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Beware: Gastrointestinal symptoms can be a manifestation of COVID-19
M Schmulson1, M F Dávalos1, J Berumen2
1Laboratorio de Hígado, Páncreas y Motilidad (HIPAM), Unidad de Investigación en Medicina Experimental, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Hospital General de México Dr. Eduardo Liceaga, Ciudad de México, México.
Background:
There is an increasing number of reports on the presentation of gastrointestinal symptoms in cases of COVID-19.
Aim:
To review the studies reporting gastrointestinal symptoms in COVID-19.
Results:
Fifteen articles (2,800 patients) were identified. Gastrointestinal symptom frequency varied from 3.0% to 39.6% and included diarrhea (7.5%), náusea (4.5%), anorexia (4.4%), vomiting (1.3%), abdominal pain (0.5%), and belching/reflux (0.3%). Those symptoms can be the first manifestation of COVID-19, but whether they reflect a better or worse prognosis, is controversial. The potential relation of the angiotensin converting enzyme 2 receptor in the digestive tract as an entry route for the virus is discussed.
Conclusion:
Gastrointestinal symptoms may be common in COVID-19, in some cases appearing as the first manifestation, even before fever and respiratory symptoms. Therefore, clinicians and gastroenterologists must be aware of those atypical cases during the current pandemic, as well as of the fecal-oral route and corresponding preventive measures.
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