Rate of Severe GI Complications Found to Be Low in Patients Hospitalized With COVID-19

Abdominal pain patient woman having medical exam with doctor on illness from stomach cancer, irritable bowel syndrome, pelvic discomfort, Indigestion, Diarrhea, GERD (gastro-esophageal reflux disease)
Investigators assessed the rate of severe gastrointestinal complications in patients hospitalized with COVID-19 across 36 medical centers in the United States and Canada.

The incidence of severe gastrointestinal (GI) complications in patients hospitalized with coronavirus disease 2019 (COVID-19) was found to be relatively low, according to findings from a multicenter study published in Gastroenterology.

The study included data from a cohort of patients hospitalized with COVID-19 at 36 medical centers in the United States and Canada. The investigators specifically collected data from the first 50 to 100 consecutive adults with a confirmed diagnosis of COVID-19 from each center. Data were collected from April 15 to June 5 2020.

There were 1992 patients included in the analysis, 878 of whom were admitted to the intensive care unit (ICU). Mechanical ventilation was required by 72.7% and vasopressor support, 60.8% of those admitted to the ICU.

The mean patient age was 61.9 years (standard deviation, 15.1). Overall, 61.8% of the patients were men, 40.8% had diabetes mellitus; 32.4%, hypertension; 31%, pulmonary disease; 25.2%, cardiac disease; and 9.1%, prior GI or liver disease.

Severe GI complications were observed in 5.1% of patients. The most common complication was elevated alanine aminotransferase (>1000 unit/L), which affected 2.5% of patients. A fraction of patients (1.1%) had GI bleeding that required endoscopic evaluation. Less frequent complications included Clostridioides difficile infection (n=6), acute mesenteric ischemia (n=2), acute colonic pseudoobstruction (n=2), acute cholecystitis (n=2), acute pancreatitis (n=1), small bowel obstruction (n=1).

“Despite recent reports of intestinal ischemia in [patients with] COVID-19, our study found a low rate of this complication and therefore provides reassurance that this phenomenon may not be as problematic as initially believed,” the study authors stated.

A total of 299 patients (34.1%) died during the study period. The mortality rate was elevated among those with severe GI complications (55.6%).

“In conclusion, in this multicenter study involving a large number of ICU patients with COVID-19 across North America, we found a low incidence of severe [GI] complications, consistent with rates reported in critically ill patients in general,” the study authors wrote.


Qayed E, Deshpande AR, Elmunzer JB; North American Alliance for the Study of Digestive Manifestation of COVID-19. Low incidence of severe gastrointestinal complications in COVID-19 patients admitted to the intensive care unit: a large, multi-center study. Gastroenterology. Published online November 11, 2020. doi:10.1053/j.gastro.2020.11.009