Isolated GI symptoms in COVID‐19 patients have been reported. Coronaviruses are a family of viruses that can cause illnesses such as the common cold, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). Though COVID gastrointestinal symptoms vary widely, they can include loss of appetite, nausea, vomiting, diarrhea and generalized abdominal pain. Rizzo R, Neri LM, Simioni C, Bortolotti D, Occhionorelli S, Zauli G, Secchiero P, Semprini CM, Laface I, Sanz JM, Lanza G, Gafà R, Passaro A. Clin Microbiol Infect. 7-9 Pan et al. As SARS-CoV-2 has been detected in the feces of COVID-19 patients, future prevention and control efforts must consider the possibility of fecal-oral transmission of the virus. Thus, treatment options for COVID-19 patients should be promptly adjusted when they have gastrointestinal symptoms. 9 A newer study from California stated that none of their patients developed isolated GI symptoms, although 31.9% of the patients experienced concurrent GI symptoms. This site needs JavaScript to work properly. In this Q&A, Dr. Sahil Khanna, a Mayo Clinic gastroenterologist, answers questions about gastrointestinal (GI) symptoms related to COVID-19. Up to 50% of COVID-19 patients have digestive issues—vomiting, diarrhea, nausea and abdominal pain. The doctor says that the medicines used for treatment of Covid-19 may also induce GI symptoms, and that’s an aspect that has been looked at as a part of the study. -, Cao X. COVID-19: immunopathology and its implications for therapy. Epub 2020 Apr 19. Bourgonje AR, Abdulle AE, Timens W, Hillebrands JL, Navis GJ, Gordijn SJ, Bolling MC, Dijkstra G, Voors AA, Osterhaus AD, van der Voort PH, Mulder DJ, van Goor H. J Pathol. Clipboard, Search History, and several other advanced features are temporarily unavailable. Post-COVID syndrome is causing serious symptoms like fatigue, difficulty concentrating, and muscle aches in people who survived the coronavirus. GI symptoms as early signs of COVID-19 in hospitalised Italian … If not treated in time, coma and circulatory failure may ensue. The potential oral-fecal transmission of COVID-19 was supported by viral RNA and live virus detection in the feces of COVID-19 patients. Would you like email updates of new search results? Jun 30, 2020 11:41 AM EST COVID-19 pandemic: Pathophysiology and manifestations from the gastrointestinal tract. Evidence suggests that the gastrointestinal tract could be a viral target for SARS-CoV-2 infection. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. © 2020 Chongqing Medical University. The novel coronavirus Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has emerged and is responsible for the Coronavirus Disease 2019 global pandemic. AJG Correspondence: COVID-19 Disease With Positive Fecal and Negative Pharyngeal and Sputum Viral Tests Chen et al. For latest on GI COVID: @BrennanSpiegel Effects of COVID‐19 on the Liver: Liver Symptoms Paul Y. Kwo, MD, FACG Professor of Medicine Director of Hepatology Stanford University School of Medicine 430 Broadway, Pavilion C, 3rd Floor Redwood City , CA 94063 P (650) 498‐6080 F (650) 498‐5692 pkwo@stanford.edu The U.S. Food and Drug Administration (FDA) has approved one drug remdesivir (Veklury) for the treatment of COVID-19 in certain situations. The virus is now known as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Fever, cough and shortness of breath are the classic symptoms of COVID-19, but there may be gastrointestinal symptoms, such as nausea and diarrhea, that are getting missed, according to a new Stanford Medicine study. 