key: cord-0833102-djzucf0y
authors: Zhao, Yajuan; Cao, Yinghao; Wang, Shuhan; Cai, Kailin; Xu, Keshu
title: COVID‐19 and gastrointestinal symptoms
date: 2020-08-05
journal: Br J Surg
DOI: 10.1002/bjs.11821
sha: 890c5e65472087266d63e501f43624c99432563f
doc_id: 833102
cord_uid: djzucf0y

nan

A: Anorexia; B: Nausea; C: Vomiting; D: Nausea and vomiting; E: Diarrhea; F: Abdominal pain.

We comprehensively reviewed studies on gastrointestinal symptoms of COVID-19 patients from Dec 1, 2019 to April 20, 2020. A total of 25 210 patients were included. The median age (IQR) was 45⋅2(36⋅6-55⋅7) years. 43⋅4% of the patients were male. Seventy-five (81%) studies were from China, eighteen (19%) studies were from other countries. Among the studies in China, twenty-nine (39%) were from Hubei Province. The number of studies on adult, pregnant women and pediatric patients were 72, 7, and 14, respectively.

The incidence of all gastrointestinal symptoms was 18⋅6% (95% CI: 15⋅7%-21⋅6%). As shown in Fig. 1 , anorexia (26⋅1%, 95% CI: 17⋅6%-34⋅5%) and diarrhea (13⋅5%, 95% CI: 10⋅8%-16⋅1%) were the most common gastrointestinal symptoms, followed by nausea and vomiting (9⋅4%, 95%CI: 5⋅8%-13⋅1%), nausea (7⋅5%, 95% CI: 5⋅0%-10⋅0%), vomiting (6⋅0%, 95% CI: 4⋅4%-7⋅6%). Abdominal pain was relatively rare (5⋅7%, 95% CI: 3⋅2%-8⋅1%). In China, the incidence of nausea, vomiting, and diarrhea was significantly higher in patients within Hubei Province than outside Hubei. And the incidence of diarrhea and abdominal pain was significantly lower in patients from China than from other countries. Abdominal pain, nausea, and vomiting were more prevalent in pediatric patients than adults but there was no significant statistical difference. The incidence of diarrhea was higher in adults than in pediatric patients and pregnant women, but there was no significant difference.

All Gastrointestinal symptoms correlate with a more severe disease course and a larger proportion of intensive care unit (ICU) admission. The pooled prevalence of all gastrointestinal symptoms was higher in COVID-19 patients with severe disease than with non-severe disease (24⋅41% versus 16⋅31%, P < 0⋅001). The proportion of ICU admission in patients with and without all gastrointestinal symptoms was 9⋅81% and 6⋅70%, respectively, and there was a significant difference (P = 0⋅008). Patients with gastrointestinal symptoms had a smaller proportion of mechanical ventilation and death. Female and elderly patients were easier to suffer from gastrointestinal injury.

Angiotensin-converting enzyme 2 (ACE2) receptor is a critical cell receptor for SARS-CoV-2 to invade the host cells. SARS-CoV-2 directly invades the digestive tract through binding with ACE2 receptors in glandular cells of gastric, duodenal and rectal epithelial cells, as well as in enterocytes of small intestinal 3 . Moreover, after infected with SARS-CoV-2, the"gut-lung" axis and the interaction between intesti-nal microbiota and pro-inflammatory cytokines may also lead to the injury of the gastrointestinal tract 4 . However, most patients were treated with antibiotics (abidol, ribavirin) and nonsteroidal anti-inflammatory drugs (NSAIDs), so drug-associated gastrointestinal symptoms should be distinguished 5 .

Gastrointestinal symptoms are common clinical manifestations of COVID-19. When accessing surgical patients, clinicians should inquiry on whether patients complain about any gastrointestinal discomfort in detail, identify COVID-19 in time, and reduce the risk of infection during surgery.

Evidence for gastrointestinal infection of SARS-CoV-2

The cross-talk between gut microbiota and lungs in common lung diseases

Digestive symptoms in COVID-19 patients with mild disease severity: clinical presentation, stool viral RNA testing, and outcomes

We also offer supplementary figures and tables in supplementary materials.