the missed appointments over the last several years, using time and cost-saving innovations borne from deep understanding of our clinical vertical.


About Motilent

Motilent is a medical imaging technology company that aims to make some of the latest and most exciting image analysis technologies available to the researchers who can use them to make the important scientific advances required to advance our understanding of gastrointestinal disease.

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