Table 1.
Narrative summary of studies that investigated the prevalence of GI symptoms in COVID-19 and their association with hospitalization outcomes.
| Author Year Journal Country | Design | Study Population | N* | Outcomes | Result | Comments |
|---|---|---|---|---|---|---|
| Han19 2020 AJG China |
Retrospective cohort. | Consecutively hospitalized COVID-19 patients with mild disease (no dyspnea or hypoxia) in Wuhan, China. Mostly women (56%) in early 60s. | 206/ 117 | Comparing the clinical features between patients with GI symptoms and those with respiratory symptoms. | • Among patients presenting with GI symptoms, 19% had Diarrhea as first symptom. • Patient with GI symptoms presented later (16 vs. 5 days P<0.001). |
• The study suggests that new-onset diarrhea after a possible COVID-19 exposure should raise suspicion for the illness, even in the absence of fever or respiratory symptoms. |
| Jin5 2020 Gut China |
Retrospective multicenter cohort. | Consecutively hospitalized COVID-19 patients in Zhejiang, China. Equal rates of men and women in mid-40′s. | 651/ 74 | Prevalence of GI symptoms and their association with clinical outcomes and inflammatory markers. | • 11% of patients had GI symptoms (8.1% with diarrhea, 1.7% with vomiting, 1.5% with nausea) • Patients with GI symptoms were more likely to: ° Develop respiratory failure or requiring ICU (23% vs. 8.1%, p< 0.001) and ARDS 6.8% vs. 2.1% (p=0.034). ° Have elevated CRP (15.7 vs. 7.9 mg/L, p=0.003). |
• Increased LDH was identified as a risk factor for the severe/critical illness in patients with COVID-19 with GI symptoms (OR 24.8, 95% CI 4.6-133.3). |
| Lin20 2020 Gut China |
Retrospective cohort. | Patients with suspect or confirmed COVID-19 admitted to a designated hospital in Zhuhai, China. Mostly women (52%) in mid-40s. | 95/ 58 | Prevalence of GI symptoms. | • About 61% of patients had a GI-specific symptom (24% with diarrhea, 18% with anorexia and 18% with nausea). | |
| Luo21 2020 CGH China |
Retrospective multicenter case series. | Consecutively hospitalized patients in a single tertiary-care medical center in Wuhan, China. Mostly men (56%) in mid-50s. | 1141/183 | Prevalence of GI symptoms and their association with renal impairment. | • 16% of patients presented with GI symptoms only (98% with anorexia, 73% with nausea, 65% with vomiting, 37% with diarrhea, and 25% with abdominal pain). | • Renal function mostly remained intact in patients with GI symptoms. |
| Pan4 2020 Gastro-enterology China |
Retrospective multicenter cross-sectional. | COVID-19 patients admitted to 3 hospitals in Hubei Providence, China who underwent Chest CT scan, and had complete blood panels collected. Mostly men (52%) in mid-50s. | 204/ 103 | Prevalence of GI symptoms and the association between GI symptoms and severity of illness, symptoms onset, and certain laboratory abnormalities. | • About 19% of patients presented with a GI-specific symptom (79% with anorexia, 34%with diarrhea, and 4% with vomiting). • Patients with GI symptoms had no significant change in kidney function. • There was no significant difference in ICU days or mortality between the 2 groups. |
• Results were confounded by excluding patients who didn't have either chest CT or complete panel of routine laboratory tests. |
| Papa10 2020 ERMPS Italy |
Retrospective cohort. | Consecutively hospitalized COVID-19 patients in an Italian university hospital. Mostly Men (65%) in early 70s. | 34/ 14 | Prevalence of GI symptoms and their association with death and ICU admission. | • Among patients with COVID-19, the mortality rate of those with GI symptoms was lower than for those without GI symptoms. | |
| Chen3 2020 Gastro-enterology USA |
Prospective case-control. | Consecutively tested patients in a single tertiary care outpatient center in Baltimore, Maryland. Mostly women (59%), AA (51%) in late 40s. | 101/ 75 | Prevalence of GI symptoms and comparing these symptoms between who tested positive and negative. | • GI symptoms occurred in 74% of patients (30% with nausea, 50% diarrhea, 53% anorexia, 59% with anosmia and 59% with ageusia). |
• The study reflects a less sick population as only 10% were hospitalized. • No significant difference in hospitalization between patients with or without GI symptoms. |
| Cholan-keril22 2020 Gastro-enterology USA |
