Covid nausea

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COVID-19 and Nausea: A Comprehensive Overview

Prevalence of Nausea in COVID-19 Patients

Global Incidence of Nausea

Nausea is a recognized symptom of COVID-19, although its prevalence varies across different studies. A meta-analysis by the AGA Institute found that nausea and vomiting were present in approximately 7.8% of COVID-19 patients . Another study highlighted that the median incidence of nausea was around 10.5%, suggesting that it is as common as diarrhea among COVID-19 symptoms . These findings indicate that while nausea is not the most prevalent symptom, it is significant enough to warrant attention.

Comparison Across Regions

Interestingly, the prevalence of gastrointestinal symptoms, including nausea, appears to be higher in studies conducted outside of China. For instance, the AGA Institute's meta-analysis reported a higher incidence of nausea and vomiting in non-Chinese cohorts . This regional variation underscores the need for standardized symptom reporting to better understand the global impact of COVID-19 on gastrointestinal health.

Mechanisms Behind COVID-19-Induced Nausea

Viral Interaction with Gastrointestinal Tract

The mechanisms by which COVID-19 induces nausea are multifaceted. The virus's spike protein binds to the angiotensin-converting enzyme 2 (ACE2) receptors, which are highly expressed in the gastrointestinal tract. This interaction can lead to the release of mediators from the intestinal epithelium, which in turn activate vagal afferents projecting to the brainstem, triggering nausea Andrews2020Zhang2020. Additionally, the increase in plasma angiotensin II, a centrally acting emetic, further contributes to the sensation of nausea .

Central Nervous System Involvement

COVID-19's impact on the central nervous system (CNS) also plays a role in nausea. The virus can potentially invade the dorsal brainstem, which may lead to delayed onset of nausea and other neurological symptoms Andrews2020D2021. This CNS involvement highlights the complex interplay between gastrointestinal and neurological pathways in COVID-19 patients.

Nausea as an Indicator of Disease Severity

Early Symptom and Disease Progression

Nausea can be an early presenting symptom of COVID-19, sometimes appearing before more common symptoms like fever and dyspnea . This early onset can serve as a clinical predictor for the progression towards severe disease. Patients presenting with gastrointestinal symptoms, including nausea, have been found to have higher odds of developing severe COVID-19 Henry2020Mao2020.

Long-Term Impact on Survivors

Prolonged gastrointestinal symptoms, including nausea, have been reported in COVID-19 survivors. A systematic review found that the global prevalence of prolonged nausea among survivors was 3.23% . This persistent symptom raises concerns about the long-term impact of COVID-19 on the quality of life of survivors, necessitating further studies to understand the underlying pathogenesis and develop effective management strategies .

Conclusion

Nausea is a significant but often underreported symptom of COVID-19, with a prevalence comparable to other gastrointestinal symptoms like diarrhea. The mechanisms behind COVID-19-induced nausea involve both gastrointestinal and neurological pathways, highlighting the virus's complex impact on the body. Recognizing nausea as an early symptom can aid in the timely identification and management of severe cases. Additionally, the persistence of nausea in COVID-19 survivors underscores the need for ongoing research to address the long-term effects of the virus. Understanding and addressing these gastrointestinal manifestations are crucial for improving patient outcomes and quality of life.

Sources and full results

Most relevant research papers on this topic

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

Gastrointestinal symptoms are associated with COVID-19 in less than 10% of patients, with higher prevalence estimates outside of China.

Meta-AnalysisHighly Cited

2020·

377citations

·S. Sultan et al.

Gastroenterology·

DOI

COVID‐19, nausea, and vomiting

Nausea is an early symptom of COVID-19, comparable to diarrhea, and may be influenced by GI effects of SARS-CoV-2.

Observational StudyRigorous Journal

2020·

55citations

·P. Andrews et al.

Journal of Gastroenterology and Hepatology·

DOI

Gastrointestinal symptoms associated with severity of coronavirus disease 2019 (COVID-19): a pooled analysis

Gastrointestinal symptoms, such as abdominal pain, nausea, and vomiting, may increase the odds of severe COVID-19.

Meta-AnalysisRigorous JournalHighly Cited

2020·

80citations

·B. Henry et al.

Internal and Emergency Medicine·

DOI

Global prevalence of prolonged gastrointestinal symptoms in COVID-19 survivors and potential pathogenesis: A systematic review and meta-analysis

Prolonged gastrointestinal symptoms are prevalent in COVID-19 survivors, highlighting the long-term impact of the infection on their quality of life.

Meta-AnalysisRigorous Journal

2021·

51citations

·Fauzi Yusuf et al.

F1000Research·

DOI

Neurological Manifestations in COVID-19 Patients: A Meta-Analysis

COVID-19 patients experience various neurological manifestations related to the central and peripheral nervous systems, with high heterogeneity among studies.

