This study found a higher rate of gastrointestinal complications, including mesenteric ischemia, in critically ill patients with COVID-19 compared with propensity score–matched patients without COVID-19, suggesting a distinct phenotype for COVID-19 compared with conventional ARDS.

High expression of angiotensin-converting enzyme 2 receptors along the epithelial lining of the gut that act as host-cell receptors for SARS-CoV-2 could explain involvement of abdominal organs.

Higher opioid requirements and COVID-19–induced coagulopathy may also explain the disproportionately high rate of ileus and ischemic bowel disease.

Differences in duration of illness did not seem to explain the differences in gastrointestinal complications.

Limitations of this study include the single center and the unavailability of inflammatory markers to use for matching. Further translational studies are warranted to examine the pathophysiology of these findings.

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