The relationship between SARS-CoV-2 infection and cholangiopathy

Coronavirus disease 2019 (COVID-19) has been in our lives for about a year, with new clinical features being discovered every day. Although COVID-19 patients typically present with respiratory symptoms, some patients experience gastrointestinal (GI) symptoms such as diarrhea, nausea, vomiting, and loss of appetite, according to our current knowledge. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can infect the GI tract via its viral receptor angiotensinconverting enzyme 2 (ACE2), and there is growing evidence of a possible fecal-oral transmission route.[1,2] The aim of this study was to evaluate the literature in terms of gallbladder involvement in COVID-19 patients. However, there is currently insufficient literature on gallbladder involvement. The incidence of this complication is uncertain because it is difficult to diagnose.

Although infectious involvement of the bile ducts is most commonly caused by bacterial agents, it can also be induced by agents such as Brucella spp. and, in rare cases, viral agents.[3,4] Viral cholangitis occurs less frequently than viral hepatitis. Hepatotropic viruses (A, B, C, and E) and systemic viral diseases can also cause cholangitis in varying degrees. Human immunodeficiency virus (HIV) and other systemic viral infections, particularly those from the herpesvirus family, have been related to cholangitis in both immunosuppressed and immunocompetent patients.[4] However, its relationship with SARS-CoV-2 is still unclear. Roth et al.[5] reported three adult post-COVID-19 patients with severe cholestasis, and Zhai et al.[6] reported a patient with acute obstructive suppurative cholangitis. There are also cases of primary biliary cholangitis and progressive cholangiopathy in the literature.[7,8]

In conclusion in terms of this disease, which may cause mortality or morbidity, urgent research is needed into the mechanism of gallbladder involvement, disease incidence, course, treatment, and prevention, both during the course of severe COVID-19 and in post/long COVID-19 patients. Furthermore, some patients with cholangiopathy should be cautious of missed COVID-19 infection.

The author declared no conflicts of interest with respect to the authorship and/or publication of this article.

The author received no financial support for the research and/or authorship of this article.

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