Gastrointestinal manifestations and outcomes of hospitalised patients with COVID-19 disease
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Keywords

Coronavirus disease 2019
Disease severity
Gastrointestinal manifestation

How to Cite

Poudel, S., Poudel, S. C., Mishra, A., & Bhattarai, T. R. (2022). Gastrointestinal manifestations and outcomes of hospitalised patients with COVID-19 disease. Journal of Kathmandu Medical College, 11(1), 68–73. Retrieved from https://jkmc.com.np/ojs3/index.php/journal/article/view/1161

Abstract

Background: COVID-19 infection usually presents with respiratory symptoms. Many hospitalised patients of COVID-19 present with gastrointestinal symptoms which can alter the clinical outcomes of patients.
Objectives: To characterise the gastrointestinal manifestations of COVID-19 patients requiring hospitalisation and their correlation with disease severity and clinical outcomes.
Methods: This was a single centre prospective, observational, cohort study done at Kathmandu Medical College, a tertiary health care centre after ethical clearance. All consecutive hospitalised patients with COVID-19 disease admitted during May and June 2021 were included in the study after ethical clearance. Diagnosis of COVID-19 infection was done by RT-PCR. Gastrointestinal symptoms of abdominal pain, aguesia, nausea/vomiting, and diarrhoea were recorded on hospital admission and outcomes accessed at discharge. Data were analysed using SPSS v.24.
Results: A total of 196 consecutive adult patients with COVID-19 infection were included in study. Gastrointestinal symptoms were recorded in 48 (24.5%) patients. The most frequent symptom was nausea/vomiting (23, 11.7%) followed by aguesia (19, 9.7%), diarrhoea (14, 7.1%), and abdominal pain (8, 4.1%). There was no significant association between duration of hospital stay and presence of gastrointestinal symptoms (10.15 vs 10.95 days; p = 0.481). No significance was seen on association of gastrointestinal symptoms with ICU admission and mortality but requirement of mechanical ventilation was significantly higher in patients without symptoms (10.4 vs 23.6%; p = 0.048).
Conclusion: Significant proportion of patients with COVID-19 infection can have gastrointestinal manifestations. Presences of these symptoms do not have any association with the final clinical outcome of the patient.

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References

Lu H, Stratton CW, Tang YW. Outbreak of pneumonia of unknown etiology in Wuhan, China: The mystery and the miracle. J Med Virol. 2020 Apr;92(4):401-2. [PubMed | Full Text | DOI]

Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study. Lancet. 2020 Feb 15;395(10223):50713. [PubMed | Full Text | DOI]

Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020 Feb;395(10223):497506. [PubMed | Full Text | DOI]

Xiao F, Tang M, Zheng X, Liu Y, Li X, Shan H. Evidence for gastrointestinal infection of SARS-CoV-2. Gastroenterology. 2020 May;158(6):1831-3. e3. [PubMed | Full Text | DOI]

Gupta A, Madhavan MV, Sehgal K, Nair N, Mahajan S, Sehrawat TS, et al. Extrapulmonary manifestations of COVID-19. Nat Med. 2020 Jul;26(7):101732. [PubMed | Full Text | DOI]

El Ouali S, Achkar J-P, Lashner B, Regueiro M. Gastrointestinal manifestations of COVID-19. Cleve Clin J Med. 2021 Feb 17;1-5. [PubMed | Full Text | DOI]

Zhang H, Shao B, Dang Q, Chen Z, Zhou Q, Luo H, et al. Pathogenesis and mechanism of gastrointestinal infection with COVID-19. Front Immunol. 2021 Nov 10;12:674074. [PubMed | Full Text | DOI]

Elrobaa IH, New KJ. COVID-19: Pulmonary and extrapulmonary manifestations. Front Public Health. 2021 Sep 28; 9:711616. [PubMed | Full Text | DOI]

Jin X, Lian JS, Hu JH, Gao J, Zheng L, Zhang YM, et al. Epidemiological, clinical and virological characteristics of 74 cases of coronavirus-infected disease 2019 (COVID-19) with gastrointestinal symptoms. Gut. 2020 Jun;69(6):10029. [PubMed | Full Text | DOI]

Leal T, Costa E, Arroja B, Gonçalves R, Alves J. Gastrointestinal manifestations of COVID-19: results from a European centre. Eur J Gastroenterol Hepatol. 2021 May;33(5):691-4. [PubMed | Full Text | DOI]

Ramachandran P, Onukogu I, Ghanta S, Gajendran M, Perisetti A, Goyal H, et al. Gastrointestinal symptoms and outcomes in hospitalised coronavirus disease 2019 patients. Dig Dis Basel Switz. 2020;38(5):373-9. [PubMed | Full Text | DOI]