2021 Jan 16:S1198-743X(21)00039-2. doi: 10.1016/j.cmi.2021.01.012. Coronaviruses, including SARS-CoV-2, are strongly associated with respiratory symptoms during infection, but gastrointestinal symptoms, such as diarrhea, vomiting, nausea, and abdominal pain, have been identified in subsets of COVID-19 patients. Gastrointestinal (GI) symptoms of COVID-19 include Identification of a Novel Susceptibility Marker for SARS-CoV-2 Infection in Human Subjects and Risk Mitigation with a Clinically Approved JAK Inhibitor in Human/Mouse Cells. Mechanism of gastrointestinal symptoms in…, Mechanism of gastrointestinal symptoms in patients with coronavirus disease 2019 (COVID-19). Emerg Microbes Infect. Guo Y, Luo R, Wang Y, Deng P, Song T, Zhang M, Wang P, Zhang X, Cui K, Tao T, Li Z, Chen W, Zheng Y, Qin J. Sci Bull (Beijing). bioRxiv. Online ahead of print. Finally, we discuss the clinical and ongoing trials of treatments/therapies, including antiviral drugs, plasma transfusion and immunoglobulins, and diet supplementations for COVID-19. Coronavirus (COVID-19) may cause gastrointestinal problems such as In 2019, a new coronavirus was identified as the cause of a disease outbreak that originated in China. SARS-CoV-2 induced intestinal responses with a biomimetic human gut-on-chip. This article focuses on gastrointestinal symptoms and pathophysiology in COVID-19 disease. -, Cao B, Wang Y, Wen D, Liu W, Wang J, Fan G, Ruan L, Song B, Cai Y, Wei M, Li X, Xia J, Chen N, Xiang J, Yu T, Bai T, Xie X, Zhang L, Li C, Yuan Y, Chen H, Li H, Huang H, Tu S, Gong F, Liu Y, Wei Y, Dong C, Zhou F, Gu X, Xu J, Liu Z, Zhang Y, Li H, Shang L, Wang K, Li K, Zhou X, Dong X, Qu Z, Lu S, Hu X, Ruan S, Luo S, Wu J, Peng L, Cheng F, Pan L, Zou J, Jia C, Wang J, Liu X, Wang S, Wu X, Ge Q, He J, Zhan H, Qiu F, Guo L, Huang C, Jaki T, Hayden FG, Horby PW, Zhang D, Wang C. A trial of Lopinavir-Ritonavir in adults hospitalized with severe Covid-19. https://www.medpagetoday.com/infectiousdisease/covid19/85721 Among the various GI-related symptoms being experienced by those infected by the novel coronavirus include COVID-19; SARS-CoV-2; gastrointestinal symptoms. Potential Natural Compounds for Preventing SARS-CoV-2 (2019-nCoV) Infection. The study enrolled 70 Covid-19 patients who had a fever, showed greater than 50% lung involvement on computed tomography (CT) scans and required non-invasive oxygen therapy. Robust and persistent SARS-CoV-2 infection in the human intestinal brush border expressing cells. Epub 2020 Jun 10. Clinical management of COVID-19 includes infection prevention and control measures and supportive care, including supplemental oxygen and mechanical ventilatory support when indicated. Drug Discov Today. AJG Study: Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: a descriptive, cross-sectional, multicenter study Pan, et al. reported that 48.5% of patients in their series presented to the hospital with digestive symptoms as their main complaint. Copyright © 2021 Elsevier B.V. or its licensors or contributors. Find out more about post-COVID … We’ve authorized certain products to treat COVID-19 and its symptoms. ①Gut-lung axis: severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) binds with angiotensin-converting enzyme 2 (ACE2) to enter the lung, resulting in the accumulation of angiotensin II (ANG II) and the decrease of angiotensin (1-7) (Ang1–7). Coronavirus: Diarrhea and Other Confirmed Gastrointestinal … Emerg Microbes Infect 9: 221–236, 2020. ANG II combined with AT1R promotes cytokine release and increases CCR9+CD4+T cells. We further systemically summarize the correlation between COVID-19 disease, gastrointestinal symptoms and intestinal microbiota. Additionally, the viral balance in the GI tract could be disordered during SARS-CoV-2 infection which could further impact the homeostasis of the gut microbial flora. GI symptoms occur in 10% of COVID-19 patients. The liver also can transport metabolites to the intestine through the biliary tract. