Science Articles

Polisorb for Gastrointestinal Damage & Diarrhea Associated with COVID-19

Annotation. A new coronavirus infection is a disease that, in addition to the respiratory system, can affect the gastrointestinal tract due to the affinity of the virus to endothelial receptors with the manifestation of dyspeptic syndrome. The manifestation of gastrointestinal disorders can be associated not only with viral damage, but also with the action of antiviral and antibacterial drugs used to treat COVID-19.

The purpose of this study is to analyze the effectiveness of enterosorbents in the treatment of dyspeptic syndrome in patients with a new coronavirus infection. This retrospective analysis evaluates the possibility of using drugs with a high sorption capacity in reducing the viral load in the intestine, thereby reducing the clinical symptoms of gastrointestinal tract damage in COVID-19.

Keywords: coronavirus, SARS-CoV-2, COVID-19, symptoms of gastrointestinal tract damage, dyspepsia, diarrhea, Polisorb MP, colloidal silicon dioxide.

Today the world faces the rise of the incidence rate due to the new coronavirus infection COVID-19. Clinical and epidemiological specifics of this disease are continuously studied and new means of its diagnostic assessment, treatment and prevention are being developed. Aside from fever and respiratory disorders patients often make complaints of the dyspeptic nature of COVID-19 infection.

During the SARS-CoV coronavirus outbreak in 2003 every fourth patient complained of diarrhea [1]. It stemmed from coronavirus receptors being not only in the respiratory tract, but also on the mucous membranes of the gastrointestinal tract. Similar situations happen with SARS-CoV-2. Viral infection starts with its entry into target cells, the surface of which has receptors of angiotensin-converting enzyme II (ACE2).  Receptors, which the virus uses to enter the cell, are situated on enterocytes – cells of epithelium of the small intestine. Disruption of these receptors is the cause of diarrhea when being infected with a coronavirus.

A study by Chinese scientists from the Fifth Hospital at Sun Yatsen University has shown that 55% of coronavirus patients have the virus RNA in their stool samples, and can be detected there within 9-27 days from the moment the first symptoms appear [2].

Appearance of gastrointestinal disorders can be connected, apart from a viral disease, to the effect of antiviral and antimicrobial drugs used for the treatment of the COVID-19 coronavirus infection.

The use of drugs with high sorption activity and a significant absorbing area can reduce the viral load in the intestine and thus reduce the clinical manifestations of dyspepsia associated with the new coronavirus infection. One of these drugs is Polisorb MP, an inorganic non-selective multifunctional enterosorbent based on highly dispersed silica with a particle size of up to 0.09 mm and a chemical formula of SiO2, which has pronounced sorption and detoxification properties. In the intestinal lumen the drug binds and removes from the body endogenous and exogenous toxic substances of various nature, including pathogenic bacteria and bacterial toxins, antigens, food allergens, drugs and poisons, heavy metal salts, radionuclides and alcohol. Polisorb MP also sorbs some metabolic products of the body, including an excess of bilirubin, urea, cholesterol and lipid complexes, as well as metabolites responsible for the development of endogenic toxicosis.

Aim of the research: to determine the effectiveness of the enterosorbent in dyspeptic syndrome relief in patients with the new coronavirus infection – COVID-19.

METHODS AND MATERIALS

A retrospective analysis of 254 medical records of patients hospitalized at the Regional Budgetary Healthcare Institution City Clinical Hospital No. 1 in Ivanovo in April-September of 2020 was carried out. They were diagnosed with a new coronavirus infection on the basis of clinical and epidemiological data, confirmed virologically - by the detection of SARS-CoV-2 virus RNA on the mucous membranes of the nasopharynx via the PCR method. The condition of all patients included in the study was assessed as moderate or severe. Patients underwent laboratory and instrumental examination, treatment in accordance with the Interim Guidelines of the Ministry of Health of Russia "Prevention, diagnosis and treatment of the new coronavirus infection (COVID-19)" [3].

Symptoms of gastrointestinal dyspepsia were recorded in 82 patients (32.2%), that is, every third patient complained of nausea, vomiting, abdominal pain, and loose stools. Characteristics of the existing clinical symptoms of gastrointestinal tract lesions are presented in Table 1. These patients were divided into 2 groups:

Group 1 (treatment group) – 56 patients (68.3%) who were prescribed the Polisorb MP enterosorbent to counter the effects of dyspepsia;

Group 2 (control group) – 26 patients (31.7%) who were not administered enterosorbents.