Meta-Analysis

2021·

58citations

·V. D et al.

ACS Chemical Neuroscience·

DOI

Gastrointestinal and hepatic abnormalities in patients with confirmed COVID‐19: A systematic review and meta‐analysis

Gastrointestinal and liver manifestations are not rare in COVID-19 patients, with diarrhea and mild liver abnormalities being relatively common regardless of comorbidities.

Meta-Analysis

2020·

48citations

·A. Zarifian et al.

Journal of Medical Virology·

DOI

The roles of nausea and vomiting in COVID-19: did we miss something?

COVID-19 can cause gastrointestinal symptoms, including nausea and vomiting, and recognizing these symptoms is crucial for effective management and prevention.

2020·

27citations

·Tongyue Zhang et al.

Journal of Microbiology, Immunology, and Infection·

DOI

COVID-19 and the gastrointestinal tract: more than meets the eye

COVID-19 patients with gastrointestinal symptoms, such as diarrhoea, nausea, and vomiting, have more severe disease and higher rates of liver injury compared to those without GI symptoms.

Observational StudyRigorous JournalHighly Cited

2020·

183citations

·S. Ng et al.

Gut·

DOI

Manifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19: a systematic review and meta-analysis

Summary Background The prevalence and prognosis of digestive system involvement, including gastrointestinal symptoms and liver injury, in patients with COVID-19 remains largely unknown. We aimed to quantify the effects of COVID-19 on the digestive system. Methods In this systematic review and meta-analysis, we systematically searched PubMed, Embase, and Web of Science for studies published between Jan 1, 2020, and April 4, 2020. The websites of WHO, CDC, and major journals were also searched. We included studies that reported the epidemiological and clinical features of COVID-19 and the prevalence of gastrointestinal findings in infected patients, and excluded preprints, duplicate publications, reviews, editorials, single case reports, studies pertaining to other coronavirus-related illnesses, and small case series (<10 cases). Extracted data included author; date; study design; country; patient demographics; number of participants in severe and non-severe disease groups; prevalence of clinical gastrointestinal symptoms such as vomiting, nausea, diarrhoea, loss of appetite, abdominal pain, and belching; and digestive system comorbidities including liver disease and gastrointestinal diseases. Raw data from studies were pooled to determine effect estimates. Findings We analysed findings from 35 studies, including 6686 patients with COVID-19, that met inclusion criteria. 29 studies (n=6064) reported gastrointestinal symptoms in patients with COVID-19 at diagnosis, and the pooled prevalence of digestive system comorbidities was 4% (95% CI 2–5; range 0–15; I 2=74%). The pooled prevalence of digestive symptoms was 15% (10–21; range: 2–57; I 2=96%) with nausea or vomiting, diarrhoea, and loss of appetite being the three most common symptoms. The pooled prevalence of abnormal liver functions (12 studies, n=1267) was 19% (9–32; range 1–53; I 2=96%). Subgroup analysis showed patients with severe COVID-19 had higher rates of gastrointestinal symptoms (odds ratio [OR] 1·60 [95% CI 1·09–2·36]; p=0·0020; I 2=44%) and liver injury (2·20 [1·60–3·02]; p<0·00001; I 2=36%) compared with those with non-severe disease. Patients in Hubei province, where the initial COVID-19 outbreak occurred, were more likely to present with abnormal liver functions (p<0·0001) compared with those outside of Hubei. Paediatric patients with COVID-19 had a similar prevalence of gastrointestinal symptoms to those of adult patients. 10% (95% CI 4–19; range 3–23; I 2=97%) of patients presented with gastrointestinal symptoms alone without respiratory features. Patients who presented with gastrointestinal system involvement had delayed diagnosis (standardised mean difference 2·85 [95% CI 0·22–5·48]; p=0·030; I 2=73%). Patients with gastrointestinal involvement had a higher prevalence of complication (OR 2·51 [95% CI 1·62–3·89]; p<0·0001; I 2=0%). Interpretation Our study showed that digestive symptoms and liver injury are not uncommon in patients with COVID-19. Increased attention should be paid to the care of this unique group of patients. Funding None.

Meta-AnalysisRigorous JournalHighly Cited

2020·

885citations

·R. Mao et al.

The Lancet. Gastroenterology & Hepatology·

DOI

Clinical Symptom Differences Between Mild and Severe COVID-19 Patients in China: A Meta-Analysis

COVID-19 patients with initial symptoms of dyspnea, hemoptysis, anorexia, diarrhea, or fatigue, especially abdominal pain, should be closely monitored for disease deterioration.

Meta-AnalysisHighly Cited

2021·

81citations

·Xiao-bo He et al.

Frontiers in Public Health·

DOI

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