Pay Attention to Distinguish Hepatitis from Novel Coronavirus Hepatitis in the Context of COVID-19 Pandemic.

We read with great interest the recently published article in The American Journal of Gastroenterology about digestive tract characteristics of Coronavirus Disease 2019 (COVID-19) patients (1). The treatment of abdominal diseases in this special period faces many risks. The gastrointestinal symptoms of COVID-19 are more challenging for clinicians than the familiar respiratory symptoms. In particular, patients with hepatitis have abdominal symptoms overlapping with novel coronavirus infection, thus bringing more difficulties and risks to the judgment of clinicians. In other words, gastroenterologists cannot make a definitive diagnosis based solely on clinical manifestations, and related examinations and may neglect the role of novel coronavirus. From this perspective, in this particular period of the pandemic, we should not focus only on the symptoms and diagnosis of hepatitis while ignoring the causes.

It should be emphasized that the gastrointestinal symptoms of COVID-19 can be confused easily with other gastrointestinal diseases, including hepatitis. This makes clinical diagnosis and treatment more difficult. To the best of our knowledge, hepatitis is a digestive tract disease mainly characterized by abdominal and constitutional symptoms, which are obviously easily confused with the abdominal symptoms of COVID-19. Given this consideration, we have come up with these new concepts—COVID-19 is mainly characterized by abdominal symptoms, hepatitis combined with COVID-19, and novel coronavirus hepatitis. It is easy to distinguish these concepts literally.

Hepatitis combined with COVID-19 means that the occurrence of the 2 diseases overlaps in time but is not cause and effect. However, novel coronavirus hepatitis indicates that hepatitis is caused by novel coronavirus infection. Novel coronavirus has been successfully isolated from liver tissue, implying a risk of novel coronavirus hepatitis (2). This means that novel coronavirus has a potential risk of triggering hepatitis because viral infection of the liver is the main cause of hepatitis. Therefore, clinicians should always remind themselves whether the hepatitis they are dealing with is directly caused by novel coronavirus infection. However, we are not sure of the pathological and clinical characteristics of novel coronavirus hepatitis. Therefore, this concept is of great significance for subsequent research and clinical work.

Because the pandemic continues to spread and worsen, it is of great importance to accurately judge hepatitis in clinical practice. More studies are needed to confirm the pathological and clinical characteristics of novel coronavirus hepatitis, so as to better serve the clinical application. After all, we do not want to cause missed diagnosis or misdiagnosis of novel coronavirus-related diseases.

CONFLICTS OF INTEREST

Guarantor of the article: Xianqiang Yu, PhD.

Specific author contributions: X.Y. completed the design and writing of the article all the content.

Financial support: Scholarship of Southeast University (Project No. 189351).

Potential competing interests: None to report.