Khan MU, Mushtaq K, Alsoub DH, Iqbal P, Ata F, Chaudhry HS, et al. Digestive system involvement and clinical outcomes among COVID-19 patients: A retrospective cohort study from Qatar. World J Gastroenterol. 2021 Dec 14;27(46):7995-8009. [PubMed | Full Text | DOI]

Living guidance for clinical management of COVID-19. Available from: https://www.who.int/publications/i/ item/WHO-2019-nCoV-clinical-2021-2. [Full Text]

Blake MR, Raker JM, Whelan K. Validity and reliability of the Bristol Stool Form Scale in healthy adults and patients with diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther. 2016;44(7):693- 703. [PubMed | Full Text | DOI]

O’Donnell LJ, Virjee J, Heaton KW. Detection of pseudodiarrhoea by simple clinical assessment of intestinal transit rate. BMJ. 1990 Feb 17;300(6722):439- 40. [PubMed | Full Text | DOI]

Wolter N, Jassat W, Walaza S, Welch R, Moultrie H, Groome M, et al. Early assessment of the clinical severity of the SARS-CoV-2 omicron variant in South Africa: A data linkage study. Lancet Lond Engl. 2022 Jan 19; S0140-6736(22):00017-4. [PubMed | Full Text | DOI]

Fang D, Ma J, Guan J, Wang M, Song Y, Tian D, et al. Manifestations of digestive system in hospitalised patients with novel coronavirus pneumonia in Wuhan, China: A single-center, descriptive study. Chin J Dig. 2020;E005-E005. [Full Text]

Nobel YR, Phipps M, Zucker J, Lebwohl B, Wang TC, Sobieszczyk ME, et al. Gastrointestinal symptoms and coronavirus disease 2019: A case-control study from the United States. Gastroenterology. 2020 Jul;159(1):373-5.e2. [PubMed | Full Text | DOI]

Zhou Z, Zhao N, Shu Y, Han S, Chen B, Shu X. Effect of gastrointestinal symptoms in patients with COVID-19. Gastroenterology. 2020 Jun;158(8):2294- 7. [PubMed | Full Text | DOI]

Sultan S, Altayar O, Siddique SM, Davitkov P, Feuerstein JD, Lim JK, et al. AGA Institute rapid review of the gastrointestinal and liver manifestations of COVID-19, meta-analysis of international data, and recommendations for the consultative management of patients with COVID-19. Gastroenterology. 2020 Jul;159(1):320-4.e27. [PubMed | Full Text | DOI]

Cheung KS, Hung IFN, Chan PPY, Lung KC, Tso E, Liu R, et al. Gastrointestinal manifestations of SARS-CoV-2 infection and virus load in fecal samples from a Hong Kong cohort: Systematic review and meta-analysis. Gastroenterology. 2020 Jul;159(1):81-95. [PubMed | Full Text | DOI]

da Silva FAF, de Brito BB, Santos MLC, Marques HS, da Silva Júnior RT, de Carvalho LS, et al. COVID-19 gastrointestinal manifestations: A systematic review. Rev Soc Bras Med Trop. 2020;53:e20200714. [PubMed | Full Text | DOI]

Redd WD, Zhou JC, Hathorn KE, McCarty TR, Bazarbashi AN, Thompson CC, et al. Prevalence and characteristics of gastrointestinal symptoms in patients with severe acute respiratory syndrome coronavirus 2 infection in the United States: A multicenter cohort study. Gastroenterology. 2020 Aug;159(2):765-7.e2. [PubMed | Full Text | DOI]

Pan L, Mu M, Yang P, Sun Y, Wang R, Yan J, et al. Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: A descriptive, crosssectional, multicenter study. Am J Gastroenterol. 2020 May;115(5):766-73. [PubMed | Full Text | DOI]

Zou X, Chen K, Zou J, Han P, Hao J, Han Z. Singlecell RNA-seq data analysis on the receptor ACE2 expression reveals the potential risk of different human organs vulnerable to 2019-nCoV infection. Front Med. 2020 Apr;14(2):185-92. [PubMed | Full Text | DOI]

Zuo T, Zhang F, Lui GCY, Yeoh YK, Li AYL, Zhan H, et al. Alterations in gut microbiota of patients with COVID-19 during time of hospitalisation. Gastroenterology. 2020 Sep;159(3):944-55.e8. [PubMed | Full Text | DOI]

Sun Z, Song Z-G, Liu C, Tan S, Lin S, Zhu J, et al. Gut microbiome alterations and gut barrier dysfunction are associated with host immune homeostasis in COVID-19 patients. BMC Med. 2022 Jan 20;20(1):24. [PubMed | Full Text | DOI]

Giron LB, Dweep H, Yin X, Wang H, Damra M, Goldman AR, et al. Plasma markers of disrupted gut permeability in severe COVID-19 patients. Front Immunol. 2021 Jun 9; 12:686240. [PubMed | Full Text | DOI]