"Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: a descriptive, cross-sectional, multicenter study
ABSTRACT
Background: Since the outbreak of coronavirus disease 2019 (COVID-19) in December2019, various digestive symptoms have been frequently reported in patients infected with the virus. In this study, we aimed to further investigate the prevalence and outcomes of COVID-19 patients with d igestive symptoms.
Methods: In this descriptive, cross-sectional, multicenter study, we enrolled confirmed patients with COVID-19 who presented to three hospitals from January 18th to February 28th, 2020. All patients were confirmed by real-time PCR and were analyzed for clinical characteristics, laboratory data, and treatment. Data were followed up until March 18th, 2020.
Results: In the present study,
204 patients with COVID-19 and full laboratory, imaging, and historical data were analyzed. The average age was 52.9 years (SD ± 16), including 107 men and 97 women. Although most patients presented to the hospital with fever or respiratory symptoms, we found that
103 patients (50.5%) reported a digestive symptom, including lack of appetite (81 [78.6%] cases),
diarrhea (35 [34%] cases), vomiting (4 [3.9%] cases), and abdominal pain (2 [1.9%] cases). If lack of appetite is excluded from the analysis (since it is less specific for the gastrointestinal tract), there were 38 total cases (18.6%) where patients presented with a gastrointestinal-specific symptom, including diarrhea, vomiting, or abdominal pain. Patients with digestive symptoms had a significantly longer time from onset to admission than patients without digestive symptoms (9.0 days vs. 7.3 days). In 6 cases there were digestive symptoms but no respiratory symptoms. As the severity of the disease increased, digestive symptoms became more pronounced. Patients with digestive symptoms had higher mean liver enzyme levels, lower monocyte count, longer prothrombin time, and received more antimicrobial treatment than those without digestive symptoms.
Conclusion: We found that digestive symptoms are common in patients with COVID-19. Moreover, these patients have a longer time from onset to admission, evidence of longer coagulation, and higher liver enzyme levels.
Clinicians should recognize that digestive symptoms, such as diarrhea, are commonly among the presenting features of COVID-19, and that the index of suspicion may need to be raised earlier in at-risk patients presenting with digestive symptoms. However, further large sample studies are needed to confirm these findings."
https://journals.lww.com/ajg/Documents/COVID_Digestive_Symptoms_AJG_Preproof.pdf_________________________________________________
"Diarrhea May Be First or Only Coronavirus Symptom in COVID-19 Patients Experience, Study Suggests
By Kashmira Gander On 4/2/20 at 8:07 AM EDT
Diarrhea may be the first or only symptom some COVID-19 patients experience, according to the authors of a study.
The study, published in The American Journal of Gastroenterology, involved
206 patients at the Union Hospital, Tongji Medical College, in Wuhan, the Chinese city where the virus first emerged. The patients were classed as having mild COVID-19 cases as they didn't have shortness of breath or respiratory distress, and had a relatively high blood oxygen saturation level. The patients were sent to the facility despite their mild symptoms so they could be monitored and quarantined during the peak of the Wuhan outbreak.
The group included
48 who only had digestive symptoms such as diarrhea; 69 with digestive and respiratory symptoms; and 89 with only respiratory symptoms. On average, the patients, who lived in Wuhan, were aged 62, and 55.8 percent were female.
Of the 67 who had diarrhea, 19.4 percent had it as their first symptom of COVID-19, while the others developed it in the first 10 days after respiratory symptoms. The diarrhea lasted between one to 14 days. For 52.2 percent of patients, their stools were "watery," while for the others it was loose, not watery. Abdominal pain, meanwhile, was rare.
Some 62.4 percent of patients with digestive symptoms also had a fever. 73.1 percent who had diarrhea had a concurrent fever. Of those, 20.4 percent had an upset stomach before the fever; 10.2 percent after fever, and the others at the same time. Those who also felt sick and felt nauseous were more likely to have a fever than those with only lower digestive symptoms.
Patients who had digestive symptoms were more likely to seek care later than those with respiratory problems, the team found. And the period between the start of their symptoms and their bodies being rid of the virus was also longer.
It was also more common for them to have the virus in their feces, at 73 percent compared with 14.3 percent in those with respiratory issues. The researchers tested the feces of 22 COVID-19 patients and found the RNA, or genetic material, of the new coronavirus in 12 samples.
Some COVID-19 patients may experience issues like diarrhea because the receptor that the virus binds to is expressed at almost 100-fold higher levels in the upper and lower gastrointestinal tract than the respiratory organs, the authors said."
https://www.newsweek.com/diarrhea-coronavirus-symptom-covid-19-patients-study-1495667_________________________________________
Diarrhea is first sign of illness for some COVID-19 patients
By Rachael Rettner - Senior Writer March 31, 2020
Some never develop respiratory symptoms at all.
https://www.livescience.com/coronavirus-diarrhea-symptoms.html_____________________________________________
Stool testing for coronavirus may be effective in detecting cases in children and infants, report says
COVID-19 can remain in stool samples after it has cleared an infected patient’s respiratory tract: researchers
https://www.foxnews.com/health/stool-testing-coronavirus-children-infants-study_______________________________________________
"Wondering If You Have COVID-19? Diarrhea May Be a Symptom
Early research suggests that gastrointestinal distress can be an early warning sign of a coronavirus infection.
By Leah ShafferApril 15, 2020 9:00 AM"
"In a preprint study from March 18, scientists found that nearly 20 percent of 204 COVID-19 patients from hospitals in China’s Hubei province, where the outbreak began, had gastrointestinal issues like diarrhea, in addition to fever or respiratory symptoms.
Another analysis of COVID-19 patients in Wuhan, China, shows a distinct group of people with milder respiratory symptoms who experienced diarrhea, abdominal pain or nausea, says Brennan Spiegel, a gastroenterologist and director of Cedars-Sinai Health Services Research. Spiegel co-authored the analysis — also still in the preprint stage — showing about 20 percent of a patient group had diarrhea as their first symptom of infection."
"
Testing stool might also provide a way to reduce false negatives of COVID-19 tests. In one study, the virus was detected in the stool of more than 50 percent of a particular group of COVID-19 patients.
More than 20 percent of them had positive stool tests while having negative respiratory samples."
https://www.discovermagazine.com/health/wondering-if-you-have-covid-19-diarrhea-may-be-a-symptom
