Gastrointestinal manifestations and outcomes of hospitalised patients with COVID-19 disease
Keywords:Coronavirus disease 2019, Disease severity, Gastrointestinal manifestation
Background: COVID-19 infection usually presents with respiratory symptoms. Many hospitalised patients of COVID-19 present with gastrointestinal symptoms which can alter the clinical outcomes of patients.
Objectives: To characterise the gastrointestinal manifestations of COVID-19 patients requiring hospitalisation and their correlation with disease severity and clinical outcomes.
Methods: This was a single centre prospective, observational, cohort study done at Kathmandu Medical College, a tertiary health care centre after ethical clearance. All consecutive hospitalised patients with COVID-19 disease admitted during May and June 2021 were included in the study after ethical clearance. Diagnosis of COVID-19 infection was done by RT-PCR. Gastrointestinal symptoms of abdominal pain, aguesia, nausea/vomiting, and diarrhoea were recorded on hospital admission and outcomes accessed at discharge. Data were analysed using SPSS v.24.
Results: A total of 196 consecutive adult patients with COVID-19 infection were included in study. Gastrointestinal symptoms were recorded in 48 (24.5%) patients. The most frequent symptom was nausea/vomiting (23, 11.7%) followed by aguesia (19, 9.7%), diarrhoea (14, 7.1%), and abdominal pain (8, 4.1%). There was no significant association between duration of hospital stay and presence of gastrointestinal symptoms (10.15 vs 10.95 days; p = 0.481). No significance was seen on association of gastrointestinal symptoms with ICU admission and mortality but requirement of mechanical ventilation was significantly higher in patients without symptoms (10.4 vs 23.6%; p = 0.048).
Conclusion: Significant proportion of patients with COVID-19 infection can have gastrointestinal manifestations. Presences of these symptoms do not have any association with the final clinical outcome of the patient.
Lu H, Stratton CW, Tang YW. Outbreak of pneumonia of unknown etiology in Wuhan, China: The mystery and the miracle. J Med Virol. 2020 Apr;92(4):401-2. [PubMed | Full Text | DOI]
Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study. Lancet. 2020 Feb 15;395(10223):50713. [PubMed | Full Text | DOI]
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020 Feb;395(10223):497506. [PubMed | Full Text | DOI]
Xiao F, Tang M, Zheng X, Liu Y, Li X, Shan H. Evidence for gastrointestinal infection of SARS-CoV-2. Gastroenterology. 2020 May;158(6):1831-3. e3. [PubMed | Full Text | DOI]
Gupta A, Madhavan MV, Sehgal K, Nair N, Mahajan S, Sehrawat TS, et al. Extrapulmonary manifestations of COVID-19. Nat Med. 2020 Jul;26(7):101732. [PubMed | Full Text | DOI]
El Ouali S, Achkar J-P, Lashner B, Regueiro M. Gastrointestinal manifestations of COVID-19. Cleve Clin J Med. 2021 Feb 17;1-5. [PubMed | Full Text | DOI]
Zhang H, Shao B, Dang Q, Chen Z, Zhou Q, Luo H, et al. Pathogenesis and mechanism of gastrointestinal infection with COVID-19. Front Immunol. 2021 Nov 10;12:674074. [PubMed | Full Text | DOI]
Elrobaa IH, New KJ. COVID-19: Pulmonary and extrapulmonary manifestations. Front Public Health. 2021 Sep 28; 9:711616. [PubMed | Full Text | DOI]
Jin X, Lian JS, Hu JH, Gao J, Zheng L, Zhang YM, et al. Epidemiological, clinical and virological characteristics of 74 cases of coronavirus-infected disease 2019 (COVID-19) with gastrointestinal symptoms. Gut. 2020 Jun;69(6):10029. [PubMed | Full Text | DOI]
Leal T, Costa E, Arroja B, Gonçalves R, Alves J. Gastrointestinal manifestations of COVID-19: results from a European centre. Eur J Gastroenterol Hepatol. 2021 May;33(5):691-4. [PubMed | Full Text | DOI]
Ramachandran P, Onukogu I, Ghanta S, Gajendran M, Perisetti A, Goyal H, et al. Gastrointestinal symptoms and outcomes in hospitalised coronavirus disease 2019 patients. Dig Dis Basel Switz. 2020;38(5):373-9. [PubMed | Full Text | DOI]
Khan MU, Mushtaq K, Alsoub DH, Iqbal P, Ata F, Chaudhry HS, et al. Digestive system involvement and clinical outcomes among COVID-19 patients: A retrospective cohort study from Qatar. World J Gastroenterol. 2021 Dec 14;27(46):7995-8009. [PubMed | Full Text | DOI]
Living guidance for clinical management of COVID-19. Available from: https://www.who.int/publications/i/ item/WHO-2019-nCoV-clinical-2021-2. [Full Text]
Blake MR, Raker JM, Whelan K. Validity and reliability of the Bristol Stool Form Scale in healthy adults and patients with diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther. 2016;44(7):693- 703. [PubMed | Full Text | DOI]
