Gastrointestinal Symptoms and Coronavirus Disease 2019: A Case-Control Study From the United States

Abstract

C oronavirus disease 2019 (COVID-19) is a pandemic characterized by a high fatality rate. 1 The incidence of COVID-19 has risen dramatically in the United States since March 2020, with the highest number of cases in the country present in New York City. 2 As health care systems rise to the challenge of unprecedented demands, there is an urgent need to characterize the spectrum of clinical presentations of this disease to allow early identification, isolation, and triage of affected patients.Although fever, cough, and shortness of breath are among the most common presenting symptoms, gastrointestinal symptoms are increasingly recognized among patients with COVID-19. [3][4][5][6][7] This case-control study aimed to describe gastrointestinal symptomatology-including diarrhea and nausea/vomiting-in US patients with COVID-19 compared to patients presenting under similar circumstances who tested negative for COVID-19. The secondary aims were to characterize the associations of gastrointestinal symptoms with total illness duration and early clinical outcomes. MethodsThis was a retrospective case-control study. Adults 18 years of age were considered for the study if they underwent nasopharyngeal swab testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between March 10, 2020, and March 21, 2020, at outpatient settings, including clinics or the emergency departments, of New York-Presbyterian-Columbia or the medical center's affiliates in New York. Indications for testing during this period were respiratory symptoms (cough, fever, shortness of breath) with intent to hospitalize or the same symptoms in essential personnel. Patients were excluded if insufficient data were available in the electronic medical record or if testing was performed during a preexisting inpatient admission. This study was approved by the Columbia University Irving Medical Center institutional review board.Manual chart review of randomly selected patients was performed by 3 investigators (YRN, MP, DEF) blinded to SARS-CoV-2 test result. The primary exposure was presence of gastrointestinal symptoms, including diarrhea or nausea/

Persistent viral shedding of SARS-CoV-2 in faeces - a rapid review

“…The high incidence of cough and fever in COVID-19 are well established [1]. Gastrointestinal symptoms are also well documented suggesting a potential faeco-oral transmission route [2]. Discharge guidelines for hospitals or declaring a COVID-19 patient recovered in the UK are largely based on time from either symptom onset or positive test depending on severity of illness and discharge destination [3].The European Centre for Disease Prevention and Control (ECDC), on the other hand, has advocated the need for continued self-isolation and hand hygiene measures even 14 days post-discharge based on prolonged viral shedding in faeces and respiratory samples [4].…”

Persistent viral shedding of SARS‐CoV‐2 in faeces – a rapid review

“…The high incidence of cough and fever in COVID‐19 is well established [1]. Gastrointestinal symptoms are also well documented suggesting a potential faeco‐oral transmission route [2]. Discharge guidelines for hospitals for declaring a COVID‐19 patient recovered in the UK are largely based on time from either symptom onset or positive test depending on the severity of illness and the discharge destination [3].…”

Severe colon ischemia in patients with severe COVID-2019 infection: a report of three cases

“…In the disease caused by coronavirus-19 (COVID-19) gastrointestinal symptoms have been reported in between 17.6 %-35 % of patients: diarrhea (12.5%), anorexia (78.6%), nausea and vomiting (10.2%), abdominal pain (9.2%), hematochezia (1.2%) all generally associated with respiratory disease or presenting on their own in 10-15% of cases [1,2].…”