Gastrointestinal symptoms common in U.S. COVID-19 patients

Last Updated: 2020-04-30

By Will Boggs MD

NEW YORK (Reuters Health) - Nearly two-thirds of U.S. patients with COVID-19 report gastrointestinal symptoms, according to a multicenter study.

"In the very early stages of the pandemic here in Boston, my co-residents and I were very impressed by how the disease was so much more than just a respiratory illness - in particular, we saw many patients struggle with those GI manifestations like anorexia and diarrhea," Dr. Walker D. Redd, internal medicine resident at Brigham and Women's Hospital, told Reuters Health by email. "Interestingly, that was even before anosmia and ageusia were being recognized as much."

This experience prompted him, along with Dr. Walter W. Chan and colleagues from Harvard Medical School, to characterize gastrointestinal manifestations associated with SARS-CoV-2 infection and to evaluate their outcomes. The study included 318 patients with confirmed COVID-19 at two tertiary care hospitals and seven community hospitals in Massachusetts.

Overall, 61.3% of patients presented with at least one gastrointestinal symptom, including most commonly anorexia (34.8%), diarrhea (33.7%), and nausea (26.4%).

Gastrointestinal symptoms were the initial symptoms in 14.2% of patients and were the predominant presenting complaint in 20.3% of patients, according to the online report in Gastroenterology.

More patients with than without gastrointestinal symptoms also reported fatigue (65.1% versus 45.5%, respectively), myalgia (49.2% versus 22%), sore throat (21.5% versus 9.8%), and loss of smell or taste (16.9% versus 6.5%).

Nausea and anorexia were significantly associated with anosmia and ageusia after controlling for other factors, whereas other gastrointestinal symptoms were not.

Laboratory findings did not differ significantly between patients with and without gastrointestinal symptoms.

Among 202 patients who had completed their hospitalizations at the time of data analysis, 17.5% required a stay in the ICU, 13% required mechanical ventilation, and 15.8% died. These rates did not differ significantly between patients with and without gastrointestinal symptoms.

"COVID-19 should be considered in patients presenting with new or acute-onset digestive symptoms, even in the absence of respiratory complaints, fevers, or other typical COVID-19 symptoms," Dr. Chan told Reuters Health by email. "Failure to identify COVID-19 patients with primarily digestive symptoms may lead to delayed care, inadequate isolation, and further transmission."

"Patients presenting with new or acute-onset digestive symptoms should be triaged and treated in the same way as patients presenting with respiratory COVID-19 symptoms," he said. "Digestive symptoms should also be included in local protocol and management guidelines to help clinicians and patients promptly recognize signs of infection."

"COVID-19 is not just cough and fever," Dr. Chan concluded.

Dr. Yael R. Nobel from Columbia University Irving Medical Center-New York Presbyterian Hospital, New York City, who also recently described gastrointestinal symptoms in patients with COVID-19, told Reuters Health by email, "This article provides further evidence that gastrointestinal symptoms are an important piece of the clinical syndrome of COVID-19. It is important for physicians and other healthcare providers to ask about gastrointestinal symptoms when evaluating patients, as these may be a sign of infection - whether in combination with respiratory symptoms, or in the absence of respiratory symptoms."

"Interestingly, while the authors found no statistical differences in clinical outcomes between patients with and without gastrointestinal symptoms, there were trends toward lower rates of ICU stay and death in the group with gastrointestinal symptoms, which is similar to early trends we have seen in New York City," she said.

SOURCE: https://bit.ly/2zHsDh3 Gastroenterology, online April 22, 2020.