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AGA Institute Rapid Review of the Gastrointestinal and Liver Manifestations of COVID-19, Meta-Analysis of
Shahnaz Sultan1, Osama Altayar2, Shazia M Siddique3
1Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis Veterans Affairs Healthcare System, Minneapolis, Minnesota.
Gastroenterology
|May 15, 2020
Summary
Gastrointestinal symptoms and liver abnormalities occur in less than 10% of patients with coronavirus disease 2019 (COVID-19), with higher prevalence outside of China. This meta-analysis offers best practice statements for managing these COVID-19 related GI and liver issues.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Hepatology
Background:
- Coronavirus disease 2019 (COVID-19) can manifest with gastrointestinal (GI) symptoms and liver enzyme abnormalities.
- Varied reports exist on the prevalence and spectrum of these manifestations.
Purpose of the Study:
- To systematically review and meta-analyze international data on GI and liver manifestations of COVID-19.
- To provide best practice statements for the consultative management of these cases.
Main Methods:
- Systematic literature search of OVID Medline, preprint servers (medRxiv, LitCovid, SSRN), and major journal sites.
- Meta-analysis of 47 studies including 10,890 patients, pooling prevalence of GI symptoms and liver function tests.
- Assessed certainty of evidence using the GRADE framework.
Main Results:
- Pooled prevalence of diarrhea was 7.7%, nausea/vomiting 7.8%, and abdominal pain 2.7%.
- Elevated aspartate transaminase and alanine transaminase were observed in 15.0% of patients.
- GI symptoms and liver abnormalities were more prevalent in studies outside of China (diarrhea 18.3%).
Conclusions:
- Gastrointestinal symptoms are associated with COVID-19 in less than 10% of patients, with higher estimates outside China.
- Standardized questionnaires and liver function test monitoring are needed for better quantification.
- Best practice statements for consultative management are provided based on the meta-analysis findings.
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