Among patients hospitalized with coronavirus disease 2019 (COVID-19), gastrointestinal symptoms and liver function test abnormalities are common but the majority are mild and their presence is not associated with a more severe clinical course, according to a study published in Clinical Gastroenterology and Hepatology.
Emerging evidence indicates that gastrointestinal and hepatic manifestations may play an important role in COVID-19, but their prevalence and significance remain unknown. Therefore, researchers aimed to assess the prevalence, spectrum, severity, and significance of digestive manifestations in 1992 consecutive patients hospitalized with COVID-19 across 36 medical centers in North America. The researchers found that, overall, 53% of patients experienced at least 1 gastrointestinal symptom at any time during their illness, most commonly diarrhea (34%), nausea (27%), vomiting (16%), or abdominal pain (11%). In 74% of cases, gastrointestinal symptoms were judged to be mild. In total, 35% of patients developed an abnormal alanine aminotransferase or total bilirubin level, and these were elevated to less than 5 times the upper limit of normal in 77% of cases. After adjusting for potential confounders, the presence of gastrointestinal symptoms at any time (odds ratio 0.93, 95% CI, 0.76-1.15) or liver function test abnormalities on admission (odds ratio 1.31, 95% CI, 0.80-2.12) were not independently associated with mechanical ventilation or death.
“Our findings affirm that digestive manifestations are common in COVID-19. However, gastrointestinal symptoms and liver test abnormalities do not appear to represent a principal aspect of this disease in terms of human suffering or resource utilization,” concluded the authors. They added, “Our findings do not support a strong association between intestinal SARS-CoV-2 infection and severe pulmonary or systemic illness through gut-lung crosstalk or other mechanisms.”
Elmunzer BJ, Spitzer RL, Foster LD, et al, for the North American Alliance for the Study of Digestive Manifestations of COVID-19. Digestive manifestations in patients hospitalized with COVID-19. Clin Gastroenterol Hepatol. Published online September 22, 2020. doi: 10.1016/j.cgh.2020.09.041