Digestive symptoms common with mild COVID-19

Last Updated: 2020-04-27

By Reuters Staff

NEW YORK (Reuters Health) - In patients who present with mild COVID-19 infection, digestive symptoms are common and are associated with longer-duration viral shedding, according to a study in Wuhan, China.

Several studies have now shown that COVID-19 can present with non-respiratory symptoms, including such digestive symptoms as diarrhea, diminished appetite and nausea. Most of these studies have focused on patients with severe or critical illness.

Dr. Chaoqun Han of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, in Wuhan, and colleagues evaluated clinical presentations, stool SARS-CoV-2 RNA test results and outcomes in their retrospective study of 206 patients with mild COVID-19.

Of these patients, 48 had digestive symptoms only, 89 had respiratory symptoms only, and 69 had both digestive and respiratory symptoms, the authors report in the American Journal of Gastroenterology.

Among the 67 patients presenting with diarrhea, the diarrhea lasted an average of 5.4 days (range, 1-14 days).

Patients with digestive symptoms had a longer period between initial symptom onset and hospitalization than did patients with only respiratory symptoms (16.0 versus 11.6 days, respectively).

The mean interval between symptom onset and viral clearance was significantly longer in the digestive-only (40.9 days) and digestive and respiratory (42.0 days) groups than in the respiratory-only group (33.5 days).

Stool tested positive for SARS-CoV-2 RNA in three of five digestive-only patients and eight of 10 digestive and respiratory patients, compared with only one of seven respiratory-only patients tested.

Patients who tested positive for viral RNA in stool had a significantly longer time to viral clearance compared with patients who tested negative (mean, 44.2 vs. 33.7 days, respectively).

"These data emphasize that patients with new-onset diarrhea after a possible COVID-19 contact should be suspected for the illness, even in the absence of cough, shortness of breath, sore throat, or even fever," the authors conclude. "These patients should self-quarantine and seek medical care if not already under evaluation. Optimally, testing for COVID-19 should be performed using both respiratory and stool samples, if available."

"Importantly, digestive symptoms are common in the community, and most instances of new-onset diarrhea, nausea, or vomiting are not from COVID-19," they note. "Nonetheless, clinicians should recognize that new-onset, acute digestive symptoms in a patient with a possible COVID-19 contact should at least prompt consideration of the illness, particularly during the times of high COVID-19 incidence and prevalence."

Dr. Han did not respond to a request for comments.

SOURCE: https://bit.ly/2S9yuC3 American Journal of Gastroenterology, online April 15, 2020.