Table 1.
Studies reporting proportion of patients with COVID-19 with gastrointestinal symptoms
| Study | Region | Time | Total number of patients | Gastrointestinal symptom | Point at which symptoms were reported | Gastrointestinal symptoms and disease severity |
|---|---|---|---|---|---|---|
| Studies in adults | ||||||
| Lin et al.25 | Zhuhai, China | 17 Jan to 15 Feb 2020 | 95 | Diarrhoea 5.3%; nausea 3.2%; anorexia 5.3%; acid reflux 1.1% | On admission | No statistically significant difference in the clinical outcomes (remained in hospital, discharged or died) |
| Diarrhoea 18.9%; nausea 14.7%; vomiting 4.2%; anorexia 12.6%; acid reflux 1.1%; epigastric discomfort 2.1% | During hospitalization | |||||
| Papa et al.27,a | Rome, Italy | 15 Mar to 14 Apr 2020 | 34 | Any gastrointestinal symptoms 8.8% | On admission | Gastrointestinal symptoms associated with reduced mortality |
| Any gastrointestinal symptoms 32.3% | During hospitalization | |||||
| Jin et al.23 | Zhejiang, China | 17 Jan to 8 Feb 2020 | 651 | Diarrhoea 8.6%; vomiting 2.15%; nausea 2.0% | On admission | Gastrointestinal symptoms associated with severe disease |
| Zhou et al.16 | Wuhan, China | 29 Dec 2019 to 31 Jan 2020 | 191 | Diarrhoea 5%; nausea or vomiting 4% | On admission | No statistically significant difference in mortality |
| Chen et al.24,a | Baltimore, USA | 9 Mar to 15 Apr 2020 | 101 | Diarrhoea 50%; nausea 30%; vomiting 14%; abdominal pain 26%; anorexia 53%; haematochezia 1% | On admission | No correlation between gastrointestinal symptoms and increased hospitalization rate or ICU care needs |
| Ferm et al.17 | New York, USA | 14 Mar to 1 Apr 2020 | 892 | Diarrhoea 9.8%; nausea 16.6%; vomiting 10.2%; loss of taste 2.4%; loss of appetite 11.8%; abdominal pain 7.8% | On admission | No difference in ICU admission, length of stay, or mortality |
| Remes-Troche et al.20 | Veracruz, Mexico | 1 Apr to 5 May 2020 | 112 | Diarrhoea 7.8%; vomiting 7.1%; abdominal pain 9.8% | On admission | No statistically significant difference in disease severity |
| Redd et al.22 | Massachusetts, USA | Until 2 Apr 2020 | 318 | Diarrhoea 33.7%; nausea 26.4%; vomiting 15.4%; abdominal pain 14.5%; anorexia 34.8%; constipation 0.94%; melena 0.63%; reflux 0.63%; dysphagia 0.31%; odynophagia 0.31%; haematochezia 0.31% | During hospitalization | No correlation between gastrointestinal symptoms and disease severity |
| Wan et al.28 | China | 19 Jan to 6 Mar 2020 | 232 | Diarrhoea 21%; abdominal pain 1%; bloody stool 4% | During hospitalization | Gastrointestinal symptoms associated with severe symptoms of pneumonia |
| Díaz et al.18 | Chile | Until 11 Apr 2020 | 7,016 | Diarrhoea 7.3%; abdominal pain 3.7% | No distinction made | Gastrointestinal symptoms associated with a higher risk of hospitalization |
| Cholankeril et al.29 | California, USA | 4 Mar to 24 Mar 2020 | 116 | Diarrhoea 10.3%; nausea and/or vomiting 10.3%; abdominal pain 8.8%; loss of appetite 25.3% | No distinction made | No correlation between gastrointestinal symptoms and disease severity |
| Hajifathalian et al.21 | New York, USA | 4 Mar to 9 Apr 2020 | 1,059 | Diarrhoea 22%; abdominal pain 7% | No distinction made | Gastrointestinal symptoms associated with lower rates of death and ICU admission |
| Studies on paediatric patients | ||||||
| Xu et al.79 | Guangdong, China | Until 20 Feb 2020 | 10 | Diarrhoea 30%; vomiting 0 | On admission | NA |
| Cai et al.81 | China | Jan 19 to 3 Feb 2020 | 10 | Diarrhoea 0% | During hospitalization | NA |
| Lu et al.170 | Wuhan, China | 28 Jan to 26 Feb 2020 | 171 | Diarrhoea 8.8%; vomiting 6.4% | No distinction made | NA |
| Fakiri et al.171 | Marrakesh, Morocco | 2 Mar to 1 Apr 2020 | 74 | Diarrhoea 5.4% | No distinction made | NA |
| de Ceano-Vivas et al.172 | Madrid, Spain | 11 Mar to 9 Apr 2020 | 58 | Diarrhoea 12.1%; vomiting 15.5% | No distinction made | NA |
| Mahmoudi et al.173 | Tehran, Iran | 7 Mar to 30 Mar 2020 | 35 | Diarrhoea 26%; vomiting 29%; abdominal pain 11% | No distinction made | NA |
| CDC COVID-19 Response Team174 | USA | 12 Feb to 2 Apr 2020 | 291 | Diarrhoea 13%; nausea and/or vomiting 11%; abdominal pain 5.8% | No distinction made | NA |
| Parri et al.175 | Italy | 3 Mar to 27 Mar 2020 | 100 | Diarrhoea 9%; nausea or vomiting 10% | No distinction made | NA |
Table 1 contains selected studies that take sample size, region, symptom collection time point (on admission or during hospitalization) and research methods (prospective or retrospective) into consideration. In detail, studies on adult patients that clarified whether the gastrointestinal symptoms were collected before or after admission and with a sample size >100 were included; the two studies that distinguish the symptoms on admission and during hospitalization are placed but samples <100 are placed at the top of the table. Two studies in Chile and California, with a sample size of >100 but missing the symptom collection time point, were included owing to the few studies in these regions. One New York study with a large sample size was also included. The number of paediatric studies containing gastrointestinal symptoms are limited; studies in different regions with symptom collection time point or a sample size >35 were included. CDC, Centers for Disease Control and Prevention; COVID-19, coronavirus disease 2019; ICU, intensive care unit; NA, not available. aProspective study.