Digestive Symptoms May Be a Presenting Symptom, Worsen Prognosis of COVID-19

Digestive symptoms are common among patients with the novel coronavirus 2019 (COVID-19), according to a new study conducted by the Wuhan Medical Treatment Expert Group for COVID-19. And the patients who have such symptoms often have a worse prognosis than patients without digestive symptoms, the researchers report.

“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,” the researchers wrote.

To evaluate the prevalence and outcomes of patients with COVID-19 who experience digestive symptoms, the researchers conducted a descriptive, cross-sectional, multicenter study. In all, 204 patients with COVID-19 who had presented to one of 3 Chinese hospitals from January 18, 2020, to February 28, 2020 were included. The patients—10 of whom were men and 97 of whom were women—had an average age of 54.9 years.

The patients’ full laboratory, imaging, and historical data were analyzed and followed-up until March 5, 2020. 

According to the researchers, 99 patients (48.5%) had presented to the hospital with digestive symptoms as their chief report. These patients were less likely to be cured and discharged than patients who did not have digestive symptoms (34.3% vs 60%).

The patients with digestive symptoms also had a significantly longer time from onset to admission than patients without digestive symptoms (9.0 days vs 7.3 days).

The manifestations among the patients with digestive symptoms varied and included anorexia (83 [83.8%] cases), diarrhea (29 [29.3%] cases), vomiting (8 [0.8%] cases), and abdominal pain (4 [0.4%] cases). Of the studied cases, 7 were of patients who had digestive symptoms but no respiratory symptoms.

As the severity of the disease increased, digestive symptoms became more pronounced. However, there was no significant liver injury in the case series, according to laboratory data.

The researchers report that further large sample studies are needed to confirm their findings.

—Colleen Murphy

Reference:

Pan L, Mu M, Ren HG, et al; Wuhan Medical Treatment Expert Group for COVID-19. Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: a descriptive, cross-sectional, multicenter study [published online March 18, 2020]. Am J Gastroenterol. https://journals.lww.com/ajg/Documents/COVID_Digestive_Symptoms_AJG_Preproof.pdf.