Terapevticheskii arkhivTerapevticheskii arkhiv0040-36602309-5342LLC Obyedinennaya Redaktsiya7952210.26442/00403660.2021.08.201020Research ArticleGastroenterological symptoms in COVID-19 patients with mild severity of the disease: opportunities to optimize antidiarrheal therapyArdatskayaMaria D.ludmilabutorova@mail.ruhttps://orcid.org/0000-0001-8150-307XButorovaLudmila I.ludmilabutorova@mail.ruhttps://orcid.org/0000-0003-4689-2844KalashnikovaMarina A.ludmilabutorova@mail.ruhttps://orcid.org/0000-0003-2606-198XNugaevaNelli R.ludmilabutorova@mail.ruhttps://orcid.org/0000-0002-1938-7829OvchinnikovYury V.ludmilabutorova@mail.ruhttps://orcid.org/0000-0003-1843-087XOynotkinovaOlga S.ludmilabutorova@mail.ruhttps://orcid.org/0000-0002-9856-8643PavlovAleksandr I.ludmilabutorova@mail.ruhttps://orcid.org/0000-0003-1836-7946PlavnikRoman G.ludmilabutorova@mail.ruhttps://orcid.org/0000-0001-5448-8812SayutinaElena V.ludmilabutorova@mail.ruhttps://orcid.org/0000-0001-9611-5096TopchiyTatiana В.ludmilabutorova@mail.ruhttps://orcid.org/0000-0003-4491-881XTrunovaSvetlana N.ludmilabutorova@mail.ruhttps://orcid.org/0000-0001-9523-9820Branch of Kirov Military Medical AcademyCentral State Medical Academy of the President of the Russian FederationCentral Clinical Hospital for Rehabilitation Treatment of the President of the Russian FederationLomonosov Moscow State UniversityResearch Institute for Healthcare Organization and Medical ManagementVishnevsky 3rd Central Military Clinical HospitalISOCARB LLCYevdokimov Moscow State University of Medicine and DentistryClinic “K+31”150820219389239310309202103092021Copyright © 2021, Consilium Medicum2021<p><strong>Background.</strong> The novel coronavirus infection COVID-19 can be manifested by damage to the organs of the gastrointestinal tract (GIT). Damage to the gastrointestinal tract by the SARS-CoV-2 virus leads to a violation of the microbial-tissue complex of the mucous membrane of the digestive tract. A common gastroenterological manifestation of COVID-19 is diarrhea.</p>
<p><strong>Aim. </strong>Study of the clinical features of gastroenterological disorders and the possibility of optimizing the treatment of diarrheal syndrome in patients with COVID-19 with a mild form of viral infection.</p>
<p><strong>Materials and methods.</strong> The observation group consisted of 230 patients with mild COVID-19: K-group (<em>n=</em>115) with respiratory symptoms, I group (<em>n=</em>115) with gastrointestinal manifestations in combination and without signs of respiratory damage. In order to compare the effectiveness of treatment of diarrheal syndrome, patients of group I are randomized into 2 subgroups: Ia (<em>n=</em>58) prebiotic treatment (Zacofalk<sup></sup>) and Ib (<em>n=</em>57) enterosorbents.</p>
<p><strong>Results. </strong>The development of gastrointestinal symptoms with SARS-CoV-2 infection is significantly more often noted in comorbid patients (67%). Gastrointestinal symptoms were dominated by diarrhea (93.9%) and flatulence (76.5%), in 1/3 of patients they were the first manifestos of infection. It was established that in 98.4% of patients of group I (against 42.6% of the K-group) signs of infectious intoxication were detected. In patients with gastrointestinal lesions, an elongation of the febrile period by 91.5 days was noted, a later (6 days) verification of the viral etiology of the disease. It was found that in patients of group I, the regression of clinical symptoms, the duration of viral disease, the dynamics of antibody formation, the prognosis for the development of IBS-like disorders in the post-infectious period depended on the treatment. In patients taking (Zacofalk<sup></sup>), these indicators were significantly better.</p>
<p><strong>Conclusion.</strong> In mild cases, to reduce the severity of viral intestinal damage, for effective relief of intestinal symptoms, to reduce the risk of IBS-like symptoms, it is advisable to prescribe (Zacofalk<sup></sup>) in an initial dose of 3 tablets per day.</p>COVID-19gastrointestinal symptomsdiarrheamicrobiocenosisZacofalkIBS-like disordersСOVID-19гастроинтестинальные симптомыдиареямикробиоценозбутиратЗакофалькСРК-подобные расстройства[Ивашкин В.Т., Шептулин А.А., Зольникова О.Ю., и др. Новая коронавирусная инфекция (COVID-19) и система органов пищеварения. Российский журн. гастроэнтерологии, гепатологии, колопроктологии. 2020;30(2):7-13 [Ivashkin VT, Sheptulin AA, Zolnikova OYu, et al. New Coronavirus Infection (COVID-19) and Digestive System. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2020;30(2):7-13 (in Russian)]. DOI:10.22416/1382-4376-2020-30-3-7][Zarifian A, Bidary MZ, Arekhi S, et al. Gastrointestinal and hepatic abnormalities in patients with confirmed COVID-19: a systematic review and meta-analysis. J Med Virol. 2020. DOI:10.1002/jmv.26314.doi:10.1002/jmv.26314][Gu J, Han B, Wang J. COVID-19: Gastrointestinal manifestations and potential fecal-oral transmission. Gastroenterology. 2020.158(6):1518-9. DOI:10.1053/j.gastro.2020.02.054][Saleh J, Peyssonnaux C, Singh KK, Edeas M. Mitochondria and microbiota dysfunction in COVID-19 pathogenesis. Mitochondrion. 2020;54:1-7. DOI:10.1016/j.mito.2020.06.008][Zuo T, Zhang F, Lui GCY, et al. Alterations in Gut Microbiota of Patients With COVID-19 During Time of Hospitalization. Gastroenterology. 2020;159(3):944-955.e8. DOI:10.1053/j.gastro.2020.05.048][Tang L, Gu S, Gong Y, et al. Clinical significance of the correlation between changes in the major intestinal bacteria species and COVID-19 severity. Engineering. 2020. DOI:10.1016/j.eng.2020.05.013][Временные методические рекомендации. Профилактика, диагностика и лечение новой коронавирусной инфекции (COVID-19). Версия 3 (03.03.20) [Temporary methodical recommendations. Prevention, diagnosis and treatment of new coronavirus infection (COVID-19). Version 3 (03.03.20) (in Russian)].][Гриневич В.Б., Губонина И.В., Дощицин В.Л., и др. Особенности ведения коморбидных пациентов в период пандемии новой коронавирусной инфекции (COVID-19). Национальный Консенсус 2020. Кардиоваскулярная терапия и профилактика. 2020;19(4):2630 [Grinevich VB, Gubonina IV, Doshchitsin VL, 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 Russian)]. DOI:10.15829/1728-8800-2020-2630][Бахарев С.Д., Бауло Е.В., Быкова С.В., и др. COVID-19 и тонкая кишка. Терапевтический архив. 2021;93(3):343-7 [Bakharev SD, Baulo EV, Bykova SV, et al. COVID-19 and the small intestine. Terapevticheskii Arkhiv (Ter. Arkh.). 2021;93(3):343-7 (in Russian)]. DOI:10.26442/00403660.2021.03.200662][Li J, Richards EM, Handberg EM, et al. Butyrate Regulates COVID-19-Relevant Genes in Gut Epithelial Organoids From Normotensive Rats. Hypertension. 2021;77(2):e13-e16. DOI:10.1161/HYPERTENSIONAHA.120.16647]