Original Article: Lei Pan, Mi Mu et al. (PRE-PRINT) Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: a descriptive, cross-sectional, multicenter study. The American Journal of Gastroenterology.
Author of summary: Giulia Peserico; Revision: Barbara Neri, Engl. version: Edda Cava
Original Article Published on April 14th, 2020
Patients with COVID-19 who have digestive symptoms were shown to have a worse prognosis than those without. Atypical symptoms, such as diarrhea, may represent the presentation COVID-19, and physicians should consider a differential diagnosis of COVID19 even without respiratory symptoms. 20% of the sample presented diarrhea, specific GI symptoms, while A small percentage of patients (3%) presented only with digestive symptoms.
This study shows that among COVID19 frequent digestive symptoms were reported, such as diarrhea, vomiting, lack of appetite. Therefore, COVID19 manifestations are not only respiratory. In the study COVID + patients were enrolled from 3 hospitals in Hubei province, investigating prevalence, clinical characteristics, and outcomes of COVID-19 patients with vs. without digestive symptoms in a descriptive, cross-sectional, multicenter study.
204 patients were enrolled between January 18 and February 28, data were followed up and analyzed up to March 18: average age was 52.9 years (SD ±16), including 107 men and 97 women, 70 critically ill. 16 patients were transferred to the ICU (7.8%), 168 were discharged (82.4%), and 37 (17.7%) died. Among all patients, 103 patients (50.5%) reported a digestive symptom, of whom 97 presented also with respiratory symptoms, in 6 cases there were digestive symptoms but no respiratory symptoms. Among the 101 patients without digestive symptoms, 84 presented only with respiratory symptoms, and 20 neither had respiratory nor digestive symptoms.
Patients with digestive symptoms had a significantly longer time from onset to admission than patients without digestive symptoms. They reported lack of appetite (81 [78.6%] cases), diarrhea (35 [34%] cases), vomiting (4 [3.9%] cases), and abdominal pain (2 [1.9%] cases). Excluding low appetite, there were 38 total cases (20% of full sample) where patients presented with a gastrointestinal-specific symptom. Focusing only on diarrhea, there were 35 cases (17% of full sample) presenting with loose stools. Cases of diarrhea were usually not high volume or clinically severe, commonly presented as non-dehydrating loose stools, typically up to thrice daily.
As the severity of the disease increased, digestive symptoms become more pronounced. However, there was no significant difference in discharge time, days of intensive care, or mortality between the two groups. Those patients with digestive symptoms were more likely to suffer liver injury although the mean alanine aminotransferase and aspartate aminotransferase were in the normal range.
- COVID-19 appears to cause digestive symptoms, even as only manifestations, therefore differential diagnosis between COVID-19 and gastrointestinal disease is mandatory.
- Patients with digestive symptoms have worse severity of the disease and significantly longer time from onset to hospital admission vs. patients without digestive symptoms (possible misdiagnosis).
- PPE are needed even in case of GI symptoms.
- COVID 19 GI symptoms hypothesis à angiotensin converting enzyme 2 (ACE-2) receptor binding upregulated in hepatocytes derived from bile duct epithelial cells; indirectly or directly damages the digestive system through an inflammatory response; dysbiosis
- Retrospective cohort with small sample
- Lack of appetite considered a GI symptom
- Pre-print undergoing additional revision