Don't Overlook Digestive Symptoms in Patients With 2019 Novel Coronavirus Disease (COVID-19)

Luo, Sai; Zhang, Xiaochun; Xu, Haibo

doi:10.1016/j.cgh.2020.03.043

Cited by 300 publications

(340 citation statements)

References 3 publications

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“…Several studies suggested that there might be an increasing trend in adults to present with GI symptoms, from about 3% reported in January to over 10% in February. [4,8] However, our study in children showed a reverse trend. Three-quarters of the patients with GI symptoms were admitted before the median admission date.…”

Section: Discussioncontrasting

confidence: 57%

Are COVID-19 infected children with gastrointestinal symptoms different from those without symptoms? A comparative study of the clinical characteristics and epidemiological trend of 244 pediatric cases from Wuhan

Xiong

Wong

Chi

et al. 2020

Preprint

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Objective: COVID-19 patients presenting with gastrointestinal (GI) symptoms occur in both adults and children. To date, however, no large sample size study focusing on gastrointestinal symptoms in pediatric cases has been published. We analyzed COVID-19 infected children in Wuhan who presented with initial GI symptoms to determine the GI characteristics and epidemiological trend of the disease. Design: We retrospectively analyzed 244 children patients confirmed with COVID-19 at Wuhan Children's Hospital from 21 Jan to 20 Mar 2020. Symptomatic cases were divided into two groups according to whether the patients presented with or without GI symptoms on admission. Demographic, epidemiological, symptoms, and laboratory data were compared. We also analyzed the respective trends of case number changes of GI cases and asymptomatic cases. Results: 34 out of 193 symptomatic children had GI symptoms. They had lower median age and weight, a higher rate of fever, a longer length of stay and more hematological and biochemical abnormalities than patients without GI symptoms. There was no significant difference in chest CT findings or stool SARS-CoV-2 test positive percentages between the two groups. The number of patients admitted with GI symptoms showed an overall downward trend with time. At the time of writing, 242 patients were discharged, one died, and one critically ill patient was still in the intensive care unit. Conclusion: COVID-19 infected children with GI symptoms are prone to presenting with more clinical and laboratory abnormalities than patients without GI symptoms. More attention and timely hospital admission are needed for these patients.

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Section: Discussioncontrasting

confidence: 57%

Are COVID-19 infected children with gastrointestinal symptoms different from those without symptoms? A comparative study of the clinical characteristics and epidemiological trend of 244 pediatric cases from Wuhan

Xiong

Wong

Chi

et al. 2020

Preprint

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“…In a recent study, diarrhoea was a presenting symptom in 37.1% of patients with COVID-19. 20 A single case of SARS-CoV-2 induced diarrhoea as presenting symptom has been reported. 21 It has been suggested that the increase in GI symptoms in the later phase of this had a high tropism for the GI tract.…”

Section: Discussionmentioning

confidence: 99%

2019 novel coronavirus disease (COVID‐19) in patients with inflammatory bowel diseases

