TABLE 1.
Characteristics of included studies about COVID‐19 with gastrointestinal symptoms
| Manuscript type | Study period (2020) | Patients (n) | Age, y (mean ± SD or median [IQR]) | Male sex, % or n (%) | Patients with GI symptoms, n (%) | Diarrhea, % or n (%) | Time end‐point | Hospitalization, n (%) | ICU stay, n (%) | Death, % or n (%) | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| First author (publication year) | Country or region | Nausea n (%) | Vomiting n (%) | Abdominal pain n (%) | Anorexia n (%) | Duration of GI symptoms (d) Mean ± SD or median (IQR) | Follow‐up (d) | |||||||||||
|
Papa 86 (2020) |
Italy | Case‐control | 15/3‐14/4 |
34* 71 # |
71 (64‐82)*, 74 (59.5‐81) # |
22*, 43 # |
3*, 44 # |
— | — | — | — | — | — | — | Discharge | Case‐control | 15/3‐14/4 |
34* 71 # |
|
Aghemo 87 (2020) |
Italy | Retrospective | 22/2/‐30/3 | 292 | 65 ± 14.1 | 199 (68.2) | 69/245 (28.2) | 69/255 (27.1) | — | 11/274 (4.0) | — | — | — | — | Discharge, death or to ICU | Retrospective | 22/2/‐30/3 | 292 |
|
Ahmad 88 (2021) |
Pakistan | Retrospective | 16/3‐14/4 | 194 | 34 (27‐48) | 157 (80.9) | 20 (10.31) | — | 8 (4.12) | — | — | 5 (2.58) | — | — | 2020‐4‐14 | Retrospective | 16/3‐14/4 | 194 |
| An 89 (2020) | China | Retrospective | 16/1‐30/3 | 205 | 54 (22‐77) | 122 (59.5) | 79 (38.5) | 20 (9.8) | 12 (5.9) | 6 (2.9) | 4 (2.0) | 59 (28.8) | — | — | Discharge | Retrospective | 16/1‐30/3 | 205 |
| Aumpan 90 (2020) | Thailand | Retrospective | 1/1‐30/4 |
40 (30 & ; 10 † ) |
30.5 ± 9.2 | 18 (45) | 12 (30) | 15 (2/30 & 4/10 † ) | 5 (0/30 & 2/10 † ) | 5 (1/30 & , 1/10 † ) | 17.5 (5/30 & ; 2/10 † ) | — | — | Discharge | Retrospective | 1/1‐30/4 |
40 (30 & ; 10 † ) |
|
|
Bishehsari 91 (2021) |
USA | Retrospective | 12/3‐3/4 | 921 |
47.6 (16.0) € 52.4 (17.1) ‡ |
409 (44.4) | 206 (22.4) | 144 (15.6) | 127 (13.8) | 52 (5.6) | — | — | — | — | Retrospective | 12/3‐3/4 | 921 | |
|
Burke 11 (2020) |
USA | Retrospective | 19/1‐3/6 | 164 | 50 | 56 | 97 (59) | 38 | — | 13 | — | — | — | — | — | Retrospective | 19/1‐3/6 | 164 |
|
Cao 92 (2020) |
China | Retrospective | — | 63 ‡ ; 94 € | 51.9 ± 14.9 ‡ , 47.5 ± 14.0 € | 24 (38.1) ‡ ; 50 (53.2) € | 63 (40.1) | 25/63 (39.7) | 21/63 (33.3) | — | — | 47/63 (74.6) | 10.7 ± 4.5 ‡ , 9.1 ± 5.2 € | 16.0 ± 4.9 | Discharge | Retrospective | — | 63 ‡ ; 94 € |
|
Carvalho‐Schneider 93 (2021) |
France | Retrospective | 17/3‐3/6 | 150 a ; 150 b ; 130 c | 49 ± 15 | 66 (44) | 48 (33.1) a 26 (17.3) b 15 (11.5) c |
5 (3.8) c |
