Diarrhea May be Common Symptom in Patients With COVID-19
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Digestive symptoms were common in patients with COVID-19, according to the American Journal of Gastroenterology. Patients with these symptoms had a longer time from onset to admission and their prognosis was worse compared with patients without symptoms.
“Clinicians should recognize that digestive symptoms, such as diarrhea, may be a presenting feature of COVID-19, and that the index of suspicion may need to be raised earlier in at-risk patients presenting with digestive symptoms rather than waiting for respiratory symptoms to emerge,” Lei Pan, MD, PhD, from the department of Respiratory and Critical Care Medicine at Binzhou Medical University Hospital and the Second Medical Center & National Clinical Research Center for Geriatric Diseases at the Chinese PLA General Hospital, and colleagues wrote. “However, further large sample studies are needed to confirm these findings.”
Pan and colleagues performed a cross-sectional, multicenter study of 204 patients with COVID-19 between January 18 to February 28, 2020 and analyzed their full laboratory, imaging and historical data. They used real-time RT-PCR to confirm diagnosis. Follow-up on data continued until March 5, 2020.
Investigators noted 99 patients (48.5%) reported digestive symptoms as their main complaint when they presented to the hospital. Compared with patients without digestive symptoms, patients with symptoms had a significantly longer time from onset to hospital admission (7.3 days vs. 9 days). Manifestations in patients with digestive symptoms included anorexia (83 cases), diarrhea (29 cases), vomiting (8 cases) and abdominal pain (4 cases). There were digestive symptoms, but no respiratory symptoms seen in seven cases. Digestive symptoms became more pronounced as the disease severity increased. Patients without digestive symptoms compared with those with symptoms were more likely to be cured and discharged (60% vs. 34.3%). There was no significant liver injury in this case series, according to laboratory data.
“Importantly, our results indicate that as the severity of the disease increases, digestive symptoms become more pronounced. Patients without digestive symptoms in this study were more likely to be cured and discharged than patients with digestive symptoms,” the investigators wrote. “It remains unclear why there were differences in mortality between patients with vs. without digestive symptoms.”
“One possibility is that digestive symptoms indicate viral load and replication within the gastrointestinal tract, which leads to more severe disease,” the researchers added. “Another possibility is that patients with extra-pulmonary symptoms reported later for care because they did not initially have typical respiratory symptoms, and thus presented at a later and less curable stage of disease. These hypotheses deserve close examination in future research.” – by Monica Jaramillo
Disclosure: The authors report they received financial support from Beijing Municipal Natural Science Foundation (CN, 7192197), National Natural Science Foundation of China (CN, 81700490), Health and Family Planning Commission of Shandong Province (CN, 2017WS366), Traditional Chinese Medicine Administration Plan Project of Shandong Province (CN, 2019-0503), Technology Plan Project of Binzhou Medical University (CN, BY2017KJ30), and Hubei Province Novel Pneumonia Emergency Research(NO, 2020FCA014).
Perspective
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Sara El Ouali, MD
This study is one of the first to describe in more detail gastrointestinal manifestations of COVID-19. Out of 204 patients with COVID-19, about 50% of patients exhibited digestive symptoms. It’s interesting to note that a subset of patients (3% in this study) might present GI symptoms without accompanying respiratory symptoms. These new data are important because early recognition is key for management and isolation considerations.
Another interesting aspect of this study was that patients with digestive symptoms presented later than patients without GI symptoms. This was also found in another study. Theoretically, this may be due to symptoms now attributed to COVID-19, which were not being recognized as being due to COVID-19. Another noteworthy finding is that there may be prognostic implications associated with GI symptoms. In the study, authors described GI symptoms as being more pronounced as the severity of the disease increased. That being said, there was no difference in discharge time, days of admission in the ICU or mortality. Although several other studies have also shown an association between GI symptoms and worse COVID-19 outcomes, recent data from the United States did not find this association. Further data are needed to understand the pathophysiology and prognostic implications of GI symptoms in COVID-19.
Cleveland Clinic
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Pan L, et al. Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: a descriptive, cross-sectional, multicenter study. Am J Gastroenterol. 2020.
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