Clinical Characteristics of COVID-19 Patients With Gastrointestinal Symptoms in Northern Italy: A Single-Center Cohort Study

Abstract

INTRODUCTION: The most typical presentation of COVID-19 is an acute respiratory syndrome whose most common symptoms include fever, cough, and dyspnea. However, gastrointestinal symptoms, such as diarrhea and nausea/vomiting, are increasingly reported in patients affected by COVID-19. This study aimed to describe the prevalence and time of onset of gastrointestinal symptoms in patients affected by COVID-19 and to find potential associations between gastrointestinal symptoms and clinical outcomes. METHODS: We performed a prospective single-center cohort study, enrolling patients who received diagnosis of COVID-19 at our institution between March 23, 2020, and April 5, 2020. We collected patient demographics and medical history, laboratory data, and clinical outcomes. Furthermore, we used a specifically designed questionnaire, administered to patients at time of diagnosis, to obtain data on the presence and time of onset of fever, typical respiratory symptoms, gastrointestinal symptoms, and other symptoms (fatigue, headache, myalgia/arthralgia, anosmia, ageusia/dysgeusia, sore throat, and ocular symptoms). RESULTS: In our cohort, 138 (69%) of 190 patients showed at least 1 gastrointestinal symptom at diagnosis; if excluding hyporexia/anorexia, 93 patients (48.9%) showed at least 1 gastrointestinal symptom. Gastrointestinal symptoms, in particular diarrhea, were associated with a lower mortality. At multivariate analysis, diarrhea was confirmed as independent predictive factor of lower mortality. DISCUSSION: Gastrointestinal symptoms are very frequent in patients with COVID-19 and may be associated with a better prognosis. These data suggest that, in some patients, the gastrointestinal tract may be more involved than the respiratory system in severe acute respiratory syndrome coronavirus 2 infection, and this could account for the less severe course of disease.

Epidemiological and Clinical Characteristics of COVID-19: A Retrospective Multi-Center Study in Pakistan

“…Fever, cough, fatigue, dyspnea, and gastrointestinal discomfort were among the most frequently reported signs and symptoms by the patients (58). The clinical symptoms of 100 patients admitted to a hospital in Karachi included dry cough, fever, lethargy, fatigue, dyspnea, myalgia, vomiting, nausea, and diarrhea (59).…”

Gut Microbiota Dysbiosis and COVID-19: Possible Links

“…The most common clinical symptoms of COVID-19 patients were reported as fever, cough, dyspnea, sore throat, fatigue, and headache. However, as the pandemic data accumulating day by day around the world, gastrointestinal manifestations emerged as important clinical symptoms ( Guo et al., 2021 ; Schettino et al., 2021 ; Schmulson et al., 2021 ). Most studies described diarrhea, vomiting, abdominal pain, and nausea as the common gastrointestinal symptoms ( Guo et al., 2021 ).…”

Pathogenesis and Mechanism of Gastrointestinal Infection With COVID-19

“…This may be due to the low level of inflammation in the lamina propria cells of the gastrointestinal tract, the downregulation of inflammatory genes, and the reduction of major inflammatory proteins in the gastrointestinal tract, which weakened the inflammatory response caused by SARS-CoV-2 ( 140 ). Diarrhea was also an independent factor predicting lower mortality ( 141 ). On the other hand, some studies pointed out that the current results were not enough to prove that there was a significant correlation between the gastrointestinal symptoms of patients with the new coronavirus and the severity of the disease ( 142 ).…”