Table 1

Characterization of clinical symptoms of gastrointestinal tract lesions in patients with novel coronavirus infection COVID-19

Symptoms

Symptom occurrence

Group 1, n=56

Group 2, n=26

Total, n=82

patients

%

patients

%

patients

%

Nausea:

persistent

sporadic


38

18


67.8

32.2


19

7


73.1

26.9


57

25


69.5

30.5

Vomiting:

up to 3 times per day

more than 3 times per day


22

10


39.2

17.8


8

3


30.7

11.5


30

13


36.5

15.8

Regurgitation:

persistent

sporadic


4

11


7.2

19.6


2

4


7.7

15.3


6

15


7.3

18.3

Heartburn:

persistent

sporadic


4

7


7.2

12.5


1

3


3.8

11.5


5

10


6.1

12.2

Bitter taste in the mouth:

persistent

sporadic


10

16


17.8

28.6


5

7


19.2

26.9


15

23


18.3

28.1

Pain:

in the epigastrium and upper abdomen

predominantly in the umbilical region

mainly in the lower abdomen


26

10

3


46.4

17.8

5.3


12

4

1


46.7

15.3

3.8


38

14

4


46.3

17.1

4.9

Constipation

-

-

6

23.1

6

7.3

Diarrhea (more than 3 times per day):

persistent

sporadic


6

13


10.7

23.2


3

5


11.5

19.2


9

18


11.0

22.0

Dryness of the mucous membranes of the oropharynx

44

78.5

16

61.5

60

73.2

Taste sense disorder

18

32.2

7

26.9

25

30.5



No significant differences of clinical manifestations were found between the compared groups.

Polisorb MP was prescribed to patients in the form of an aqueous suspension within which the drug was stirred in 1/4-1/2 glass of water, ingested 1 hour before meals or other drugs. The dosage was calculated depending on the patient's body weight and amounted to 0.1-0.2 g/kg body weight (6-12 g). Frequency - 3-4 times per day.

All observed patients received combined antimicrobial therapy including azithromycin. Patients with signs of intestinal dysfunction underwent bacteriological and virological stool examination. All of them received negative results.

RESULTS

Among the most frequent clinical symptoms of gastrointestinal dyspepsia recorded in patients with new coronavirus infection were dryness of the mucous membranes of the oropharynx (n = 60; 73.2%), persistent nausea (n = 57; 69.5%), pain in the epigastrium and upper abdomen (n = 38; 46.3%), as well as vomiting up to 3 times a day (n = 30; 36.5%), which was most often associated with coughing fits characteristic of the classic manifestations of coronavirus infection.

Nausea is a symptom recorded in all observed patients and in two thirds of cases nausea was identified on the constant basis, in 30% of cases it appeared sporadically. Vomiting was recorded in half of the patients (52.3%), bitterness in the mouth - in 46.4% of the patients. Only 6 patients (7.3%) complained of constipation, and this complaint was never a singular case – most often the patients complained of bitterness in the mouth and regurgitation.

Abdominal pain was recorded in more than half of the observed patients (68.3%), and most often the pain was localized in the epigastrium and in the upper abdomen, very rarely (4.9%) - in the lower parts. Liquid stools were found in every third patient (33.0%) with gastrointestinal disorders, and diarrhea most often developed sporadically. Every third patient admitted to an infection ward of the hospital had a change in taste perception or a complete loss of it. Changes in taste were mainly related to a decrease in the perception of sweetness and an increased sensitivity to salted products, i.e. most often patients added sugar to their food and believed that their food was too salty. The duration of this symptom could not be established since most often this symptom persisted after the patient was discharged from the hospital.

Group 1 patients were prescribed Polisorb MP for the treatment of dyspeptic disorders in accordance with the prescribing information of the drug. In the course of the treatment with the enterosorbent, the duration of disorder symptoms was significantly reduced (Table 2).

Thus patients receiving Polisorb MP complained of nausea on average 5.22 ± 1.36 days, while patients without enterosorption suffered from nausea for more than 9 days. Vomiting in patients of the 1st group was relieved 3 times faster - on average after 2 days. Regurgitation and heartburn persisted in the patients a little longer – up to 4 days. In patients of the control group these symptoms lasted up to 8 and 5 days respectively.