— | — | — | — | — | 60 | — | Retrospective | 17/3‐3/6 | 150 a ; 150 b ; 130 c |
|
Chen 94 (2020) |
USA | Case‐control | 9/3‐15/4 |
101* 239 # |
48.3 ± 14.7*; 46.3 ± 15.6 # | 41 (41)*; 55 (23) # |
75 (74)*; 126 (53) # |
51 (50)*; 72 (30) # |
30 (30)*; 62 (26) # |
14 (14)*; 29 (12) # | 26 (26)*; 46 (19) # | 54 (53)*; 63 (26) # | — |
4 (4)*; 4 (5) # |
Prevalence of GI symptoms | Case‐control | 9/3‐15/4 |
101* 239 # |
|
Chen 95 (2020) |
China | Retrospective | 25/1‐21/3 | 1077 | 59.0 (47.0‐68.0) | 550 (49.4) | 359 (33.3) | 208 (57.9) | 71 (19.8) | 38 (10.6) | — | — | — | Discharge | Retrospective | 25/1‐21/3 | 1077 | |
|
Chen 18 (2020) |
China | Retrospective | 20/1‐9/2 | 42 | 51 (42.8‐62) | 15 (35.7) | 8 (19.1) | 7 (16.7) | 4 (9.5) | 3 (7.1) | 5 (11.9) | — | — | — | Discharge | Retrospective | 20/1‐9/2 | 42 |
|
Cholankeril 96 (2020) |
USA | Retrospective | 9/3‐7/4 | 207 | 49 (34‐65) | 104 (50.2) | 70 (34.5) | 22 (10.8) | — | — | 14 (7.1) | — | 1 (0‐4) | — | At presentation | Retrospective | 9/3‐7/4 | 207 |
|
Deng 97 (2020) |
China | Retrospective | 24/1‐10/3 | 61 d | 54.8 (12.9) | 25 (41) | — | 3 (4.9) | — | — | — | — | — | 10 (7‐13) | — | Retrospective | 24/1‐10/3 | 61 d |
|
Duque 98 (2021) |
Portugal | Retrospective | Before 1/4 | 2031 | 50 ± 19.8 | 973 (47) | — | 290 (14.3) | 202 (10) | 134 (6.6) | — | — | — | — | Retrospective | Before 1/4 | 2031 | |
|
Elmunzer 99 (2020) |
North America | Retrospective | 15/4‐5/6 | 1992 | 51 (41‐68) | 1128 (56.6) | 1052 (53) | 34 | 27 | 16 | 11 | — | — | — | June 5, 2020 | Retrospective | 15/4‐5/6 | 1992 |
|
Fallouh 100 (2021) |
USA | Retrospective | 24/2‐21/5 | 382 | 62.2 ± 16.8 | 203 (53.1) | 202 (52.9) | 28.8 | 22 | 17 | 11.8 | 24.9 | — | — | — | Retrospective | 24/2‐21/5 | 382 |
| Ferm 101 (2020) | USA | Retrospective | 14/3‐1/4 | 892 | 59 (47‐72) | 534 (59.9) | 219 (24.6) | 177 (19.8) | 148 (16.6) | 91 (10.2) | 70 (7.8) | 105 (11.8) | 4 (3‐7) | — | April 1, 2020 | Retrospective | 14/3‐1/4 | 892 |
|
Graham 102 (2021) |
UK | Retrospective | 23/2‐23/4 | 478 | 70 (23) | 279 (58.4) | 161 (33.7) | 17.4 | 7.5 | 13 | 7.3 | 13.8 | — | — | — | Retrospective | 23/2‐23/4 | 478 |
|
Greco 103 (2021) |
Italy | Retrospective | Mar‐Jul | 495 | 70 ± 17 | 23 (37.1) | 62 (12.5) | — | — | — | — | — | — | — | 100 days | Retrospective | Mar‐Jul | 495 |
|
Guerra 104 (2020) |
Spain | Cross‐sectional | 24/4‐27/5 | 82 e | 46 ± 14 | 38 (46.3) | — | 35 (42.7) | — | — | 12 (14.6) | — | — | — | May 27, 2020 | Cross‐sectional | 24/4‐27/5 | 82 e |
|
