Patients With COVID-19 and Gastrointestinal Symptoms Likely To Have Indolent Infection

Gastrointestinal symptoms in patients with COVID-19 may be indicative of a more acute, but also more persistent infection, according results of a new study.

Gastrointestinal symptoms in patients with COVID-19 may be indicative of a less acute, but also more persistent infection, according results from a retrospective case-control study published in Gastroenterology.

Researchers recruited adults (N=516) with respiratory symptoms who had received a nasopharyngeal swab test for COVID-19 between March 10-21, 2020 around the New York City area (Manhattan, Brooklyn, and Westchester County) in the United States of America.

The results of the swab test were positive for a majority of the patients (n=278, 54%). All participants were followed after testing for a duration of 5 to 18 days. Of the patients with a positive test result, 35% of them experienced gastrointestinal distress including diarrhea, nausea, or vomiting.

Patients with gastrointestinal symptoms were significantly more likely to test positive for COVID-19 (61% vs 39%; P =.04), while patients without gastrointestinal symptoms were equally likely to test positive or negative (51% vs 49%, respectively). The adjusted odds ratio of testing positive for COVID-19 when gastrointestinal symptoms were present was 1.7 (95% CI, 1.1-2.5).

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The duration of illness was significantly correlated with gastrointestinal distress. In patients with COVID-19 symptoms lasting longer than a week, 33% of them experienced gastrointestinal symptoms compared with 22% of those without gastrointestinal symptoms (P =.048). The investigators also observed a lower death rate among patients with gastrointestinal symptoms (0.0% vs 5.0%; P =.03).

A limitation of the study was the short follow-up time. The investigators allowed for a brief study period due to the urgent need for information that may guide clinical decision-making during the pandemic.

The study authors concluded that gastrointestinal distress coupled with COVID-19 respiratory symptoms increased the likelihood of positive nasopharyngeal swab test results, increased the duration of COVID-19 illness, and decreased the mortality rate. However, they emphasized the need for further study in larger cohorts and with longer follow-up periods to draw more concrete conclusions.

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Nobel Y R, Phipps M, Zucker J, et al. Gastrointestinal symptoms and COVID-19: case-control study from the United States. [available online April 12, 2020] Gastroenterology doi:10.1053/j.gastro.2020.04.017.