Susceptibility Factors of Stomach for SARS-CoV-2 and Treatment Implication of Mucosal Protective Agent in COVID-19

Objectives: This work aims to study the gastrointestinal (GI) symptoms in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected patients and the susceptibility factors of the stomach for SARS-CoV-2 Materials and Methods: We investigated the SARS-CoV-2 susceptibility by analyzing the expression distribution of viral entry-associated genes, ACE2 and TMPRSS2, in single-cell RNA sequencing data derived from 12 gastric mucosa samples We also analyzed the epidemiological, demographic, clinical, and laboratory data of 420 cases with SARS-CoV-2-caused coronavirus disease 2019 (COVID-19) Results: ACE2 and TMPRSS2 are specifically expressed in enterocytes which are mainly from gastric mucosa samples with Helicobacter pylori (H pylori) infection history and intestinal metaplasia (IM) A total of 420 patients were surveyed, of which 62 were with and 358 were without GI symptoms There is a significant difference in average hospital stay (p < 0 001) and cost (p < 0 001) between the two groups Among 23 hospitalized patients including seven with upper GI symptoms and 16 with lower GI symptoms, six (85 7%) and five (31 3%) had H pylori infection history, respectively (p = 0 03) Of 18 hospitalized patients with initial upper GI symptoms, none of the eight patients with mucosal protective agent therapy (e g , sucralfate suspension gel, hydrotalcite tablets) had diarrhea subsequently, whereas six out of 10 patients without mucosal protective agent therapy had diarrhea subsequently (p = 0 01) Conclusion: IM and H pylori infection history may be susceptibility factors of SARS-CoV-2, and the mucosal protective agent may be useful for the blockade of SARS-CoV-2 transmission from the stomach to the intestine