COVID-19 GI Symptoms Common, Tied to More Severe Disease, Worse Outcomes

By Megan Brooks

October 28, 2020

NEW YORK (Reuters Health) - Gastrointestinal (GI) symptoms such as diarrhea, vomiting and stomach pain are common presenting symptoms of COVID-19 infection and are associated with increased disease severity and worse outcomes, according to a series of studies presented October 26 at the American College of Gastroenterology (ACG) virtual annual meeting.

While SARS-CoV-2 was initially defined predominantly by respiratory symptoms, it is now well understood that the virus affects multiple systems, including the GI tract.

Dr. Subash Ghimire of Guthrie Robert Packer Hospital, in Sayre, Pennsylvania, reported the results of a systematic review and meta-analysis of 38 studies reporting GI symptoms in COVID-19 patients

Among more than 8,400 patients, 15% had at least one GI symptom. The pooled prevalence of diarrhea and nausea/vomiting was 12% and 8%, respectively. Patients with diarrhea as a presenting symptom of COVID-19 were more likely to have severe disease (odds ratio, 1.63; P=0.01).

"Patients with diarrhea likely harbor increased viral load, which can potentially lead to an increased systemic response to the virus and associated respiratory complications from it. Early recognition of patients is needed for prompt management of this at-risk population," Dr. Ghimire said in his conference presentation.

Dr. Darbaz Adnan of Rush University Medical Center reported results of a review of electronic records on 921 patients who tested positive for SARS-CoV-2 at a major COVID-19 response center in Chicago.

"Overall, 22.4% of our patients reported at least one GI symptom at the onset of their infection, with nausea/vomiting being the most common complaint," Dr. Adnan reported.

GI symptoms in COVID-19 patients were independently linked to poor outcomes with higher admission rates to the hospital, intensive-care unit and higher intubation rates. There was a stepwise increased likelihood of worse outcomes in patients with one, two or three GI symptoms when compared with those without any GI symptoms, he noted.

"These results indicate that presenting with GI symptoms may place COVID-19 patients at a markedly higher risk of a worsened disease course from COVID-19 and need to be considered at the time of triage," Dr. Adnan concluded.

Dr. Hafsa Abbas of Bronx Lebanon Hospital Center, in New York City, reported results of an investigation into the incidence of GI bleeding (GIB) in patients hospitalized with SARS-CoV-2.

Among 1,206 patients, 3.1% developed GIB, including 16 (43%) who suffered a major bleed. The upper GI tract was the most common site of bleeding and coffee ground emesis was the most common presentation, Dr. Abbas reported.

A total of 412 (34%) patients died. Patients on therapeutic anticoagulation had a higher mortality than did those not on anticoagulation (18.7 % vs. 10%; P=0.001).

"However, the presence of GIB did not contribute to the overall mortality. Therefore, it can be deduced that anticoagulants can be given safely in these patients if clinically indicated, and if there are no contraindications in these patients with COVID-19," Dr. Abbas noted in her presentation.

SOURCE: American College of Gastroenterology 2020 Virtual Annual Meeting.