The emergence of coronavirus disease 2019 (COVID-19), which caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has put unprecedented challenges on the public health [1, 2]. It is well- known that most of the infected patients presented with fever or respiratory manifestations, while a portion of patients presented with gastrointestinal (GI) symptoms [2]. In early published study from the USA, SARS-CoV-2 viral RNA has been present in the feces of the illness [3]. However, part of COVID-19 patients present GI symptoms at the onset of diseases may be overlooked by clinicians [4].
Our experience was conducted in Ningbo First Hospital, Jingzhou Central Hospital, and Hubei Provincial Hospital of Integrated Chinese & Western Medicine. One hundred fifty-seven patients we treated were diagnosed as COVID-19 according to the World Health Organization interim guidance [5]. Nasopharyngeal swabs and chest computed tomography were collected from all patients. Demographic data, symptoms, laboratory values, comorbidities, and clinical outcomes were collected from the electronic medical records.
Anzeige
Of 157 patients with COVID-19, 63 (40.1%) presented with 1 or more GI symptoms (anorexia, nausea, or diarrhea). The mean age of 157 patients was 49.3 years (standard deviation, SD, 14.5), and 74 (47.1%) were male.
Of the 63 patients, 21 (33.3%) had nausea, 47 (74.6%) had anorexia, and 25 (39.7%) had diarrhea. The mean age of those patients was 51.9 years (SD, 14.9). Twenty-four (38.1%) were male, and 24 (38.1%) had chronic diseases. The most common symptoms were cough, fatigue, fever, and muscle soreness. Neither the median white blood cell nor lymphocyte counts were different between patients with and without GI symptoms (Table 1).
Table 1
Demographics and clinical features of coronavirus disease 2019
Total (n = 157) | GI symptoms(n = 63) | Without GI symptoms (n = 94) | p value* | |
|---|---|---|---|---|
Age, mean (SD), years | 49.3 (14.5) | 51.9 (14.9) | 47.5 (14.0) | 0.0599 |
Gender | ||||
Male | 74 (47.1%) | 24 (38.1%) | 50 (53.2%) | 0.0633 |
Female | 83 (52.9%) | 39 (61.9%) | 44 (46.8%) | |
Comorbidities | ||||
Hypertension | 28 (17.8%) | 12 (19.1%) | 16 (17.0%) | 0.7451 |
Diabetes | 9 (5.7%) | 5 (7.9%) | 4 (4.3%) | 0.5337 |
Chronic kidney disease | 3 (1.9%) | 1 (1.6%) | 2 (2.1%) | 1.0000 |
Chronic lung disease | 2 (1.3%) | 1 (1.6%) | 1 (1.1%) | 1.0000 |
Heart disease | 2 (1.3%) | 2 (3.2%) | 0 | 0.1595 |
Malignancy | 4 (2.6%) | 1 (1.6%) | 3 (3.2%) | 0.9135 |
Total with ≥ 1 comorbidity | 55 (35.0%) | 24 (38.1%) | 31 (33.0%) | 0.5101 |
Symptoms | ||||
Fever | 65 (41.4%) | 23 (36.5%) | 42 (44.7%) | 0.3082 |
Cough | 109 (69.4%) | 47 (74.6%) | 62 (66.0%) | 0.2491 |
Sore throat | 12 (7.6%) | 4 (6.4%) | 8 (8.5%) | 0.8468 |
Muscle soreness | 44 (28.0%) | 23 (36.5%) | 21 (22.3%) | 0.0527 |
Fatigue | 73 (46.5%) | 44 (69.8%) | 29 (30.9%) | < 0.001 |
Initial laboratory parameters, median (IQR) | ||||
WBCs count, × 109/L | 4.9 (3.8–6.3) | 4.9 (3.4–6.0) | 5.0 (4.0–6.4) | 0.4838 |
Lymphocyte count, × 109/L | 1.0 (0.7–1.4) | 1.0 (0.7–1.4) | 1.0 (0.7–1.5) | 0.4423 |
C-reactive protein, mg/L | 13.2 (3.4–32.9) | 17.8 (7.2–41.1) | 9.1 (2.9–30.3) | 0.0561 |
ALT level, IU/L | 21.7 (15.4–38.8) | 23.1 (15.0–43.0) | 21.7 (16.2–34.3) | 0.8062 |
AST level, IU/L | 26.2 (20.7–34.7) | 26.0 (20.0–35.0) | 26.9 (20.8–34.7) | 0.7189 |
Severe cases | 41 (26.1%) | 8 (12.7%) | 33 (35.1%) | 0.0016 |
Corticosteroid usage | 112 (71.3%) | 40 (63.5%) | 72 (76.6%) | 0.0751 |
Hospital course, mean (SD), days | ||||
Duration onset to treatment | 5.3 (5.4) | 5.9 (6.0) | 4.9 (4.9) | 0.2580 |
Clinical recovery time | 9.8 (4.9) | 10.7 (4.5) | 9.1 (5.2) | 0.0607 |
Time of virus nucleic acid turn to negative | 12.4 (6.4) | 13.0 (6.1) | 12.0 (6.7) | 0.3509 |
Hospitalization duration | 16.0 (4.9) | 16.1 (5.1) | 15.8 (4.7) | 0.7003 |
There was no significant difference in viral shedding, the time to clinical recovery, or hospitalization duration between patients with and without GI symptoms (Table 1). Among patients with GI symptoms, 63.5% received corticosteroids treatment, which is much lower than patients without GI symptoms group (63.5% vs 76.6%; p = 0.0751). Moreover, less patients with GI symptoms developed into severe cases compared with those without GI symptoms (12.7% vs 35.1%; p = 0.0016).
In our experience, 4 out of 10 patients with COVID-19 have significant GI symptoms. There was no significant difference in gender, age, and comorbidities between patients with and without GI symptoms. Leukocyte and lymphocyte counts were similar between the two groups. Besides, there was no significant difference in viral shedding, the time to clinical recovery, or hospitalization duration between patients with and without GI symptoms. Nonetheless, less patients with GI symptoms received corticosteroids and developed into severe cases.
Anzeige
This study suggested that GI symptoms in COVID-19 are frequent but are not associated with the severity of diseases or worse outcomes. However, because SARS-CoV-2 can be found in patient feces and the digestive system, we should be cautious with these potential routes for transmission [2, 3]. This study is limited by the lacked of data of reverse transcriptase polymerase chain reaction on COVID-19 in GI specimens. Our observations indicate that a substantial number of patients present with predominantly GI symptoms, and caution about this atypical presentation is necessary.
Acknowledgements
Not applicable.
Ethics approval and consent to participate
Ethical approvals for this study were obtained from the Ethics Commission of Ningbo First Hospital (2020-R017) and the Ethics Commission of Jingzhou Central Hospital (2020-2-19). Written informed consent was waived due to the rapid emergence of this disease.
Consent for publication
Not applicable.
Competing interests
Authors have disclosed no conflicts of interest.
Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.