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editorial
. 2020 Mar 27;158(8):2024–2027. doi: 10.1053/j.gastro.2020.03.046

Table 1.

Key Points of the Consensus on Diagnosis and Treatment of Digestive System Involvement in COVID-19 by the Chinese Society of Gastroenterology

Pathogen and route of transmission
 Novel coronavirus, severe acute respiratory syndrome corona virus 2 (SARS-CoV-2), respiratory droplets and contact transmission; fecal contamination is suspected.
Clinical manifestations in gastrointestinal symptoms
 Most patients have respiratory symptoms, but some may present gastrointestinal symptoms first, including loss of appetite, diarrhea, nausea, vomiting, abdominal pain, GI bleeding in severe cases, and abnormal liver function.
Management recommendations
 Diarrhea: Mostly mild, differentiate causes, symptomatic treatment, prevention needed.
 Viral: May account for 22.2% of the patients with diarrhea.
 Drug-induced: Many antiviral agents cause diarrhea.
 Antibiotic-associated: Seen with elderly patients and comorbidity of chronic illness, particularly in patients with ventilation in the intensive care unit.
 Liver injury: Most COVID-19–associated liver injury is mild, with <2 times of abnormal liver function test and need no treatment.
 Diet and nutrition: Enteral nutrition by oral feeding is preferred. A nutritional risk assessment is recommended for severe patients. A nasogastric tube can be inserted for enteral nutrition for those who are unable to take food by mouth (such as those receiving mechanical ventilation).
Precaution and limitation for GI examinations
 Endoscopy: Only emergency endoscopy is indicated during the outbreak, such as treatment of acute gastrointestinal hemorrhage, removal of foreign bodies in the digestive tract, suppurative obstructive cholangitis, and biliary pancreatitis. Screen for COVID-19 before the procedure and provide appropriate protection for the endoscopists in an isolated and preferably a negative-pressure room for the procedure.
 Suspend other examinations such as esophageal acid test, gastrointestinal motility test, hydrogen breath test, Helicobacter pylori test, and fecal antigen test.

NOTE. Adapted from The Chinese Society of Gastroenterology. Consensus on diagnosis and treatment of digestive system involvement in COVID-19. Chinese Journal of Medicine 2020 https://doi.org/10.3760/cma.j.cn112137-20200308-00645.