Retrospective cohort. | COVID-19 patients evaluated in the ED, outpatient clinic, or admitted at a tertiary care center in California. Mostly Caucasian (51%) or Hispanic (22%), men (53%), in early 50s. | 116/ 37 | Prevalence of GI symptoms and association with clinical outcomes. | • 32% of patients had GI symptoms (22% with anorexia, 12% with nausea/vomiting, 12% with diarrhea, and 9% with abdominal pain). • None developed isolated GI symptoms or GI symptoms as an initial manifestation. |
• The study reflects a less sick population as only 28.5% were hospitalized. |
| Hajifathalian8 2020 Gastro-enterology USA |
Retrospective multicenter cohort. | Consecutive COVID-19 patients presented to 2 hospitals in Manhattan, NY. Mostly men (58%) in early 60s. | 1059 /349 | Prevalence of GI symptoms and the association with the composite ICU admission and death. | • 33% of patients had GI symptoms (22% with diarrhea, 7% with abdominal pain, 16% with nausea and 9% with vomiting). • GI symptoms had lower rates of death (8.5% vs. 16.5%, p=0.003), and lower risk of the composite of death and ICU admission (28% vs. 38%, p=0.006). |
• The study reflects a less sick population as 27% of patients did not require admission. |
| Laszkow-ska11 2020 CGH USA |
Retrospective multicenter cohort. | Consecutively hospitalized COVID-19 patients in 2 hospitals in New York City. Mostly Men (56%), Hispanic (43%) in mid 60s. |
2804 / 1084 | Prevalence of GI symptoms and their association with intubation and death. | • GI symptoms occurred in 38.7% of patients, diarrhea in 23.4%, nausea or vomiting in 23.2% and abdominal pain in 11.9%. • Patient with GI symptoms had a lower rate of intubation (aHR 0.66, 95%CI 0.55-0.79) and death (aHR 0.71, 95%CI 0.59-0.87). |
• Patients with GI symptoms had lower inflammatory markers including significantly lower CRP, D-Dimer, and LDH. |
| Nobel9 2020 Gastro-enterology USA |
Retrospective multicenter case-control. | Randomly selected patients who were tested because of respiratory symptoms in the ED or outpatient clinic of multiple centers in New York who were either planned for admission or essential workers. COVID-19 patients were 28% AA, 38% Hispanic and mostly middle-aged men (52%). | 278/ 97 | Prevalence of GI symptoms and the associations of GI symptoms with illness duration and early clinical outcomes. | • 35% of patients presented with a GI-specific symptom (20% with diarrhea and 23% with nausea or vomiting). • Patients with GI symptoms had a lower short-term mortality compared to patients with no GI symptoms (0 vs 5%, p=0.03). • No significant difference in hospitalization or ICU admission rates. |
|
| Ramacha-ndrana 2020 Digestive Diseases USA |
Retrospective cohort. | Patients admitted to a tertiary medical center in Brooklyn, NY with COVID-19. Mostly men (53%) in late 50s. | 150/ 31 | To assess if GI symptoms could be used for prognostication in hospitalized patients with COVID-19. | • About 21% of patients had GI symptoms (48% with diarrhea, 19% with nausea or vomiting). • Mortality and mechanical ventilation rates were not different between the group with and without GI symptoms (41.9 vs. 37.8%, p=0.68) and (29 vs. 26.9%, p=0.82), respectively. |
|
| Redd7 2020 Gastro-enterology USA |
Retrospective multicenter cohort. | Consecutively hospitalized COVID-19 patients in 2 tertiary and 7 community hospitals in Massachusetts. Mostly men (55%) in mid-60s. | 318/ 195 | Prevalence of GI symptoms at presentation and the association between GI symptoms and laboratory results, patient characteristics, and hospital course. | • 61% of patients had GI symptoms (26% with nausea, 34% with diarrhea, 35% with anorexia, 10% with anosmia, and 8% with ageusia) on presentation. • No significant differences in laboratory results, patient characteristics, hospital course or mortality between the 2 groups. |
* Total COVID+ patients/ COVID+ patients with GI symptoms
Legend
AA: African American, AJG: American Journal of Gastroenterology, aHR: Adjusted Hazard Ration, ALT: Alanine Aminotransferase, ARDS: Acute Respiratory Distress Syndrome, AST: Aspartate Aminotransferase, CGH: Clinical Gastroenterology and Hepatology, CI: Confidence Interval, COVID: Corona Virus Disease, CRP: C-Reactive Protein, CT: computerized tomography, ED: Emergency Department, ERMPS: European Review for Medical and Pharmacological Sciences, ICU: Intensive Care Unit, GERD: Gastroesophageal Reflux Disease, GI: Gastrointestinal, LDH: Lactate dehydrogenase, μmol/L: micromole per liter, mg/L: milligrams per liter, NASH: Non-Alcoholic Steatohepatitis, OR: Odd Ratio, RR: Relative Risk, U/L: Units per Liter, C: Centigrade