COVID-19 patients commonly present with gastrointestinal symptoms

Last Updated: 2020-04-24

By Will Boggs MD

NEW YORK (Reuters Health) - About a third of patients who present with COVID-19 have gastrointestinal symptoms, according to a new U.S. study.

"In the early stages of the COVID-19 outbreak, there was a sense that cough, shortness of breath, and fever were the only relevant symptoms; in fact, many centers were only testing patients who had those symptoms," Dr. Yael R. Nobel of Columbia University Irving Medical Center-New York Presbyterian Hospital, in New York City, told Reuters Health by email. "Now, we realize that gastrointestinal symptoms, including diarrhea, nausea, and vomiting, are a big part of this disease."

Dr. Nobel and colleagues compared the rates of gastrointestinal symptoms between 278 patients who tested positive for SARS-CoV-2, the coronavirus that causes COVID-19, and 238 patients who tested negative for the virus.

Significantly more patients who tested positive (61%) than who tested negative (39%) had gastrointestinal symptoms. And in a multivariable model, the presence of gastrointestinal symptoms was associated with 70% greater odds of testing positive for SARS-CoV-2, the researchers report in Gastroenterology.

Among the COVID-19 patients, 35% had gastrointestinal symptoms, and more patients with gastrointestinal symptoms than without had an illness duration of one week or more (33% vs. 22%, respectively).

During short-term follow-up, the rate of death among patients with COVID-19 was significantly lower for those with gastrointestinal symptoms (0%) than for those without (5.0%).

"These findings may suggest that patients who have gastrointestinal symptoms at the time of testing have a less severe disease course," Dr. Nobel said.

"Around the United States, we are still working to increase access to testing, and it is important for healthcare providers to have accurate information about how this disease presents in order to be able to correctly prioritize testing for patients who are at higher risk of having COVID-19," she said.

"We hope that this study will help healthcare providers recognize the importance of asking about diarrhea, nausea, and vomiting when patients are evaluated for COVID-19," Dr. Nobel said. "When these symptoms are present, there should be a high index of suspicion for this disease."

Dr. Long Rong and Dr. Yuan Tian of Peking University First Hospital, in Beijing, who recently reviewed the gastrointestinal features of COVID-19 and the possibility of fecal transmission, told Reuters Health in a joint email, "About 20-30% of patients have GI symptoms. Some patients have only GI symptoms and no respiratory symptoms, which makes screening difficult."

"It is generally believed that patients with GI symptoms have a high proportion of mild disease, with diarrhea as the main specific manifestation, but the proportion of abdominal pain is higher in severe patients, and abdominal pain is rare in mild patients," they said. "Patients with diarrhea may have viral RNA in feces, but there is no statistical correlation between the two. Patients with abdominal symptoms may have a longer hospital duration."

"It is unclear whether these differences are caused by viral virulence or viral variation," they concluded. "We look forward to more research on the mechanism of viral infections."

SOURCE: https://bit.ly/2VuvGS4 Gastroenterology, online April 12, 2020.