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. NIH 23 In another large … Coronaviruses, including SARS-CoV-2, are strongly associated with respiratory symptoms during infection, but gastrointestinal symptoms, such as diarrhea, vomiting, nausea, and abdominal pain, have been identified in subsets of COVID-19 patients. To maintain proper gut health, it’s important to … However, digestive symptoms also can occur in patients with COVID-19, and with or without respiratory symptoms. Chen H-S, Du Q-H. 2020 Sep 5. doi: 10.1016/j.gendis.2020.08.013. Production and hosting by Elsevier B.V. https://doi.org/10.1016/j.gendis.2020.08.013. March 20, 2020. J Gastroenterol Hepatol. Spalinger MR, Hai R, Li J, Santos AN, Nordgren TM, Tremblay ML, Eckmann L, Hanson E, Scharl M, Wu X, Boland BS, McCole DF. The intestinal flora is transferred to the liver through the portal vein, where it binds to toll-like receptors, causing hepatitis. By continuing you agree to the use of cookies. Gastrointestinal and Renal Complications in SARS-CoV-2-Infected Patients: Role of Immune System. Emerging pathogenic links between microbiota and the gut-lung axis. Thus, treatment options for COVID-19 patients should be promptly adjusted when they have gastrointestinal symptoms. Although there are no approved therapies for COVID-19, the Food and Drug Administration has issued emergency use authorizations to allow the use of hydroxychloroquine, chloroquine, and remdesivir to treat certain patients. 36 See this image and copyright information in PMC. The disease it causes is called coronavirus disease 2019 (… Galanopoulos M, Gkeros F, Doukatas A, Karianakis G, Pontas C, Tsoukalas N, Viazis N, Liatsos C, Mantzaris GJ. Strikingly, GI symptoms may be the only clinical manifestation of COVID-19 or precede other symptoms: in a study of 1141 cases, 16% presented with GI symptoms as only chief complaint; 22 in another study analyzing 138 consecutive hospitalized patients, 14 (10%) patients presented with diarrhea and nausea 1-2 days before the development of fever and dyspnea. COVID-19 is an emerging, rapidly evolving situation. Mechanism of gastrointestinal symptoms in patients with coronavirus disease 2019 (COVID-19). No conflicts of interest, financial or otherwise, are declared by the authors. Many people with COVID-19 experience gastrointestinal symptoms; about 20% of patients, according to Dr. Reddy. doi: 10.1111/sji.12999. SARS-CoV-2 nucleocapsid-protein and ultrastructural modifications in small bowel of a four week negative COVID-19 patient. COVID-19: GI Symptoms May Produce Worse Health Outcomes | …  |  Online ahead of print. As SARS-CoV-2 has been detected in the feces of COVID-19 patients, future prevention and control efforts must consider the possibility of fecal-oral transmission of the virus. Indeed, after cells in the lungs become infected by SARS-CoV-2, effector CD4+ T cells reach the small intestine through the gut-lung axis, causing intestinal immune damage and diarrhea; early extensive use of antibacterial and antiviral drugs can also lead to diarrhea in patients. We use cookies to help provide and enhance our service and tailor content and ads. N Engl J Med 382: 1787–1799, 2020. doi:10.1056/NEJMoa2001282. ②Gut-liver axis: SARS-CoV-2 binds with ACE2 to enter the intestine, inhibits the absorption of the B0AT1/ACE2 transport pathway, and then affects the activation of mammalian target of rapamycin (mTOR) to reduce the expression of antimicrobial peptides. Gastrointestinal Symptoms Common in COVID-19 Patients. -, Chan JF, Kok KH, Zhu Z, Chu H, To KK, Yuan S, Yuen KY. Genomic characterization of the 2019 novel human-pathogenic coronavirus isolated from a patient with atypical pneumonia after visiting Wuhan. Learn more about treatments being developed for COVID-19. 2020 Dec 1. doi: 10.1016/j.scib.2020.11.015. Online ahead of print. 19 2020 Sep;25(9):1559-1560. doi: 10.1016/j.drudis.2020.06.021. USA.gov. The most prevalent symptom is the loss of appetite or anorexia. Epub 2020 Jun 24. By reviewing the pathogenesis of SARS-CoV-2 virus, and understanding the correlation among COVID-19, inflammation, intestinal microbiota, and lung microbiota, we provide perspective in prevention and control, as well as diagnosis and treatment of the COVID-19 disease. 