Symptoms of gastrointestinal virus

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Symptoms of Gastrointestinal Virus

Common Gastrointestinal Symptoms in COVID-19

Diarrhea, Nausea, and Vomiting

Diarrhea, nausea, and vomiting are frequently reported gastrointestinal symptoms in patients with COVID-19. Studies have shown that approximately 12% of patients with SARS-CoV-2 infection experience these symptoms . Diarrhea is particularly common, affecting around 11.5% of patients, followed by nausea and vomiting at 6.3% . These symptoms can occur both at the onset of the disease and during hospitalization .

Abdominal Pain and Anorexia

Abdominal pain and anorexia are also noted among COVID-19 patients. Abdominal pain is less common, affecting about 2.3% of patients . Anorexia, or loss of appetite, is reported in a significant number of cases, with one study indicating that 78.6% of patients experienced this symptom .

Severity and Gastrointestinal Symptoms

The severity of COVID-19 appears to correlate with the presence of gastrointestinal symptoms. Patients with severe COVID-19 are more likely to report gastrointestinal issues compared to those with non-severe disease Cheung2020Henry2020Mao2020. For instance, a pooled analysis found that 17.1% of patients with severe COVID-19 had gastrointestinal symptoms, compared to 11.8% of those with non-severe disease .

Fecal Viral Shedding and Transmission

Detection of Viral RNA in Stool

A significant proportion of COVID-19 patients exhibit viral RNA in their stool. Studies have found that up to 48.1% of patients have detectable viral RNA in their feces, even after respiratory samples test negative . This suggests a potential fecal-oral transmission route for the virus Organization2020Parasa2020.

Implications for Healthcare Workers

The presence of viral RNA in stool samples highlights the need for caution among healthcare workers when handling fecal samples or performing endoscopic procedures on COVID-19 patients . This is crucial to prevent potential transmission through fecal matter.

Pathophysiology and Impact on the Gastrointestinal Tract

ACE2 Receptor and Gastrointestinal Involvement

The gastrointestinal tract is a potential target for SARS-CoV-2 due to the high expression of the ACE2 receptor, which the virus uses to enter cells Henry2020Organization2020. This receptor's presence in the GI tract is associated with digestive symptoms and can lead to inflammation and bleeding in the intestines .

Impact on Gut Microbiota

SARS-CoV-2 infection can disrupt the balance of the gut microbiota, further complicating the disease's impact on the gastrointestinal system. This disruption can affect the overall homeostasis of the gut, potentially leading to additional health issues .

Conclusion

Gastrointestinal symptoms such as diarrhea, nausea, vomiting, abdominal pain, and anorexia are common in COVID-19 patients. The severity of the disease often correlates with the presence of these symptoms. Additionally, the detection of viral RNA in stool samples suggests a potential fecal-oral transmission route, necessitating caution among healthcare workers. Understanding the pathophysiology of SARS-CoV-2 in the gastrointestinal tract and its impact on gut microbiota is crucial for developing effective prevention and treatment strategies.

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Most relevant research papers on this topic

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-AnalysisHighly Cited

2020·

1496citations

·K. Cheung et al.

Gastroenterology·

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

WHO R&D Blueprint: novel Coronavirus: prospects for evaluating cross-reactivity of nCoV with SARS-CoV: January 24, 2020, Geneva, Switzerland

COVID-19 may target the gastrointestinal tract, causing bleeding, inflammation, and disrupting gut microbial flora, with potential oral-fecal transmission and impacting gut microbial flora homeostasis.

2020·

54citations

·W. Organization

Prevalence of Gastrointestinal Symptoms and Fecal Viral Shedding in Patients With Coronavirus Disease 2019

Gastrointestinal symptoms, including diarrhea, nausea, and vomiting, are common in 12% of SARS-CoV-2 patients, with possible fecal-oral transmission due to viral RNA in stool.

Meta-AnalysisRigorous JournalHighly Cited

2020·

333citations

·S. Parasa et al.

JAMA Network Open·

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

COVID-19 gastrointestinal manifestations: a systematic review

Digestion symptoms are common in COVID-19 patients, with diarrhea being the most common, followed by nausea and vomiting, and abdominal pain, and alterations in liver function biomarkers.

Systematic ReviewHighly Cited

2020·

70citations

·Filipe Antônio França da Silva et al.

Revista da Sociedade Brasileira de Medicina Tropical·

DOI

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 StudyHighly Cited

2020·

1601citations

·L. Pan et al.

The American Journal of Gastroenterology·

DOI

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 ReportRigorous JournalHighly Cited

2020·

311citations

·Y. Song et al.

Gut·

DOI

Gastrointestinal symptoms of 95 cases with SARS-CoV-2 infection

The gastrointestinal tract may be a potential transmission route and target organ for SARS-CoV-2, with diarrhea, anorexia, and nausea being the main symptoms in patients.

Observational StudyRigorous JournalHighly Cited

2020·

842citations

·Lu Lin et al.

Gut·

DOI

Prevalence of Gastrointestinal Symptoms in Severe Acute Respiratory Syndrome Coronavirus 2 Infection: Results of the Prospective Controlled Multinational GI-COVID-19 Study

The prevalence of gastrointestinal symptoms in COVID-19 patients is higher than previously reported, with nausea persisting after infection resolution.

Observational Study

2021·

54citations

·G. Marasco et al.

The American Journal of Gastroenterology·

DOI

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