New research published in the journal Gastroenterology this week indicates that some patients with a COVID-19 infection may initially present with acute pancreatitis, even before exhibiting the more widely recognized respiratory symptoms that have been associated with the infection. According to lead researcher Sumant Inamdar, M.B.B.S., an assistant professor in the Division of Gastroenterology at the University of Arkansas for Medical Sciences, and colleagues, while most COVID-19-positive patients present with respiratory symptoms, gastrointestinal (GI) symptoms like abdominal pain, nausea, vomiting, diarrhea and appetite loss have been reported in up to 25% of patients with COVID-19. In fact, some COVID-19-positive patients experience GI symptoms prior to developing a fever and respiratory symptoms.
The ongoing coronavirus pandemic has spread to more than 200 countries and territories around the world, affecting more than 20 million people and resulting in approximately 830,000 deaths worldwide. Since the COVID-19 outbreak first emerged at the very end of 2019, it has become a major public health issue and researchers are scrambling to learn as much as they can about the COVID-19 infection and its various manifestations, in order to better predict the likelihood of testing positive for COVID-19 and improve outcomes among COVID-19-positive individuals who present with acute pancreatitis.
The COVID-19 infection is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and many patients with COVID-19 initially present with a fever and respiratory symptoms like shortness of breath or difficulty breathing. However, COVID-19 affects different people in different ways and infected patients have reported a wide range of symptoms, including gastrointestinal symptoms like abdominal pain, diarrhea or vomiting. According to Inamdar and colleagues, acute pancreatitis may be a gastrointestinal manifestation of COVID-19 in some patients. “As islet cells of the pancreas contain ACE2 receptor proteins, SARS-CoV2 can bind to these receptors and cause pancreatic injury,” the authors write. In fact, they note that “Some case reports have shown acute pancreatitis as the initial presentation in patients with COVID-19.”
In this new study, the researchers looked at the prevalence, risk factors and outcomes of hospitalized patients with COVID-19 presenting with acute pancreatitis in a large New York health system between March 1 and June 1, 2020. The researchers compared the outcomes for patients with pancreatitis and COVID-19 and those with pancreatitis but without COVID-19. According to their findings, 189 of the study participants were diagnosed with pancreatitis and 32 of those patients (17%) also tested positive for COVID-19. The researchers found that patients with pancreatitis and COVID-19 were more likely to require mechanical ventilation and longer hospital stays compared to patients with pancreatitis who did not have COVID-19. “These findings support the notion that pancreatitis should be included in the list of gastrointestinal manifestations of COVID-19,” the study authors wrote.
This isn’t the first time COVID-19 has been linked to acute pancreatitis. Another study published in the journal Pancreatology in July 2020 found that, while the most common symptoms of a COVID-19 infection are a cough, fever and shortness of breath, “gastrointestinal manifestations of COVID-19 are increasingly being recognized.” The study highlighted a case involving a COVID-19 patient who presented with acute pancreatitis without any other risk factors for the condition. About one month prior, another Pancreatology study discussed the potential link between COVID-19 and pancreatitis, focusing on three family members with COVID-19 who were admitted to the intensive care unit at Copenhagen University Hospital Hvidovre in Denmark in March 2020, two of whom presented with acute pancreatitis. The study authors noted that “These cases highlight acute pancreatitis as a complication associated with COVID-19 and underline the importance of measuring pancreas-specific plasma amylase in patients with COVID-19 and abdominal pain.”