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Gastrointestinal and hepatic manifestations of COVID-19: A systematic review and meta-analysis
Robert D Dorrell1, Michael K Dougherty2, Eric L Barash3
1Department of Medicine Medical Center Blvd Winston-Salem North Carolina USA.
Insights
Gastrointestinal (GI) symptoms occurred in 20% of COVID-19 patients, with isolated GI symptoms in only 1%. GI issues were linked to severe disease but not mortality, suggesting continued vigilance for COVID-19 in patients with GI complaints.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Hepatology
Background:
- COVID-19 (Coronavirus Disease 2019) can present with a range of symptoms, including gastrointestinal (GI) and hepatic manifestations.
- The prevalence and significance of isolated GI symptoms in COVID-19 patients require further investigation.
Purpose of the Study:
- To review the role of GI and hepatic manifestations in COVID-19.
- To determine the prevalence of isolated GI symptoms in COVID-19 patients.
Main Methods:
- A systematic literature search was conducted across PubMed, Embase, and Cochrane Library for COVID-19 publications from December 2019 to May 2020.
- Studies reporting GI symptoms in over 5 COVID-19 patients were included; meta-analysis was performed where data allowed.
Main Results:
- The review included 108 studies with 17,776 COVID-19 patients.
- GI symptoms were present in 20% of patients, with anorexia (21%), diarrhea (13%), nausea/vomiting (8%), and abdominal pain (4%) being most common.
- Isolated GI symptoms occurred in 1% of patients. Transaminase elevations were noted in 24% of patients. GI symptoms correlated with severe COVID-19 (OR 2.1) but not mortality (OR 0.90).
Conclusions:
- Isolated GI symptoms, though infrequent (1%), represent a significant subgroup of COVID-19 cases.
- Clinicians should consider COVID-19 testing for patients with isolated GI symptoms or elevated transaminases, especially when testing is available.
- Recent data suggest a higher overall prevalence of GI involvement in COVID-19 than previously recognized.
Background And Aim:
This review investigates the role of gastrointestinal and hepatic manifestations in COVID-19, particularly with regard to the prevalence of isolated gastrointestinal (GI) symptoms.
Methods:
We searched PubMed, Embase, and Cochrane library for COVID-19 publications from 1 December 2019 to 18 May 2020. We included any study that reported the presence of GI symptoms in a sample of >5 COVID-19 patients. Data collection and risk of bias assessment were performed independently by two reviewers. Where ≥3 studies reported data sufficiently similar to allow calculation of a pooled prevalence, we performed random effects meta-analysis.
Results:
This review included 17 776 COVID-19 patients from 108 studies. Isolated GI symptoms only occurred in 1% (95% confidence interval [CI] 0-6%) of patients. GI symptoms were reported in 20% (95% CI 15-24%) of patients. The most common were anorexia (21%, 95% CI 15-27%), diarrhea (13%, 95% CI 11-16%), nausea or vomiting (8%, 95% CI 6-11%), and abdominal pain (4%, 95% CI 2-6%). Transaminase elevations were present in 24% (95% CI 17-31%) of patients. Higher prevalence of GI symptoms were reported in studies published after 1st April, with prevalence of diarrhea 16% (95% CI 13-20), nausea or vomiting 12% (95% CI 8-16%), and any GI symptoms 24% (95% CI 18-34%). GI symptoms were associated with severe COVID-19 disease (odds ratio [OR] 2.1, 95% CI 1.3-3.2), but not mortality (OR 0.90, 95% CI 0.52-1.54).
Conclusions:
Patients with isolated GI symptoms may represent a small but significant portion of COVID-19 cases. When testing resources are abundant, clinicians should still consider testing patients with isolated GI symptoms or unexplained transaminase elevations for COVID-19. More recent studies estimate higher overall GI involvement in COVID-19 than was previously recognized.
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