Taxonera

Sagastagoitia

Alba

et al. 2020

Aliment Pharmacol Ther

164

188

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Background: Data on patients with inflammatory bowel diseases (IBD) who have had 2019 novel coronavirus (SARS-CoV-2) disease (COVID-19) are needed.Aim: To report the clinical characteristics, including gastrointestinal symptoms, of COVID-19 in IBD patients, and to assess the risk of COVID-19 in IBD. Methods:This case series included consecutive IBD patients with laboratory-confirmed COVID-19. Age-adjusted cumulative incidences were compared with the general population in the Madrid region.Results: Through April 8, 12 of 1918 IBD patients were diagnosed with COVID-19. The average age was 52 years, 75% of the patients were female and 58.3% had Crohn's disease. Seven patients (58%) were on maintenance treatment with immunomodulators/biologics, of these four with combined therapy (33%). Eight patients (66%) required hospitalisation (one intensive care unit admission, and two deaths), and four patients were isolated at home. Nine patients had diarrhoea ranging between 4 and 10 loose stools per day (mean 5.4, SD 1.6). In five patients (42%) diarrhoea was a presenting symptom. In two patients, diarrhoea was the only symptom at debut. Cumulative incidence of COVID-19 was 6.2 per 1000 IBD patients. IBD patients had a lower adjusted incidence ratio of COVID-19 (OR 0.74, 95% CI 0.70-0.77; P < 0.001), and a similar associated mortality ratio (OR 0.95, 95% CI: 0.84-1.06; P = 0.36), compared with the general population.Conclusions: IBD patients do not have an increased risk of COVID-19 and associated mortality compared with the general population. In many IBD patients, diarrhoea was a presenting symptom, and sometimes, was the only symptom at onset of COVID-19. IMM treatment, n (%) 559 (29.1) Azathioprine, n (%) 353 (63.1) Mercaptopurine, n (%) 105 (18.8) Methotrexate, n (%) 90 (16.1) Tofacitinib*, n (%) 6 (1.1) Tacrolimus, n (%) 2 (0.3) Mycophenolate, n (%) 3 (0.5) Biological treatment, n (%) 301 (15.7) Infliximab, n (%) 110 (36.5) Adalimumab, n (%) 119 (39.5) Golimumab, n (%) 31 (10.3) Vedolizumab, n (%) 18 (6.0) Ustekinumab, n (%) 23 (7.6) Biological + IMM treatment, n (%) 157 (8.2) IMM alone, n (%) 402 (20.9) Biologics alone n (%) 144 (7.5) Disease location (L): L1 terminal ileum, L2 colon, L3 ileocolon, L4 upper gastrointestinal tract; Disease behaviour (B): B1 nonstricturing nonpenetrating; B2 stricturing, B3 penetrating. IMM: immunomodulator; Tofacitinib* is a JAKinase inhibitor not similar to conventional IMM. Abbreviations: IQR, interquartile range; Montreal classification' of Crohn's disease (CD); SD, standard deviation; UC, ulcerative colitis.

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“…Increasing number of reports and clinical observations demonstrate that patients infected with SARS-CoV-2 present not only respiratory signs of infection but also diarrhoea, vomiting, nausea or abdominal pain. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] showed ground-glass opacities in CT scan and was afterwards tested positive from nasopharyngeal swab. 22 Interestingly, the first described case of COVID-19 in United…”

Section: Covid-19 and Gastrointestinal Tractmentioning

confidence: 99%

COVID‐19: Focus on the lungs but do not forget the gastrointestinal tract

Smyk

Janik

Portincasa

et al. 2020

Eur J Clin Investigation

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The coronavirus disease 2019 (COVID‐19) caused by SARS‐CoV‐2 was declared in the last weeks as global pandemic. Currently affecting more than 5 000 000 individuals worldwide, COVID‐19 is most commonly associated with symptoms caused by the acute respiratory distress syndrome (ARDS). As the number of infected individuals increases, we are learning that not only lungs, but also other organs can be affected by the virus. The gastrointestinal symptoms, for example diarrhoea, vomiting, nausea or abdominal pain, are frequent in patients with COVID‐19. Moreover, alimentary tract symptoms may precede the respiratory presentation of SARS‐CoV‐2 infection. This can lead to delayed diagnosis and inappropriate management of infected patients. In addition, SARS‐CoV‐2 nucleic acid can be detected in faeces of infected patients and rectal swabs are even reported to remain positive for a longer period of time than nasopharyngeal swabs. Here, we aim to provide an update on the gastrointestinal involvement of COVID‐19 presenting the symptoms that can be encountered in infected patients. We address the role of angiotensin‐converting enzyme 2 (ACE2), as a functional receptor for SARS‐CoV‐2, which also was found in the gastrointestinal tract. Finally, we briefly discuss faecal shedding of SARS‐CoV‐2 and its potential role in the pathogenesis of the disease.

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Don't Overlook Digestive Symptoms in Patients With 2019 Novel Coronavirus Disease (COVID-19)

Cited by 300 publications

References 3 publications

Are COVID-19 infected children with gastrointestinal symptoms different from those without symptoms? A comparative study of the clinical characteristics and epidemiological trend of 244 pediatric cases from Wuhan

Are COVID-19 infected children with gastrointestinal symptoms different from those without symptoms? A comparative study of the clinical characteristics and epidemiological trend of 244 pediatric cases from Wuhan

2019 novel coronavirus disease (COVID‐19) in patients with inflammatory bowel diseases

COVID‐19: Focus on the lungs but do not forget the gastrointestinal tract

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