Vojnosanitetski pregled 2022 Volume 79, Issue 5, Pages: 475-480
https://doi.org/10.2298/VSP210908014B
Full text ( 349 KB)
Gastrointestinal symptoms in COVID-19 patients
Branković Marija (University Hospital Medical Center “Bežanijska Kosa”, Department of Internal Medicine, Belgrade, Serbia + University of Belgrade, Faculty of Medicine, Belgrade, Serbia), manive23@gmail.com
Jovanović Igor (University Hospital Medical Center “Bežanijska Kosa”, Department of Internal Medicine, Belgrade, Serbia)
Radonjić Tijana (University Hospital Medical Center “Bežanijska Kosa”, Department of Internal Medicine, Belgrade, Serbia)
Pančevski Igor (Military Medical Academy, Clinic for Ophthalmology, Belgrade, Serbia)
Bukurecki Ilija (University Hospital Medical Center “Bežanijska Kosa”, Department of Internal Medicine, Belgrade, Serbia)
Dukić Marija (University Hospital Medical Center “Bežanijska Kosa”, Department of Internal Medicine, Belgrade, Serbia)
Popadić Višeslav (University Hospital Medical Center “Bežanijska Kosa”, Department of Internal Medicine, Belgrade, Serbia)
Klašnja Slobodan (University Hospital Medical Center “Bežanijska Kosa”, Department of Internal Medicine, Belgrade, Serbia)
Zdravković Marija (University Hospital Medical Center “Bežanijska Kosa”, Department of Internal Medicine, Belgrade, Serbia + University of Belgrade, Faculty of Medicine, Belgrade, Serbia)
Background/Aim. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a global threat and a huge problem for our community. There are so many open questions. The aim of this study was to establish the frequency of gastrointestinal (GI) symptoms in hospitalized patients with infection caused by this virus (coronavirus disease-19 –COVID-19), but also to compare if patients with GI symptoms have a higher computed tomography (CT) scan severity score of interstitial pneumonia (IP) compared to patients with COVID-19 without GI symptoms. Methods. Our database comprised 322 patients with COVID-19 who were divided into two groups, patients with and without GI symptoms. All information was taken from anamnestic data and patients’ history, followed by statistical analysis. Results. Thorax CT scans of 206 patients (63.9%) were described as bilateral IP, of which 76 CT scans (36.9%) were described by radiologists as the peak of infection. Moreover, 130 patients (40.4%) had GI symptoms, and even 58 out of 130 patients (44.6%) reported GI symptoms as the first manifestation of COVID-19 infection. The most commonly reported one was the lack of appetite (73 patients or 56.15%). Furthermore, 65 (50%) patients reported diarrhea, 25 (19.2%) patients reported nausea and vomiting, and 9 (6.9%) patients reported abdominal pain. In addition, among patients with bilateral IP and GI tract symptoms, 31 (40.79%) of them did not have a higher CT scan severity score at the peak of the disease compared to the patients without GI symptoms (45 of them or 59.2%), (p = 0.704). Conclusion. GI symptoms often are the first manifestation of COVID-19. Therefore, every patient with newly formed digestive tract symptoms should be tested for COVID-19. On the other hand, GI symptoms do not indicate COVID-19 patients will have a severe form of IP.
Keywords: covid-19, diagnosis, diarrhea, feeding and eating disorders, sars-cov-2, severity of illness index, signs and symptoms, digestive, tomography, x-ray computed
Show references
Wang C, Horby PW, Hayden FG, Gao GF. A novel coronavirus outbreak of global health concern. Lancet 2020; 395(10223): 470-3.
Lu R, Zhao X, Li J, Niu P, Yang B, Wu H, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet 2020; 395(10224): 565-74.
Shahid Z, Kalayanamitra R, McClafferty B, Kepko D, Ramgobin D, Patel R, et al. COVID-19 and Older Adults: What We Know. J Am Geriatr Soc 2020; 68(5): 926-9.
Burki TK. Coronavirus in China. Lancet Respir 2020; 8(3): 238.
Hajifathalian K, Mahadev S, Schwartz RE, Shah S, Sampath K, Schnoll-Sussman F, et al. SARS-COV-2 infection (coronavirus disease 2019) for the gastrointestinal consultant. World J Gastroenterol 2020; 26(14): 1546-53.
Baj J, Karakuła-Juchnowicz H, Teresiński G, Buszewicz G, Ciesielka M, Sitarz E, et al. COVID-19: Specific and Non-Specific Clinical Manifestations and Symptoms: The Current State of Knowledge. J Clin Med 2020; 9(6): 1753.
Lee KS, Han J, Chung MP, Jeong YJ. Consolidation. Radiol Illust Chest Radiol 2013; 221-33.
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; 395(10223): 497-506.
Bai Y, Yao L, Wei T, Tian F, Jin DY, Chen L, et al. Presumed Asymptomatic Carrier Transmission of COVID-19. JAMA 2020; 323(14): 1406-7.
