GI Symptoms Not Associated With Severe COVID-19 Course
The North American Alliance for the Study of Digestive Manifestations of COVID-19 found that 53% of patients hospitalized with the viral illness had at least one gastrointestinal (GI) symptom or abnormality in a hepatic indicator, but these manifestations were not associated with a severe clinical course of the disease.
The alliance identified patients hospitalized with COVID-19 in medical centers throughout North America to determine the prevalence and severity of GI symptoms in these patients. The research team analyzed data on baseline characteristics, symptomatology, laboratory assessment, imaging, and endoscopic findings from the onset of symptoms through discharge or death, and performed regression analyses to evaluate any association between digestive symptoms and COVID-19 outcomes.
Of 1992 patients in 36 centers who were eligible for inclusion in the study, 53% experienced at least one GI symptom during the course of their illness. The most common symptom was diarrhea (34%), followed by nausea (27%), vomiting (16%), and abdominal pain (11%). In 74% of these cases, the symptoms were classified as mild.
In addition, 35% of patients developed an abnormal alanine aminotransferase or total bilirubin level. In 77% of these cases, the elevation of these markers was under 5 times the upper limit of normal. The researchers found that GI symptoms at any time during hospitalization with COVID-19 (odds ratio 0.93, 95% confidence interval 0.76-1.15) or liver test abnormalities on admission (odds ratio 1.31, 95% confidence interval 0.80-2.12) had no independent association with mechanical ventilation or death.
“Our findings affirm that digestive manifestations are common in COVID-19,” the researchers concluded. “However, gastrointestinal symptoms and liver test abnormalities do not appear to represent a principal aspect of this disease in terms of human suffering or resource utilization.”
They added, “Furthermore, our findings do not support a strong association between intestinal SARS-CoV-2 infection and severe pulmonary or systemic illness through gut-lung crosstalk or other mechanisms.”
--Rebecca Mashaw
Elmunzer BJ, Spitzer RL, Foster LD, et all, for The North American Alliance for the Study of Digestive Manifestations of COVID-19. Digestive manifestations in patients hospitalized with COVID-19. Clin Gastroenterol Hepatol. Published online September 30, 2020.
