Published Paper Details:

SARS-CoV2, a novel coronavirus of Coronaviridae family, has caused a worldwide pandemic of COVID-19 infections. Most patients had respiratory symptoms causing pneumonia in severe cases, thus droplets have been focus of investigations in disease-transmission. However, gastrointestinal (GI) symptoms in some cases have warranted research, revealing possible fecal-oral routes. Proton Pump Inhibitors (PPIs), one of the most commonly-used drugs in gastric acid-related disorders, act by inhibiting H+-K+-ATPase pumps in parietal cells of oxyntic glands of stomach. This paper aims at finding the risk of COVID-19 infections in patients on PPI therapy. SARS-CoV2 enters human body through ACE-2 receptors. These receptors, though present extensively, are expressed primarily in alveolar tissue of lungs, enterocytes of small intestine. Surface expression of ACE2 receptors in alveolar epithelium explains widespread respiratory symptoms of COVID-19. To access ACE-2 receptors of small intestinal enterocytes, the virus has to pass through the stomach, where normal pH is around 2. SARS-CoV2, being pH-dependant, cannot tolerate this acidification and its half-life is greatly reduced. This study focuses on 150 patients across India, positive for COVID-19 infections by RT-PCR, where medication-history, specially PPIs were noted. PPIs increased risk of GI symptoms in COVID-19 from 14% to 61.9% with odds ratio of 5.6, proving PPIs greatly affect chances of GI symptoms. The explanation is by reducing gastric HCl, PPIs increase gastric pH from 2 to around 6. Once pH of 5-6 is achieved, virus can easily pass through stomach and reach ACE-2 receptors of small intestine, explaining a route for fecal-oral transmission.