O’Donnell LJ, Virjee J, Heaton KW. Detection of pseudodiarrhoea by simple clinical assessment of intestinal transit rate. BMJ. 1990 Feb 17;300(6722):439- 40. [PubMed | Full Text | DOI]
Wolter N, Jassat W, Walaza S, Welch R, Moultrie H, Groome M, et al. Early assessment of the clinical severity of the SARS-CoV-2 omicron variant in South Africa: A data linkage study. Lancet Lond Engl. 2022 Jan 19; S0140-6736(22):00017-4. [PubMed | Full Text | DOI]
Fang D, Ma J, Guan J, Wang M, Song Y, Tian D, et al. Manifestations of digestive system in hospitalised patients with novel coronavirus pneumonia in Wuhan, China: A single-center, descriptive study. Chin J Dig. 2020;E005-E005. [Full Text]
Nobel YR, Phipps M, Zucker J, Lebwohl B, Wang TC, Sobieszczyk ME, et al. Gastrointestinal symptoms and coronavirus disease 2019: A case-control study from the United States. Gastroenterology. 2020 Jul;159(1):373-5.e2. [PubMed | Full Text | DOI]
Zhou Z, Zhao N, Shu Y, Han S, Chen B, Shu X. Effect of gastrointestinal symptoms in patients with COVID-19. Gastroenterology. 2020 Jun;158(8):2294- 7. [PubMed | Full Text | DOI]
Sultan S, Altayar O, Siddique SM, Davitkov P, Feuerstein JD, Lim JK, et al. AGA Institute rapid review of the gastrointestinal and liver manifestations of COVID-19, meta-analysis of international data, and recommendations for the consultative management of patients with COVID-19. Gastroenterology. 2020 Jul;159(1):320-4.e27. [PubMed | Full Text | DOI]
Cheung KS, Hung IFN, Chan PPY, Lung KC, Tso E, Liu R, et al. Gastrointestinal manifestations of SARS-CoV-2 infection and virus load in fecal samples from a Hong Kong cohort: Systematic review and meta-analysis. Gastroenterology. 2020 Jul;159(1):81-95. [PubMed | Full Text | DOI]
da Silva FAF, de Brito BB, Santos MLC, Marques HS, da Silva Júnior RT, de Carvalho LS, et al. COVID-19 gastrointestinal manifestations: A systematic review. Rev Soc Bras Med Trop. 2020;53:e20200714. [PubMed | Full Text | DOI]
Redd WD, Zhou JC, Hathorn KE, McCarty TR, Bazarbashi AN, Thompson CC, et al. Prevalence and characteristics of gastrointestinal symptoms in patients with severe acute respiratory syndrome coronavirus 2 infection in the United States: A multicenter cohort study. Gastroenterology. 2020 Aug;159(2):765-7.e2. [PubMed | Full Text | DOI]
Pan L, Mu M, Yang P, Sun Y, Wang R, Yan J, et al. Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: A descriptive, crosssectional, multicenter study. Am J Gastroenterol. 2020 May;115(5):766-73. [PubMed | Full Text | DOI]
Zou X, Chen K, Zou J, Han P, Hao J, Han Z. Singlecell RNA-seq data analysis on the receptor ACE2 expression reveals the potential risk of different human organs vulnerable to 2019-nCoV infection. Front Med. 2020 Apr;14(2):185-92. [PubMed | Full Text | DOI]
Zuo T, Zhang F, Lui GCY, Yeoh YK, Li AYL, Zhan H, et al. Alterations in gut microbiota of patients with COVID-19 during time of hospitalisation. Gastroenterology. 2020 Sep;159(3):944-55.e8. [PubMed | Full Text | DOI]
Sun Z, Song Z-G, Liu C, Tan S, Lin S, Zhu J, et al. Gut microbiome alterations and gut barrier dysfunction are associated with host immune homeostasis in COVID-19 patients. BMC Med. 2022 Jan 20;20(1):24. [PubMed | Full Text | DOI]
Giron LB, Dweep H, Yin X, Wang H, Damra M, Goldman AR, et al. Plasma markers of disrupted gut permeability in severe COVID-19 patients. Front Immunol. 2021 Jun 9; 12:686240. [PubMed | Full Text | DOI]
How to Cite
Copyright © Journal of Kathmandu Medical College
The ideas and opinions expressed by authors or articles summarized, quoted, or published in full text in this journal represent only the opinions of the authors and do not necessarily reflect the official policy of Journal of Kathmandu Medical College or the institute with which the author(s) is/are affiliated, unless so specified.
Authors convey all copyright ownership, including any and all rights incidental thereto, exclusively to JKMC, in the event that such work is published by JKMC. JKMC shall own the work, including 1) copyright; 2) the right to grant permission to republish the article in whole or in part, with or without fee; 3) the right to produce preprints or reprints and translate into languages other than English for sale or free distribution; and 4) the right to republish the work in a collection of articles in any other mechanical or electronic format.