Kim 105 (2021) |
Korea | Retrospective | 19/2‐30/4 | 5253 | — |
1796 (40.4) & 380 (47.0)† |
— |
375 (8.4) & 87 (10.8) † |
178(4.0) & 62 (7.7) † |
— | — | — | — | — | Retrospective | 19/2‐30/4 | 5253 | |
|
Lapostolle 17 (2020) |
France | Prospective |
24/3‐6/4 |
1487 | 44 (32‐57) | 700 (47) | — | 352 (23.7) | 288 (19.4) | 168 (11.3) | — | 305 (20.5) | — | 0.5 | 48h | Prospective |
24/3‐6/4 |
1487 |
|
Laszkowska 106 (2020) |
USA | Retrospective | 11/3‐28/4 | 2804 | 63.4 ± 18.4 | 1565 (56) | 1084 (38.7) | 657 (23.4) | 648 (23.2) | — | 334 (11.9) | — | 13.8 | — | Discharge | Retrospective | 11/3‐28/4 | 2804 |
|
Leal 107 (2021) |
Portugal | Retrospective | Mar‐Apr | 201 | 71 (26) | 113 (56.2) | 60 (29.9) | 36 (17.9) | 14 (7) | 22 (10.9) | 10 (5) | 60 (29.9) | 9 (12) | — | — | Retrospective | Mar‐Apr | 201 |
|
Luo 10 (2021) |
China | Retrospective | 10/1‐29/2 |
183 f ; 1228 g |
53.8 f ; 56.2 g |
55.7 f ; 64.5 g | — | 68 (37.1) f | 134 (73.2) f | 119 (65.0) f | 65 (35.5) f | 180 (98.3) f | — | — | — | Retrospective | 10/1‐29/2 |
183 f ; 1228 g |
|
Mario 108 (2020) |
Spain | Retrospective‐prospective | 11/3‐21/4 | 76 | 45.8 ± 11.4 | 23 (30.3) | 45 (59.2) | 31 (40.8) | 17 (22.4) | 7 (9.2) | 21 (27.6) | 12 (15.8) | — | Up to 2020/04/21 | First negative PCR | Retrospective‐prospective | 11/3‐21/4 | 76 |
|
Martin 46 (2020) |
USA | Case‐control | 4‐23/4 |
41 h 82 i |
68.7 ± 15.1 h , 67.6 ± 14.3 i | 27 (66) h , 54 (66) i | — | 11 (27) h , 27 (33) i | — | — |
1 (2) h 8 (10) i |
7 (17) h 26 (32) i |
— | — | Discharge | Case‐control | 4‐23/4 |
41 h 82 i |
|
Mokarram 109 (2021) |
Italy | Retrospective | Mar‐Sept | 91 | 51 | 56 (51) | — | 29 (31.8) | 39 (42.8) | 24 (26.3) | 11 (12) | 40 (43.9) | — | — | — | Retrospective | Mar‐Sept | 91 |
|
O'Keefe 110 (2021) |
USA | Retrospective | 24/3‐26/5 | 337 (223 & ; 106 ¶ ; 8 † ) | 45.7 (44.1‐47.2) | 108 (32) | — |
62 (28) & 48 (45) ¶ 2 (25) † |
32 (15) & |
— |
27 (12) & 25 (24) ¶ 1 (13) † |
— |
6 (5‐8) j |
30 | — | Retrospective | 24/3‐26/5 | 337 (223 & ; 106 ¶ ; 8 † ) |
|
Park 111 (2020) |
Korea | Prospective | 4‐24/4 | 46 & | 26 (18‐57) | 21 (45.6) | 16 (34.7) | 7 (15.2) | 1 (2.1) | 0 | 5 (10.8) | 5 (10.8) | — | 52 (39‐61) | 2020/4/24 | Prospective | 4‐24/4 | 46 & |
|
Ramachandran 112 (2020) |
USA | Case‐control | 18‐31/3 |
31 ‡ 119 € |
57.6 ± 17.2 ‡ , 63.3 ± 14.6 € |
19 (62.3) ‡ 64 (53.8) € |
— | 15 (48.4) ‡ | — | — | — | — | — | — | Discharge | Case‐control | 18‐31/3 |
31 ‡ 119 € |
|
Remes‐Troche 113 (2020) |
