GI Symptoms Common and Associated With Worse Outcomes in COVID-19
Douglas K. Rex, MD, FASGE, reviewing Pan L, et al. Am J Gastroenterol 2020 Mar 18.
In a cross-sectional study from 3 hospitals in China’s Hubei province (which includes Wuhan), 310 patients admitted with pneumonia of unknown cause between January 18 and February 28 were randomly selected; 96 patients were excluded because they lacked a chest CT or COVID-19 polymerase chain reaction (PCR) test, had a negative PCR test, or did not have a full set of labs. Two hundred four patients with confirmed diagnoses of COVID-19 met criteria for analysis. Data collected prior to and including March 5 were included. Of the patients included in the study, 7.8% had been transferred to intensive care units, 35% remained hospitalized, 47% were discharged, and 17.6% had died.
Among the patients, 48.5% had GI symptoms as their chief complaint, of which anorexia was most common (84%), followed by diarrhea (29%). Vomiting and abdominal pain were each <1%. Diarrhea was usually not pronounced, with around 3 loose stools per day reported as typical. GI symptoms often progressed as the COVID-19 disease worsened. Only 7 patients had GI symptoms and no respiratory symptoms.
Patients with GI symptoms presented later after onset of symptoms (9.0 vs 7.3 days; P=.02). Those without GI symptoms were more likely to be cured and discharged at study close (60% vs 34%), but deaths were only slightly lower (16% vs 19%; P=.57).
Lab evaluations showed no substantial issues with liver or kidney function.
COMMENT
These results from China indicate that GI symptoms are common as the chief complaint in COVID-19, though most patients had simultaneous respiratory symptoms. GI symptoms might contribute to community transmission because patients may be unaware that digestive symptoms can occur with this disease, erroneously believing the illness is solely respiratory. To the extent that the worse prognosis with GI symptoms holds up in future studies, it may reflect a delay in presentation for medical care amongst persons with dominant digestive symptoms or perhaps that replication in the GI tract somehow exacerbates COVID-19 disease.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
Douglas K. Rex, MD, FASGE
CITATION(S)
Pan L, Mu M, Ren HG, et al. Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: a descriptive, cross-sectional, multicenter study. Am J Gastroenterol 2020 Mar 18. (Epub ahead of print) (Study Pre-proof)