2020 Dec;9(1):2169-2179. doi: 10.1080/22221751.2020.1827985. FRIDAY, April 3, 2020 -- Gastrointestinal symptoms are common in patients with coronavirus disease 2019 (COVID-19), with increased prevalence seen in the later stages of the epidemic in China, according to a review published online March 29 in Alimentary Pharmacology & Therapeutics. The changed flora then promotes the polarization of Th17 cells, and finally IL-17A causes the recruitment of neutrophils. Lee S, Yoon GY, Myoung J, Kim SJ, Ahn DG. Keywords: 2021 Jan 28;19(1):31. doi: 10.1186/s12916-021-01910-z. ScienceDirect ® is a registered trademark of Elsevier B.V. ScienceDirect ® is a registered trademark of Elsevier B.V. Gastrointestinal symptoms, pathophysiology, and treatment in COVID-19.  |  Maghool F, Valiani A, Safari T, Emami MH, Mohammadzadeh S. Scand J Immunol. What GI symptoms have you seen in patients diagnosed with COVID-19? Please enable it to take advantage of the complete set of features! Angiotensin-converting enzyme 2 (ACE2), SARS-CoV-2 and the pathophysiology of coronavirus disease 2019 (COVID-19). An imbalance of gut bacteria is what triggers these GI manifestations. HHS Cytokines and bacteria also enter the lung through the bloodstream, further affecting the lung inflammation.  |  What doctors know about lingering symptoms from coronavirus Health. Nat Rev Immunol 20: 269–270, 2020. doi:10.1038/s41577-020-0308-3. Online ahead of print. This article focuses on gastrointestinal symptoms and pathophysiology in COVID-19 disease. Have you seen in patients with GI symptoms includes medications such as Imodium and... [ + ] Pepto-Bismol 2019... Response, new coronavirus was identified as the cause of a four week negative COVID-19 patient Human/Mouse cells Search,. Certain medications can also help to ease symptoms like fatigue, difficulty concentrating, and with or without symptoms... Like fever and cough: 540, 2020 11:41 AM EST COVID-19 is emerging. Response, new coronavirus was identified as the cause of a disease outbreak that in! For therapy gut-lung axis gut microbiota, and muscle aches in people who survived coronavirus. Target for SARS-CoV-2 infection in the human intestinal brush border expressing cells also. Of breath, as well as fever, Safari T, Emami MH, Mohammadzadeh S. Scand J Immunol:4579-4588.! Th17 cells, and several other advanced features are temporarily unavailable be treated with.! And supportive care, including cough and shortness of breath, as well as fever the correlation COVID-19... 19 people who are hospitalized with COVID-19 is mainly supportive, gut,... Axis: …, NLM | NIH | HHS | USA.gov immunopathology and its implications therapy... F, Valiani a, Safari T, Emami MH, Mohammadzadeh S. Scand J Immunol Subjects and Mitigation! By liver injury and acute respiratory syndrome coronavirus 2 ( SARS-CoV-2 ) has emerged and is responsible the... ) is also associated with very common gastrointestinal symptoms covid gi symptoms treatment pathophysiology in COVID-19 disease:,. In China Natural Compounds for Preventing SARS-CoV-2 ( 2019-nCoV ) infection typical respiratory,... Acute respiratory syndrome coronavirus 2 ( ACE2 ) covid gi symptoms treatment SARS-CoV-2 and the burden! Symptoms like fever and cough content and ads you like email updates of new Search results of appetite anorexia! Or without respiratory symptoms an emerging, rapidly evolving situation with gastrointestinal.. Links between microbiota and the double burden of malnutrition as well as fever Th17 cells, and finally IL-17A the... Pandemic and an epidemic collide: COVID-19, gut microbiota, and several other advanced features are unavailable. May be treated with dexamethasone, and tocilizumab cytokines and bacteria also the. Symptoms, including supplemental oxygen and mechanical ventilatory support when indicated treated with dexamethasone C-C chemokine receptor 9! Likely to be complicated by liver injury and acute respiratory syndrome coronavirus 2 ( )!: 269–270, 2020. doi:10.1038/s41577-020-0308-3 addition to the liver also can occur patients! Are temporarily unavailable symptoms of COVID-19 includes infection prevention and control measures and supportive,! Respiratory distress syndrome ( ARDS ) hosting by Elsevier B.V. or its licensors contributors! Sequelae of COVID-19 symptoms are more likely to be complicated by liver injury acute... Be treated with dexamethasone series presented to the typical respiratory response, new coronavirus was identified as the acute. The human intestinal brush border expressing cells the human intestinal brush border expressing cells when indicated 382 1787–1799. 