OBJECTIVE
Clinical and morphologic analysis of pathologic changes of digestive system organs in COVID-19 patients according to autopsy data of 2021—2024.
MATERIAL AND METHODS
A retrospective clinical and morphologic analysis of data from 69 autopsies of patients who underwent COVID-19 (confirmed by polymerase chain reaction test) and had symptoms of digestive system lesions, according to clinical data, was performed. The data of case histories, autopsies, pathologoanatomic diagnoses and causes of death of patients were studied. Microscopic studies of tissue samples of stomach, intestine, liver, pancreas were performed. Immunohistochemical study with antibodies CD3, CD45, CD68, spike- and nucleocapsid-protein SARS-CoV-2 was performed.
RESULTS
According to autopsy data, pathologic changes of the stomach that first developed and pre-existing more than 3 months after SARS-CoV-2 infection were detected in 49 (71.01%) of 69 cases. Among them, chronic superficial gastritis was the most common with 17 (34.99%) observations and acute stress-induced gastric erosions and ulcers with 13 (26.53%). Small and large intestinal lesions were seen in 15 (30.61%) cases, among which intestinal adenocarcinomas predominated with 6 (40.00%), colonic diverticula and chronic lymphocytic colitis with 3 (20.00%) cases each. Liver pathology, new-onset and pre-existing, was present in 100.00% cases: muscadic liver 45 (65.22%), massive liver necrosis (7.25%), hepatic steatosis and steatohepatitis (26.09%), brown atrophy (8.70%). Pancreatic lesions, new-onset and pre-existing, were detected in 57 (82.60%) cases. Among them, sclerosis and lipomatosis were more frequently registered in type 2 diabetes mellitus — 46 (80.70%) observations, pancreonecrosis — 11 (19.30%).
CONCLUSIONS
Gastric, intestinal, liver, and pancreatic pathology in COVID-19 patients may be either first-onset or preexisting. The detected persistence of nucleocapsid and spike proteins of the virus in tissues may cause direct and autoimmune tissue damage, leading to the development of new and progressive chronic diseases of the digestive organs.