The longest symptoms in terms of duration were persistent bitterness in the mouth, abdominal pain and dryness of the mucous membranes of the oropharynx - about 7 days, but in patients who did not receive enterosorbents these symptoms lasted much longer - about 9 days.

Table 2

Characteristics of the duration of the main clinical symptoms of dyspepsia in patients with the new coronavirus infection

Symptoms

Duration of the symptoms (days)

p

Group 1 (n=56)

Group 2 (n=26)

Nausea

5.22 ± 1.36

9.37 ± 2.44

p<0.05

Vomiting

2.16 ± 0.76

6.63 ± 1.15

p<0.05

Regurgitation

4.39 ± 1.02

8.57 ± 2.42

p<0.05

Heartburn

4.87 ± 0.55

5.42 ± 1.03


Bitterness in the mouth

7.51 ± 2.28

9.34 ± 2.31


Abdominal pain

6.44 ± 2.07

8.50 ± 2.00


Diarrhea

2.94 ± 0.46

7.19 ± 1.25

p<0.05

Dryness of the mucous membranes of the oropharynx

7.18 ± 1.04

9.13 ± 1.46




CONCLUSION

Dyspeptic disorders in patients with the new coronavirus infection occur in every third patient (32.2%), are always characterized by the appearance of nausea, often (73.2%) by dryness of the mucous membranes of the oropharynx accompanied by pain in the epigastrium and upper abdomen (46.3% ). Changes in taste (in 30.5% of patients with moderate and severe forms of infection) were mainly related to a decrease in the perception of sweet and an increased sensitivity to salted products.

The use of Polisorb MP in the comprehensive therapy of the new coronavirus infection in patients with gastrointestinal dysfunction significantly (p <0.05) reduces the duration of nausea, vomiting, regurgitation and diarrhea, which significantly improves the patients' well-being and, most importantly, promotes adherence to the therapy.

REFERENCES

  1. Supotnitskiy M. V. Novel coronavirus SARS-CoV-2 in the context of global epidemiology of coronavirus infections // Journal of NBC Protection
    Corps. — 2019. — V. 4. — №1. — P. 32—65. https://doi.org/10.35825/2587—5728-2020—4-1—32-65.

  2. Xiao F., Tang M., Zheng X., Liu Y., Li X., Shan H. Evidence for gastrointestinal infection of SARS-CoV-2 // Gastroenterology. — 2020. DOI: https://doi.org/10.1053/j.gastro.2020.02.055.

  3. Interim Guidelines: Prevention, diagnosis and treatment of the new coronavirus infection (COVID-19), 2020.

INFORMATION ON AUTHORS

Svetlana Nikolaevna Orlova – Doctor of Medicine, Professor, Head of the Department of Infectious Diseases, Epidemiology and Dermatovenereology, Federal State Budgetary Educational Institution of Higher Education Ivanovo State Medical Academy of the Ministry of Health of the Russian Federation; e-mail: orloff3.dok@mail.ru.

Oksana Valentinovna Dudnik - Candidate of Medical Sciences, Associate Professor of the Department of Infectious Diseases, Epidemiology and Dermatovenereology, Federal State Budgetary Educational Institution of Higher Education Ivanovo State Medical Academy of the Ministry of Health of the Russian Federation; e-mail: dudnik_oks@mail.ru.

Maria Aleksandrovna Kolosova - Assistant of the Department of Infectious Diseases, Epidemiology and Dermatovenereology, Federal State Budgetary Educational Institution of Higher Education Ivanovo State Medical Academy of the Ministry of Health of the Russian Federation; infectious diseases doctor, Regional Budgetary Healthcare Institution City Clinical Hospital No.1, Ivanovo; e-mail: maska-koks@mail.ru.

Sergey Evgenievich Lebedev - Assistant of the Department of Infectious Diseases, Epidemiology and Dermatovenereology, Federal State Budgetary Educational Institution of Higher Education Ivanovo State Medical Academy of the Ministry of Health of the Russian Federation; Board certified doctor in infectious diseases, Regional Budgetary Healthcare Institution City Clinical Hospital No.1, Ivanovo.

Zemskov Dmitry Ivanovich - infectious diseases doctor, head of the infectious diseases department, Regional Budgetary Healthcare Institution City Clinical Hospital No.1, Ivanovo.

Popilov Mikhail Andreevich - General Director of JSC Polisorb, Chelyabinsk Region, Kopeysk; e-mail: info@polisorb.com.