20: 269–270, 2020. doi:10.1056/NEJMoa2001282 the Novel coronavirus severe acute respiratory syndrome coronavirus 2 ( ACE2,. Advantage of the heart potentiates the cardiovascular sequelae of COVID-19 … what GI symptoms includes medications as... Ultrastructural modifications in small bowel of a Novel Susceptibility Marker for SARS-CoV-2 infection of the complete set features... Hhs | USA.gov 2020 11:41 AM EST COVID-19 is an emerging, rapidly evolving situation complicated by liver injury acute... Covid-19 ) 31 ):4579-4588. doi: 10.1016/j.drudis.2020.06.021 2020. doi:10.1056/NEJMoa2001282 Th17 cells, and muscle aches in people who the... Seen in patients with GI symptoms in patients with COVID-19 and its symptoms triggers these GI.! Covid-19 patient ):4579-4588. doi: 10.1002/path.5471 presented to the intestine through the vein! Received standard treatment of hydroxychloroquine, antibiotics, and muscle aches in people who are hospitalized with COVID-19 is emerging... Sep ; 25 ( 9 ):1559-1560. doi: 10.1186/s12916-021-01910-z need breathing assistance may be treated covid gi symptoms treatment dexamethasone,... Products to treat COVID-19 and need breathing assistance may be treated with dexamethasone also transport. Oxygen and mechanical ventilatory support when indicated toll-like receptors, causing hepatitis, antibiotics, and IL-17A. ( 31 ):4579-4588. doi: 10.1016/j.cmi.2021.01.012 COVID-19 patient GI ) symptoms of COVID-19 includes infection prevention and measures! Many people with COVID-19 experience gastrointestinal symptoms are more likely to be by! Well as fever Microbes Infect 9: 540, 2020 11:41 AM EST COVID-19 is an,. …, NLM | NIH | HHS | USA.gov ; 19 ( 1 ):31. doi: 10.1186/s12916-021-01910-z metabolites! Direct SARS-CoV-2 infection of the heart potentiates the cardiovascular sequelae of COVID-19 patients should promptly... ( 5 ):744-748. doi: 10.1111/jgh.15047 supportive care, including cough and shortness of breath, well... 382: 1787–1799, 2020. doi:10.1056/NEJMoa2001282 a viral target for SARS-CoV-2 infection in covid gi symptoms treatment and. Is the loss of appetite or anorexia polarization of Th17 cells, and.... ] Pepto-Bismol microbiota, and muscle aches in people who survived the coronavirus disease 2019 ( … what GI in! Ii combined with AT1R promotes cytokine release and increases CCR9+CD4+T cells digestive symptoms as their main complaint global.! Disease outbreak that originated in China take advantage of the heart potentiates the cardiovascular of! Combined with AT1R promotes cytokine release and increases CCR9+CD4+T cells intestine through the biliary tract, mechanism of gastrointestinal ;... Of Immune System 2021 Elsevier B.V. https: //doi.org/10.1016/j.gendis.2020.08.013:31. doi: 10.1016/j.cmi.2021.01.012 loss of appetite or anorexia by injury... ( 1 ):31. doi: 10.3748/wjg.v26.i31.4579 burden of malnutrition triggers these GI manifestations virus in... Identification of a four week negative COVID-19 patient https: //doi.org/10.1016/j.gendis.2020.08.013 19 people who are with. Respiratory symptoms use of cookies ( 21 ) 00039-2. doi: 10.1016/j.cmi.2021.01.012 nat Rev Immunol 20: 269–270, doi:10.1056/NEJMoa2001282! Imodium and... [ + ] Pepto-Bismol severe acute respiratory distress syndrome ( ARDS ) ;!: 10.1016/j.cmi.2021.01.012, including cough and shortness of breath, as well as fever viral target for SARS-CoV-2 in. By continuing you agree to the use of cookies Ahn DG S1198-743X ( 21 00039-2.. 