Is vomiting a symptom of covid

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Vomiting as a Symptom of COVID-19

Introduction to COVID-19 Symptoms

COVID-19, caused by the SARS-CoV-2 virus, is primarily known for its respiratory symptoms such as fever, cough, and shortness of breath. However, gastrointestinal symptoms, including vomiting, have also been reported in a subset of patients.

Prevalence of Vomiting in COVID-19 Patients

Several studies have highlighted the occurrence of vomiting among COVID-19 patients. A meta-analysis of international data found that the pooled prevalence of nausea and vomiting was approximately 7.8% 3. Another study reported that vomiting was present in 6.7% of COVID-19 patients, indicating a notable, though not predominant, symptom 6. Additionally, a systematic review and meta-analysis of pediatric COVID-19 cases found that vomiting occurred in 33% of children, particularly those under one year old 9.

Mechanisms Behind Vomiting in COVID-19

The mechanisms by which SARS-CoV-2 induces vomiting are multifaceted. The virus's receptor, angiotensin-converting enzyme 2 (ACE2), is highly expressed in the gastrointestinal tract, which may facilitate viral entry and subsequent gastrointestinal symptoms 2. The interaction between SARS-CoV-2 and ACE2 can lead to the release of mediators from the intestinal epithelium, which activate vagal afferents projecting to the brainstem, potentially triggering vomiting 1. Additionally, increased plasma levels of angiotensin II, a centrally acting emetic, have been observed in COVID-19 patients, providing another possible mechanism for vomiting 1.

Clinical Implications and Management

Recognizing vomiting as a symptom of COVID-19 is crucial for timely diagnosis and management. Patients presenting with gastrointestinal symptoms, including vomiting, may experience a delay in diagnosis due to the atypical presentation 10. Moreover, these patients often have a longer time from symptom onset to hospital admission and may exhibit more severe disease progression 10. Therefore, healthcare providers should maintain a high index of suspicion for COVID-19 in patients presenting with vomiting, especially during the pandemic.

Conclusion

Vomiting is a recognized symptom of COVID-19, though it occurs in a minority of patients. Understanding the prevalence and mechanisms behind this symptom can aid in the timely diagnosis and management of COVID-19, particularly in cases where gastrointestinal symptoms are the primary presentation. Increased awareness and early intervention can help mitigate the severity of the disease and improve patient outcomes.

Sources and full results

Most relevant research papers on this topic

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 Study

Rigorous Journal

2020·

49citations

·P. Andrewset al.

Journal of Gastroenterology and Hepatology

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 Zhanget al.

Journal of Microbiology, Immunology, and Infection

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-Analysis

Highly Cited

2020·

358citations

·S. Sultanet al.

Gastroenterology

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-Analysis

Rigorous Journal

Highly Cited

2020·

80citations

·B. Henryet al.

Internal and Emergency Medicine

SARS-CoV-2 induced diarrhoea as onset symptom in patient with COVID-19

COVID-19 patients with gastrointestinal symptoms should be evaluated for virus infectivity, especially during the outbreak period.

Case Report

Rigorous Journal

Highly Cited

2020·

301citations

·Y. Songet al.

Gut

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·

53citations

·Vitalakumar Det al.

ACS Chemical Neuroscience

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-Analysis

Rigorous Journal

Highly Cited

2020·

853citations

·R. Maoet al.

The Lancet. Gastroenterology & Hepatology

Gastrointestinal Manifestations of SARS-CoV-2 Infection and Virus Load in Fecal Samples From a Hong Kong Cohort: Systematic Review and Meta-analysis

17.6% of COVID-19 patients in Hong Kong had gastrointestinal symptoms, and 48.1% had virus RNA detected in their stool samples, highlighting the need for caution in fecal sample collection and endoscopic procedures.

Meta-Analysis

Highly Cited

2020·

1442citations

·K. Cheunget al.

Gastroenterology

A systematic review and meta‐analysis of children with coronavirus disease 2019 (COVID‐19)

Pediatric COVID-19 patients may experience milder illness with atypical symptoms, rare lymphopenia, and high incidence of critical illness and vomiting symptoms.

Meta-Analysis

Highly Cited

2020·

303citations

·Xiaojian Cuiet al.

Journal of Medical Virology

Clinical Characteristics of COVID-19 Patients With Digestive Symptoms in Hubei, China: A Descriptive, Cross-Sectional, Multicenter Study

COVID-19 patients with digestive symptoms, such as diarrhea, have a longer time from onset to admission, longer coagulation, and higher liver enzyme levels.

Observational Study

Highly Cited

2020·

1571citations

·L. Panet al.

The American Journal of Gastroenterology

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