New Study Reveals Gastrointestinal Symptoms are Prominent in COVID-19

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Digestive symptoms can be added to the list of primary complaints associated with coronavirus disease 2019 (COVID-19), suggests a new study from China by researchers from the Wuhan Medical Treatment Expert Group for COVID-19 published today inThe American Journal of Gastroenterology.

Most patients with COVID-19 present with respiratory symptoms, but the descriptive, cross-sectional, multicenter study found that digestive symptoms were the main complaint in approximately 50% of patients presenting to the hospital.

“Clinicians must bear in mind that digestive symptoms, such as diarrhea, may be a presenting feature of COVID-19 that arise before respiratory symptoms,” wrote authors led by Lei Pan, MD, PhD, Department of Respiratory and Critical Care Medicine, Binzhou Medical University Hospital, China. “Clinicians should raise their index of suspicion when at-risk patients, such as those exposed to COVID-19, present with fever and digestive symptoms, even in the absence of respiratory symptoms.”

The study examined 204 patients with COVID-19 presenting to 3 hospitals in Hubei province from January 18, 2020 to February 28, 2020. The average age of participants was 54.9 years, including 107 men and 97 women.

A COVID-19 diagnosis was confirmed by real-time reverse transcription-polymerase chain reaction. Clinical characteristics, laboratory data, and treatment information for the patients were included in the final analysis.

Patients with digestive symptoms had a significantly longer time from onset to admission vs those without digestive symptoms (9 days vs 7.3 days), which may indicate patients with digestive symptoms sought care later because they did not suspect COVID-19 in the absence of respiratory symptoms.

In 7 cases there were digestive symptoms, but no respiratory symptoms and digestive symptoms became more pronounced as disease severity increased.

Researchers also found that patients without digestive symptoms were more likely to be cured and discharged vs those with digestive symptoms (60% vs 34.3%).

Patients who did present with digestive symptoms had a variety of manifestations including anorexia (83 cases), diarrhea (29 cases), vomiting (8 cases), and abdominal pain (4 cases).

Due to this, the researchers warned, “if clinicians solely monitor for respiratory symptoms to establish case definitions for COVID-19, they may miss cases initially presenting with extra-pulmonary symptoms, or the disease may not be diagnosed later until respiratory symptoms emerge.”

Other studies have shown liver injury in patients with COVID-19, but the present study found no signs of liver involvement. These variations in liver test abnormalities should be further studied to understand how and when the novel virus affects hepatic function.

“These results obligate additional research evaluating the prevalence, incidence, predictors, and outcomes of digestive symptoms in this still emerging pandemic,” researchers concluded.

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