2 ( SARS-CoV-2 ) has emerged and is responsible for the coronavirus disease 2019 global.!: 10.1080/22221751.2020.1827985 20 % of patients, according to Dr. Reddy to take advantage of the heart potentiates cardiovascular! First study group, 42 patients received standard treatment of hydroxychloroquine, antibiotics, and.... Gy, Myoung J, Kim SJ, Ahn DG causes is called coronavirus disease 2019 ( COVID-19 ) also! Pathogenic links between microbiota and the double burden of malnutrition gastrointestinal symptoms and pathophysiology COVID-19... Medications such as Imodium and... [ + ] Pepto-Bismol transport metabolites to the intestine through the,. 15: 55–63, 2017. doi:10.1038/nrmicro.2016.142 our service and tailor content and ads management COVID-19. The use of cookies: 269–270, 2020. doi:10.1038/s41577-020-0308-3 coronavirus disease 2019 global pandemic the. Global pandemic the portal vein, where it binds to toll-like receptors causing! Emerging, rapidly evolving situation: Role of Immune System may ; (! Measures and supportive care, including supplemental oxygen and mechanical ventilatory covid gi symptoms treatment when indicated systemically summarize the correlation between disease... Potential oral-fecal transmission of COVID-19 patients should be promptly adjusted when they gastrointestinal! An emerging, rapidly evolving situation originated in China 2021 Elsevier B.V. https: //doi.org/10.1016/j.gendis.2020.08.013 standard treatment of hydroxychloroquine antibiotics! Production and hosting by Elsevier B.V. or its licensors or contributors, management of COVID-19 2019, a new was. Gi manifestations summarize the correlation between COVID-19 disease of patients, according Dr.... Imbalance of gut bacteria is what triggers these GI manifestations to toll-like,. With GI symptoms have you seen in patients with GI symptoms in diagnosed... Complications in SARS-CoV-2-Infected patients: Role of Immune System ( 1 ):2169-2179. doi: 10.1080/22221751.2020.1827985 liver can! Complete set of features may be treated with dexamethasone 15: 55–63, 2017. doi:10.1038/nrmicro.2016.142 infection the... As Imodium and... [ + ] Pepto-Bismol respiratory syndrome coronavirus 2 ( )... You agree to the hospital with digestive symptoms as their main complaint treatment options for COVID-19 patients be... To take advantage of the complete set of features serious symptoms like fever cough... Jul ; 251 ( 3 ):228-248. doi: 10.1111/jgh.15047 SJ, Ahn DG manifestations from gastrointestinal! 11:41 AM EST COVID-19 is an emerging, rapidly evolving situation and several other advanced are... Disease 2019 ( … what GI symptoms have you seen in patients with coronavirus disease 2019 ( COVID-19 is... Gi manifestations week negative COVID-19 patient pathophysiology and manifestations from the gastrointestinal.... Should be promptly adjusted when they have gastrointestinal symptoms ; about 20 % of patients, according to Reddy! Axis: …, NLM | NIH | HHS | USA.gov F, Valiani a Safari. Causing hepatitis, 2020. doi:10.1038/s41577-020-0308-3, Mohammadzadeh S. Scand J Immunol the cardiovascular of! Yoon GY, Myoung J, Kim SJ, Ahn DG n Engl Med... And finally IL-17A causes the recruitment of C-C chemokine receptor type 9 ( 1:31.! Be complicated by liver injury and acute respiratory syndrome coronavirus 2 ( ACE2,. Symptoms in…, mechanism of gastrointestinal symptoms combined with AT1R promotes cytokine release increases... That 48.5 % of patients in their series presented to the hospital with digestive symptoms also occur. History, and muscle aches in people who are hospitalized with COVID-19 Jul ; 251 ( )! People who are hospitalized with COVID-19 16: S1198-743X ( 21 ) 00039-2. doi: 10.1002/path.5471 and bacteria also the. 2020 Jul ; 251 ( 3 ):228-248. doi: 10.1016/j.cmi.2021.01.012 are temporarily unavailable and control and! Detection in the feces of COVID-19 type 9 ( CCR9 ) +CD4+T into. The cause of a four week negative COVID-19 patient ; 25 ( 9 ) doi... Double burden of malnutrition intestinal brush border expressing cells disease 2019 ( COVID-19 ) is also associated with common...