Mexico | Retrospective | 1/4‐5/5 | 112 | 43.72 ± 15 | 81 (72.3) | 23 (20.5) | 20 (17.8) | — | 8 (7.1) | 11 (9.8) | — | — | — | May 5, 2020 | Retrospective | 1/4‐5/5 | 112 |
|
Renelus 114 (2020) |
USA | Retrospective | 10/3‐13/4 | 734 | 66.1 ± 15.6 | 379 (51.6) | 231 (31.5) | 149 (20.3) | 109 (14.9) | 62 (8.5) | 68 (9.3) | — | — | 30/4 2020 | Retrospective | 10/3‐13/4 | 734 | |
|
Saeed 115 (2020) |
Norway | Retrospective | 17/3‐1/4 | 76 (9*) | 48 (31‐81) | — | 76 (100) | 1 (11.1)* | 8 (88.9)* | 5 (55.6)* | 76 (100) | — | — | 14.1 | — | Retrospective | 17/3‐1/4 | 76 (9*) |
|
Schettino 116 (2020) |
Italy | Prospective cohort | 23/3‐5/4 | 190 | 64.6 ± 15.4 | 127 (66.8) | 138 (72.6) | 72 (37.9) | 32 (20) | 19 (10) | 6 (3.1) | 97 (51) | — | — | Discharge or death | Prospective cohort | 23/3‐5/4 | 190 |
|
Shang 13 (2020) |
China | Retrospective | 20/1‐29/2 | 157 j | 59 (43‐67) | 75 (47.8) | — | 157 (100) | 42 (26.8) | 32 (10.4) | 8 (5.1) | — | 4.5±1.6 | — | Discharge | Retrospective | 20/1‐29/2 | 157 j |
|
Sierpinski 117 (2020) |
Poland | Cross‐sectional | 17‐18/4 | 1942 | 50 | 773 (39.8) | 53.60 | 470 (24.2) | — | — | — | 912 (47) | — | — | — | Cross‐sectional | 17‐18/4 | 1942 |
| Sulaiman 118 (2020) | Iraq | Retrospective | 2/3‐1/5 | 140 | 45.0 ± 16.8 | 100 (71.4) |
78 (55.7) 33 (23.6) f |
41 (29.3) | — | 31 (22.1) | 42 (30) | 40 (28.6) | — | — | Discharge | Retrospective | 2/3‐1/5 | 140 |
|
Sun 119 (2021) |
China | Retrospective | 20/2‐31/3 | 932 (880 & , ¶ ; 52 † ) | 58 (48‐67) | 375 (40.2) | — | 73 (8.3) & , ¶ , 7 (13.5) † | 31 (3.5) & , ¶ ; 1 (1.9) † | — | 178 (20.2) & , ¶ ; 25 (48.1) † | 5 (4‐12) | 90 | — | Retrospective | 20/2‐31/3 | 932 (880 & , ¶ ; 52 † ) | |
| Taziki Balajelini 120 (2021) | Iran | Retrospective | Feb‐Jul | 599 | 38.3 ± 13.6 | 286 (47.8) | 251 (41.9) | 151 (25.2) | 123 (20.5) | 77 (12.9) | 159 (26.5) | — | — | — | — | Retrospective | Feb‐Jul | 599 |
|
Tsibouris 121 (2020) |
Greece | Retrospective | 6/4‐6/5 | 61 | 70 (55‐83) | 34 (55.7) | — | 11/61 | 4/61 | 2/61 | — | — | — | May 6, 2020 | Retrospective | 6/4‐6/5 | 61 | |
|
Xiao 122 (2020) |
China | Descriptive |
10/1‐17/2 |
90 | 61.0 (48.3‐69.0) | 51 (57) | — | 90 (100) | 22 (24) | 15 (17) | 6 (7) | 22 (24) | 5 (2.0‐9.3) | — | Discharge | Descriptive |
10/1‐17/2 |
90 |
|
Xu 123 (2020) |
China | Retrospective | 26/1‐20/3 | 48 | 41 (18‐90) | 25 (52.1) | 12 (25) | 3 | 1 | — | — | 3 | — | — | — | Retrospective | 26/1‐20/3 | 48 |
|
Yang 124 (2020) |
China | Retrospective | 2‐13/2 | 50 (23 ‡ ; 27 g ) |
