Mar 18, 2020

Digestive Symptoms Are Common in COVID-19

Digestive symptoms are common in coronavirus disease 2019 (COVID-19), occurring as the chief complaint in nearly half of patients presenting to hospital, according to a new descriptive, cross-sectional multicentre study from China published in the American Journal of Gastroenterology.

Most patients with COVID-19 present with typical respiratory symptoms and signs. However, early experience with the outbreak in Wuhan, China, revealed that many patients experienced digestive symptoms as their chief complaint.

“Clinicians must bear in mind that digestive symptoms, such as diarrhoea, may be a presenting feature of COVID-19, and that the index of suspicion may need to be raised earlier in these cases rather than waiting for respiratory symptoms to emerge,” wrote Lei Pan, MD, Binzhou Medical University Hospital, Binzhou, China, and colleagues, on behalf of the Wuhan Medical Treatment Expert Group for COVID-19. “If clinicians solely monitor for respiratory symptoms to establish case definitions for COVID-19, they may miss cases initially presenting with extra-pulmonary symptoms, or the disease may not be diagnosed later until respiratory symptoms emerge.”

“In this study, patients with COVID-19 with digestive symptoms have a worse clinical outcome and higher risk of mortality compared with those without digestive symptoms, emphasising the importance of including symptoms like diarrhoea to suspect COVID-19 early in the disease course before respiratory symptoms develop,” said Brennan Spiegel, MD, Cedars-Sinai Medial Center, Los Angeles, California. “This may lead to earlier diagnosis of COVID-19, which can lead to earlier treatment and more expeditious quarantine to minimize transmission from people who otherwise remain undiagnosed.”

Compared with patients with COVID-19 without digestive symptoms, those with digestive symptoms had a longer time from onset to admission and a worse clinical outcome, according to an analysis of data on 204 patients with COVID-19 presenting to 3 hospitals in the Hubei province from January 18, 2020, to February 28, 2020. Diagnosis was confirmed by real-time reverse transcription-polymerase chain reaction.

Of the patients, the average age was 54.9 years (107 men and 97 women). The average time from symptom onset to hospital admission was 8.1 days (SD +4.9).

Patients with digestive symptoms had a significantly longer time from onset to admission than patients without digestive symptoms (9.0 days vs 7.3 days). This may indicate that patients presenting with digestive symptoms sought care later because they did not yet suspect COVID-19 in the absence of respiratory symptoms, like cough or shortness of breath.

Patients with digestive symptoms had a variety of manifestations, such as anorexia (83.8%), diarrhoea (29.3%), vomiting (0.8%), and abdominal pain (0.4%).

Seven patients with COVID-19 presented with digestive symptoms but no respiratory symptoms.
As the severity of the disease increased, digestive symptoms became more pronounced.

Patients without digestive symptoms were more likely to be cured and discharged than patients with digestive symptoms (60% vs 34.3%).

Laboratory data revealed no significant liver injury, although other studies have shown signs of liver involvement; more research is required to understand the impact of COVID-19 on liver function.

Reference: https://journals.lww.com/ajg/Documents/COVID_Digestive_Symptoms_AJG_Preproof.pdf

SOURCE: American College of Gastroenterology

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