Gastrointestinal Symptoms Associated With COVID-19 Infection

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A team of investigators conducted a comprehensive search of several databases to identify the prevalence of gastrointestinal symptoms in patients with COVID-19 infection.

Gastrointestinal (GI) symptoms have been reported in as many as 1 in 5 patients with SARS-CoV-2 infection, according to a systematic review and meta-analysis published in Mayo Clinic Proceedings.

Recent studies have shown the presence of GI manifestations in patients with coronavirus disease 2019 (COVID-19), with 16% to 50% of patients reporting 1 or more GI symptoms at presentation or during the illness. Recognition of these symptoms would influence testing and isolation strategies. Therefore, a team of investigators conducted a systematic review and meta-analysis evaluating the prevalence of GI symptoms and mortality in individuals diagnosed with COVID-19.

A comprehensive search of several databases was conducted to assess research performed from 2019 to May 7, 2020. Studies measured in this meta-analysis were observational studies that included adults with confirmed COVID-19 infection and reporting GI symptoms. The grading of recommendations, assessment, development, and evaluations (GRADE) system was used to interpret the findings of each study.  The primary outcome assessed weighted pooled prevalence (WPP) of GI symptoms in patients with COVID-19 infection occurring at any time during illness. Secondary outcomes were WPP of mortality in all COVID patients and in patients with GI symptoms.

Overall, 78 studies reporting a total of 12,767 patients were included in the analysis. The majority (57/78) were performed in mainland China, with 6 conducted in the United States. Ages of patients ranged from 15 to 96 years, and 58.4% were female. Among the studies, GI symptoms were reported at onset of illness in 6, at admission in 17, data given separately for both in 3, and data were unavailable in 52 studies. Overall, of the 12,688 patients, the WPP of diarrhea was 12% (95% CI, 8%-17%), I2=94%; nausea and/or vomiting was 9.0% (95% CI, 5.5%-12.9%), I2=93%; loss of appetite was 22.3% (95% CI, 11.2%-34.6%), I2=94%; and abdominal pain was 6.2% (95% CI, 2.6%-10.3%), I2=92%. Overall mortality among patients with COVID-19 was reported in 42 studies and ranged from 0 to 100%. Mortality among patients with GI symptoms was found to be similar to overall mortality (0.4% [95% CI, 0%-1.1%], I2=74% and 2.1% [95% CI, 0.2%-4.7%], I2=94%, P =.15, respectively).

Limitations of the analysis include the retrospective design of most of the studies with a high risk for bias including publication bias, significant heterogeneity, and the overall quality of evidence was low to very low for all outcomes.

The researchers conclude that the study highlights the need for clinicians to be acutely aware of the possibility that patients with COVID-19 infection can have GI symptoms and to have a low threshold for testing for the infection.

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Tariq R, Saha S, Furqan F, Hassett L, Pardi D, Khanna S. Prevalence and mortality of COVID-19 patients with gastrointestinal symptoms: a systematic review and meta-analysis (published online June 10, 2020). Mayo Clin Proc.