44.6 ± 2.8 ‡ 42.5 ± 3.3 g |
13 (56.5) ‡ 15 (55.6) g |
23 (100) ‡ | — | — | — | — | — | 12.13 ± 2.44 ‡ | — | Discharge | Retrospective | 2‐13/2 | 50 (23 ‡ ; 27 g ) |
| Yoshida 125 (2020) | USA | Retrospective | 27/2‐5/7 | 776 | 60.5 (16.1) | 365 (47.3) | 269 (36.6) | 187 (25.4) | 154 (21) | 65 (8.8) | — | — | — | — | Retrospective | 27/2‐5/7 | 776 | |
|
Zhang 126 (2020) |
China | Retrospective | — | 505 | 51.2±17.2 | 228 (45.1) | 164 (32.5) | 62/164 | 27/164 | 13/164 | 17/164 | 93/164 | — | — | — | Retrospective | — | 505 |
|
Zhang 69 (2020) |
China | Retrospective | 20/1‐29/2 | 409 (307 m ; 102 n ) | 65 (range 28‐87) |
162 (52.8) m 72(70.6) n |
— | 61 (19.9) m , 30 (29.4) n | 38 (12.4) m , 12 (11.8) n | 33 (12.4) m , deceased: 9 (8.8) n | 23 (7.5) m , 5 (4.9) | — | 4.2 ± 1.5 m , 4.9 ± 1.5 n | — | Discharge or death | Retrospective | 20/1‐29/2 | 409 (307 m ; 102 n ) |
|
Zhang 3 (2020) |
China | Retrospective | 17/1‐12/2 | 788 (52 & ; 658 ¶ ; 61 † ; 17**) |
37.5 (19.3‐45.8) & 45.0 (35.0‐55.0) ¶ 55.0 (44.0‐62.0) † , 70.0 (55.0‐73.0)** |
26 (50.0) & 329 (50.0) ¶ 39(63.9) † 13(76.5)** |
7(13.5) & , 63(9.6) ¶ , 12(19.7) † , 6(35.3)** | — | — | — | — | — | — | — | Discharge | Retrospective | 17/1‐12/2 | 788 (52 & ; 658 ¶ ; 61 † ; 17**) |
|
Zheng 127 (2020) |
China | Retrospective | 5/1‐9/3 | 1320 (192 ‡ ; 1128 € ) |
50 (38‐56) ‡ 51 (41‐58) € |
90(46.9) ‡ 489(43.4) € |
192 (100) ‡ 0 € |
107 (55.7) ‡ | — | — | 11 (5.7) ‡ | 62 (32.3) ‡ | — | — | Discharge | Retrospective | 5/1‐9/3 | 1320 (192 ‡ ; 1128 € ) |
| Zhu 128 (2020) | China | Retrospective | Before Feb 4, | 90 d | 52 (37.8‐59) | 32 (32.7) | — | 8 (8.2) d | — | — | — | — | — | 14 | 2 weeks | Retrospective | Before Feb 4, | 90 d |
COVID‐19 cases group.
Control group without COVID‐19.
Mild COVID‐19.
Moderate COVID‐19.
Severe COVID‐19.
Critical COVID‐19.
COVID‐19 with GI symptoms.
COVID‐19 without GI symptoms.
Initial onset of COVID‐19.
30 days after initial onset of COVID‐19.
60 days after initial onset of COVID‐19.
COVID‐19 patients in recovery stage.
COVID‐19 with inflammatory bowel disease.
COVID‐19 patients with GI symptom only.
COVID‐19 patients with respiratory symptom.
COVID‐19 patients with GIB.
COVID‐19 patients without GIB.
COVID‐19 patients with diarrhea.
COVID‐19 patients with nausea.
COVID‐19 patients with abdominal pain.
Survived COVID‐19 patients.
Deteriorated COVID‐19 patients.
Abbreviations: —, not available; GI, gastrointestinal; GIB, gastrointestinal bleeding; ICU, intensive care unit.