Novelty in the gut: a systematic review and meta-analysis of the gastrointestinal manifestations of COVID-19

Abstract

BackgroundThe COVID-19 epidemic has affected over 2.6 million people across 210 countries. Recent studies have shown that patients with COVID-19 experience relevant gastrointestinal (GI) symptoms. We aimed to perform a systematic review and meta-analysis on the GI symptoms of COVID-19.MethodsA literature search was conducted via electronic databases, including PubMed, Embase, Scopus, and Google Scholar, from inception until 20 March 2020. Data were extracted from relevant studies. A systematic review of GI symptoms and a meta-analysis comparing symptoms in severe and non-severe patients was performed using RevMan V.5.3.ResultsPooled data from 2477 patients with a reverse transcription-PCR-positive COVID-19 infection across 17 studies were analysed. Our study revealed that diarrhoea (7.8%) followed by nausea and/or vomiting (5.5 %) were the most common GI symptoms. We performed a meta-analysis comparing the odds of having GI symptoms in severe versus non-severe COVID-19-positive patients. 4 studies for nausea and/or vomiting, 5 studies for diarrhoea and 3 studies for abdominal pain were used for the analyses. There was no significant difference in the incidence of diarrhoea (OR=1.32, 95% CI 0.8 to 2.18, Z=1.07, p=0.28, I2=17%) or nausea and/or vomiting (OR=0.96, 95% CI 0.42 to 2.19, Z=0.10, p=0.92, I2=55%) between either group. However, there was seven times higher odds of having abdominal pain in patients with severe illness when compared with non-severe patients (OR=7.17, 95% CI 1.95 to 26.34, Z=2.97, p=0.003, I2=0%).ConclusionOur study has reiterated that GI symptoms are an important clinical feature of COVID-19. Patients with severe disease are more likely to have abdominal pain as compared with patients with non-severe disease.

Gastrointestinal Manifestations and Associated Health Outcomes of COVID-19: A Brazilian Experience From the Largest South American Public Hospital

“…Two meta-analyses found relation between abdominal pain and severe disease, but this did not significantly impact mortality. Severe disease was reported with high heterogeneity between those studies, including oxygen saturation parameters, pulmonary involvement on image exams, and ICU admission, which may lead to imprecision on analyses ( 13 , 14 ).…”

Chemoprophylaxis, diagnosis, treatments, and discharge management of COVID-19: An evidence-based clinical practice guideline (updated version)

“…Severe-type patients: Two systematic review and meta-analysis (7827 patients from China) showed that the severe group had a higher risk of fever (OR = 1.67, 95% CI 1.15-2.42, P = 0.007, I 2 = 38.8%) [28], dyspnea (OR = 4.17, 95% CI 2.04-8.53, P < 0.001, I 2 = 71.3% / OR = 5.50, 95% CI 2.45-12.33, P < 0.001, I 2 = 61%) [28,29] and gastrointestinal symptoms (OR = 1.86, 95% CI 1.19-2.89, P = 0.006, I 2 = 0%) [29] than non-severe group, while another systematic review and meta-analysis (2477 patients from China, Singapore, and Australia) found that there was no significant difference in the incidence of diarrhea (OR = 1.32, 95% CI 0.8-2.18, Z = 1.07, P = 0.28, I 2 = 17%) or nausea and/or vomiting (OR = 0.96, 95% CI 0.42-2.19, Z = 0.10, P = 0.92, I 2 = 55%) between either group. However, there was seven times higher odds of having abdominal pain in patients with severe illness when compared with non-severe patients (OR = 7.17, 95% CI 1.95-26.34, Z = 2.97, P = 0.003, I 2 = 0%) [27]. TCM clinical symptoms: A systematic review and meta-analysis (484 patients from China) showed that the most common symptoms of COVID-19 patients were fever (74.0%), poor appetite (61.3%), fatigue (53.5%) and cough (50.4%).…”

“…Gastrointestinal symptoms: Four systematic reviews/ meta-analyses (19,007 patients from China, USA, South Korea, Singapore, UK, Australia, Belgium, Cambodia, France, Germany, Italy, Japan, Malaysia, Nepal, Philippines, Russia, Thailand and Vietnam) showed that the pooled prevalence of digestive symptoms was 9.8-17.6% [24][25][26], with diarrhea (7.8-10.4%) [24,25,27], nausea or vomiting (5.5-7.7%) [24,25,27], abdominal discomfort/pain (3.0-6.9%) [24,25] and loss of appetite (11%) [25] being the most common symptoms.…”

Transaminitis is an indicator of mortality in patients with COVID-19: A retrospective cohort study

“…While it is evident that manifestations are primarily respiratory in nature[ 6 ], the gastrointestinal manifestations of COVID-19 too, have been described as an important finding and have sparked a great deal of interest among clinicians and researchers alike. There currently exists a great deal of literature describing the GI manifestations of COVID-19 and its importance in diagnosis, prognosis and mode of transmission[ 7 - 9 ]. The most commonly described gastrointestinal symptom that has been reported is diarrhea, which has been reported to be present in 3%-30% of patients testing positive with COVID-19[ 7 - 10 ].…”