Expanded Dengue and the Digestive System: A Systematic Review and Meta-Analysis

Area of Science:

• Infectious Diseases
• Gastroenterology
• Public Health

Background:

• Expanded dengue syndrome involves multisystemic atypical manifestations beyond classic symptoms.
• Digestive organ involvement, including hepatitis and cholecystitis, can occur in severe dengue.
• Accurate frequency data for these gastrointestinal complications are limited.

Purpose of the Study:

• To systematically review and quantify the frequency of digestive system involvement in expanded dengue syndrome.
• To provide evidence-based data on gastrointestinal manifestations in dengue virus infection.

Main Methods:

• A systematic review and meta-analysis adhering to PRISMA guidelines.
• Searched multiple databases (MEDLINE, Scopus, Web of Science, Embase, CENTRAL, Scielo, BIREME) from inception to December 10, 2025.
• Included 7 studies with 1774 participants reporting laboratory-confirmed dengue and atypical digestive involvement.

Main Results:

• Pooled frequency of hepatic involvement was 7% (hepatitis 33%, fulminant hepatic failure 3%).
• Acute pancreatitis occurred in 3% of cases.
• Acute acalculous cholecystitis was most frequent at 21%.

Conclusions:

• Digestive system involvement is a significant feature of expanded dengue syndrome.
• Acute acalculous cholecystitis and hepatic involvement are notable complications.
• Further research may clarify the precise incidence and impact of these manifestations.