Although GI symptoms such as diarrhea or nausea were initially thought to be uncommon among Covid-19 patients,^1,2 more recent reports suggest that GI symptoms are relatively common.^3-8

A review article found that as many as 50.0% of Covid-19 patients had diarrhea, ~30.0% had nausea, ~14.0% had gastrointestinal bleed, and 6.0% had abdominal pain.⁸  In a case series from New York City, ~25.0% of patients presented with diarrhea, while ~20.0% had nausea and vomiting. ⁹ 

Some patients may have GI symptoms in the absence of any respiratory complaints.  Fecal tests for RNA  have found nearly one-third to a half of patients with Covid-19 shedding the virus, with some patients testing positive even after  respiratory specimens test negative.⁸ How often these patients harbor viable or infectious virus is not known, however.

Some have reported that as the severity of the disease worsens so do the GI symptoms.³ GI symptoms have also been associated with later presentation of Covid-19, higher liver enzymes and longer prothrombin time.³

Although the exact mechanism of GI symptoms in Covid-19 is unclear, direct invasion of virus is a plausible explanation. Indeed, potential targets for SARS-CoV-2 virus, the ACE2-expressing cells, have been identified in the GI tract, including the esophagus, gastric, intestinal and colonic epithelial cells.^5,8  

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 References

 

1. Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of Coronavirus disease 2019 in China. N Eng J Med 2020, Feb 28. https://www.nejm.org/doi/full/10.1056/NEJMoa2002032
2. Young BE, Ong SWX, Kalimuddin S, et al. Epidemiologic features and clinical course of patients infected with SARS-CoV-2 in Singapore. JAMA. March 3, 2020. (17% diarrhea) https://jamanetwork.com/journals/jama/fullarticle/2762688
3. Pan L, Mu M, Yang P, et al. Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: a descriptive, cross-sectional, multicenter study. Am j Gastroenterol 2020. https://journals.lww.com/ajg/Documents/COVID_Digestive_Symptoms_AJG_Preproof.pdf
4. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novle coronavirus in Wuhan, China. Lancet 2020;395:497-506. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30183-5/fulltext
5. Gu J, Han B, Wang J. COVID-19: Gastrointestinal manifestations and potential fecal-oral transmission. J Gastroenterol https://www.gastrojournal.org/article/S0016-5085(20)30281-X/pdf
6. Wolfel R, Corman VM, Guggemos W, et al. Virological assessment of hospitalized patients with Covid-2019. Nature, April 1, 2020. https://doi.org/10.1038/a41586-020-2196-x
7. Xiao F, Tang M, Zheng X, et al. Evidence of gastrointestinal infection of SARS-CoV-2. Gastroenterology 2020, March 3. https://www.sciencedirect.com/science/article/pii/S0016508520302821?via%3Dihub
8. Tian Y, Rong L, Nian W, et al. Review article: gastrointestinal features in COVID-19 and the possibility of faecal transmission. Aliment Pharmacol Ther 2020;March 29. https://doi.org/10.1111/apt.15731
9. Goyal P, Choi JJ, Pinheiro LC, et al. Clinical characteristics of Covid-19 in New York City. N Engl J Med 2020.  https://www.nejm.org/doi/full/10.1056/NEJMc2010419

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