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020; 395(10229): 1054-62.
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; 395(10223): 507-13.
Ellulu MS, Patimah I, Khaza H, Rahmat A, Abed Y. Obesity and inflammation: the linking mechanism and the complications. Arch Med Sci 2017; 13(4): 851-63.
Albini A, Di Guardo G, Noonan DMC, Lombardo M. The SARS-CoV-2 receptor, ACE-2, is expressed on many different cell types: implications for ACE-inhibitor- and angiotensin II receptor blocker-based cardiovascular therapies. Intern Emerg Med 2020; 15(5): 759-66.
Schmulson M, Dávalos MF, Berumen J. Beware: Gastrointestinal symptoms can be a manifestation of COVID-19 (Spanish). Rev Gastroenterol Mex 2020; 85(3): 282-7.
Chooi YC, Ding C, Magkos F. The epidemiology of obesity. Metabolism 2019; 92: 6-10.
Richardson S, Hirsch JS, Narasimhan M, Crawford JM, Mcginn T, Davidson KW. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized with COVID-19 in the New York City Area. JAMA 2020; 323(20): 2052-9.
Jin YH, Cai L, Cheng ZS, Cheng H, Deng T, Fan YP, et al. A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version). Mil Med Res 2020; 7(1): 4.
Chan JF, Yuan S, Kok K, To KK, Chu H, Yang J, et al. A familial cluster of pneumonia associated with the 2019 novel corona-virus indicating person-to-person transmission: a study of a family cluster. Lancet 2020; 395(10223): 514-23.
Lei J, Li J, Li X, Qi X. CT Imaging of the 2019 Novel Coronavirus (2019-nCoV) Pneumonia. Radiology 2020; 295(1): 18.
Bernheim A, Mei X, Huang M, Yang Y, Fayad ZA, Zhang N, et al. Chest CT Findings in Coronavirus Disease-19 (COVID-19): Relationship to Duration of Infection. Radiology 2020; 295(3): 200463.
Chung M, Bernheim A, Mei X, Zhang N, Huang M, Zeng X, et al. CT Imaging Features of 2019 Novel Coronavirus (2019-nCoV). Radiology 2020; 295(1): 202-7.
Neurath MF. Covid-19 and immunomodulation in IBD. Gut 2020; 69(7): 1335-42.
Yang L, Tu L. Implications of gastrointestinal manifestations of COVID-19. Lancet Gastroenterol Hepatol 2020; 5(7): 629-30.
Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA 2020; 323(11): 1061-9.
Zhang H, Kang Z, Gong H, Xu D, Wang J, Li Z, et al. Digestive system is a potential route of COVID-19: an analysis of single-cell coexpression pattern of key proteins in viral entry process. Gut 2020; 69: 1010-8.
Xiao F, Tang M, Zheng X, Liu Y, Li X, Shan H. Evidence for Gastrointestinal Infection of SARS-CoV-2. Gastroenterology 2020; 158(6): 1831-1833.e3.
Wan Y, Shang J, Graham R, Baric RS, Li F. Receptor Recognition by the Novel Coronavirus from Wuhan: an Analysis Based on Decade-Long Structural Studies of SARS Coronavirus. J Virol 2020; 94(7): e00127-20.
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 gastroin-testinal symptoms. Gut 2020; 69(6): 1002-9.
Wei XS, Wang X, Niu YR, Ye LL, Peng WB, Wang ZH, et al. Diarrhea is associated with prolonged symptoms and viral carriage in COVID-19. Clin Gastroenterol Hepatol. (2020) 18:1753-9.e2.
Wei XS, Wang X, Niu YR, Ye LL, Peng WB, Wang ZH, et al. Clinical Characteristics of SARS-CoV-2 Infected Pneumonia with Diarrhea. 2020. Available from: https://papers.ssrn.com › papers
Guan W, Ni Z, Hu Y, Liang W, Ou C, He J, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020; 382(18): 1708-20.
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, cross-sectional, multicenter study. Am J Gastroenterol 2020; 115(5): 766-73.
Wu Y, Guo C, Tang L, Hong Z, Zhou J, Dong X, et al. Prolonged presence of SARS-CoV-2 viral RNA in faecal samples. Lancet Gastroenterol Hepatol 2020; 5(5): 434-5.
Chen L, Lou J, Bai Y, Wang M. COVID-19 Disease with Positive Fecal and Negative Pharyngeal and Sputum Viral Tests. Am J Gastroenterol 2020; 115(5): 790.
WHO issues consensus document on the epidemiology of SARS. Wkly Epidemiol Rec 2003; 78(43): 373-5. (English, French)
Wong SH, Lui RN, Sung JJ. Covid-19 and the digestive system. J Gastroenterol Hepatol 2020; 35(5): 744-8.
Yeo C, Kaushal S, Yeo D. Enteric involvement of coronaviruses: is faecal-oral transmission of SARS-CoV-2 possible? Lancet Gastroenterol Hepatol 2020; 5(4): 335-7.