Gastrointestinal symptoms as Covid-19 onset in hospitalized Italian patients

Buscarini, Elisabetta; Manfredi, Guido; Brambilla, Gianfranco; Menozzi, Fernanda; Londoni, C.; Alicante, Saverio; Iiritano, E.; Romeo, S.; Pedaci, Marianna; Benelli, Gianpaolo; Canetta, Ciro; Lapiana, Giuseppe; Merli, Guido; Scartabellati, Alessandro; Viganò, Giovanni; Sfogliarini, Roberto; Melilli, G. A.; Assandri, Roberto; Cazzato, Daniele; Rossi, Davide Sebastiano; Usai, Susanna; Tramacere, Irene; Pellegata, Germano; Lauria, Giuseppe

doi:10.1101/2020.04.20.20064873

Cited by 5 publications

(4 citation statements)

References 10 publications

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“…The incidence of nausea and/or vomiting and diarrhea from 41 clinical studies 1,2,4,5,16,22–57 : nausea, n = 34; vomiting, n = 39; diarrhea, n = 39. Values for individual studies are shown together with the median and 95% confidence intervals.…”

Section: How Good Is the Epidemiological Data On The Incidence Of Naumentioning

confidence: 99%

COVID‐19, nausea, and vomiting

Andrews

Cai

Rudd

et al. 2020

J of Gastro and Hepatol

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Exclusion of nausea (N) and vomiting (V) from detailed consideration as symptoms of COVID‐19 is surprising as N can be an early presenting symptom. We examined the incidence of NV during infection before defining potential mechanisms. We estimate that the overall incidence of nausea (median 10.5%), although variable, is comparable with diarrhea. Poor definition of N, confusion with appetite loss, and reporting of N and/or V as a single entity may contribute to reporting variability and likely underestimation. We propose that emetic mechanisms are activated by mediators released from the intestinal epithelium by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) modulate vagal afferents projecting to the brainstem and after entry into the blood, activate the area postrema (AP) also implicated in anorexia. The receptor for spike protein of SARS‐CoV‐2, angiotensin 2 converting enzyme (ACE2), and transmembrane protease serine (for viral entry) is expressed in upper gastrointestinal (GI) enterocytes, ACE2 is expressed on enteroendocrine cells (EECs), and SARS‐CoV‐2 infects enterocytes but not EECs (studies needed with native EECs). The resultant virus‐induced release of epithelial mediators due to exocytosis, inflammation, and apoptosis provides the peripheral and central emetic drives. Additionally, data from SARS‐CoV‐2 show an increase in plasma angiotensin II (consequent on SARS‐CoV‐2/ACE2 interaction), a centrally (AP) acting emetic, providing a further potential mechanism in COVID‐19. Viral invasion of the dorsal brainstem is also a possibility but more likely in delayed onset symptoms. Overall, greater attention must be given to nausea as an early symptom of COVID‐19 and for the insights provided into the GI effects of SARS‐CoV‐2.

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Section: How Good Is the Epidemiological Data On The Incidence Of Naumentioning

confidence: 99%

COVID‐19, nausea, and vomiting

Andrews

Cai

Rudd

et al. 2020

J of Gastro and Hepatol

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“…In an Italian study, mean age of the GI symptoms patients was 68.2 ± 14.2 years with 64% male and 35% female. 11 In this study most common GI symptom was anorexia (69%) followed by ageusia (38%), diarrhea (35%), nausea (31%), vomiting (16%) and abdominal pain (14%). A study done in Bangladesh showed that the common GI symptoms were anorexia (44.7%), diarrhea (35%) and nausea.…”

Section: Resultsmentioning

confidence: 53%

“…12 Another study revealed that among GI symptoms, most common are nausea (4.3%), vomiting (3.8%), diarrhea (3.6%) and abdominal pain (1.2%). 11 Three-fifths of patients with GI symptoms in recent study had co-morbidities and most common co-morbidity was hypertension followed by diabetes. Comorbidities were more (69%) among patients with GI symptoms.…”

Section: Resultsmentioning

confidence: 98%

Gastrointestinal symptoms among patients with COVID-19 and their relation with co-morbidities

et al. 2023

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Background: Initially, coronavirus disease 2019 (COVID-19) was considered as respiratory disease; later on, it was seen that a large number of patients develop gastro-intestinal (GI) symptoms. Many patients with COVID-19 have underlying co-morbidities. This study was conducted to evaluate the frequency of GI symptoms in COVID-19 patients and to find out its relation with co-morbidities. Methods: This cross-sectional study was done among consecutive COVID-19 positive patients admitted in Mugda Medical College Hospital, Dhaka, Bangladesh from July to September 2020. Information regarding patients’ symptoms and co-morbidities were collected in predesigned structured questionnaire. Results: Among 166 COVID-19 patients, 69% had GI symptoms. Common GI symptoms were anorexia (69%), ageusia (38%), diarrhea (35%) and nausea (31%). Sixty percent patients with GI symptoms had comorbidities; common comorbidities were hypertension (55%) and diabetes mellitus (47%). Comorbidities were more common among patients with GI symptoms (69%) than those without GI symptoms (31%) (p 0.001). Conclusion: This study reflects that over two-thirds of COVID-19 patients developed GI symptoms. More than half of the patients with GI symptoms had co-morbidities. Co-morbidities were common among patients with GI symptoms than non-GI symptoms. BIRDEM Med J 2023; 13(1): 12-15

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“…which represent about 20% of those infected, with around 5% mortality in this group (10). Cases with anosmia, hyposmia, and ageusia (11); gastrointestinal conditions with diarrhea (12); and painful abdominal lymphadenopathy (13) have also been identified. The diagnosis is made using clinical symptoms, nasal swab reverse transcriptase-polymerase chain reaction (RT-PCR) for SARS-CoV-2 (gold standard for diagnosis in the acute phase), IgG and IgM serology (later stage), and chest computed tomography (especially in patients with respiratory symptoms).…”

mentioning

confidence: 99%

Recommendations for head and neck surgical procedures during the COVID-19 pandemic

Kulcsar

Montenegro

Santos

et al. 2020

Clinics

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The coronavirus disease (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread exponentially worldwide. In Brazil, the number of infected people diagnosed has been increasing and, as in other countries, it has been associated with a high risk of contamination in healthcare teams. For healthcare professionals, the full use of personal protective equipment (PPE) is mandatory, such as wearing surgical or filtering facepiece class 2 (FFP2) masks, waterproof aprons, gloves, and goggles, in addition to training in care processes. A reduction in the number of face-to-face visits and non-essential elective procedures is also recommended. However, surgery should not be postponed in the case of the most essential elective indications (mostly associated with head and neck cancers). As malignant tumors of the head and neck are clinically time sensitive, neither consultations for these tumors nor their treatment should be postponed. Postponing surgical treatment can result in a change in the disease stage and alter an individual's chance of survival. In this situation, planning of all treatments must begin with the request for, in addition to routine examinations, a nasal swab polymerase chain reaction for SARS-CoV-2 and chest computed tomography. Only if the results of these tests are positive or if fever or other symptoms suggestive of COVID-19 are present should the surgical procedure be postponed until the patient completely recovers. This is mandatory not only because of the risk of contamination of the surgical team but also because of the increased risk of postoperative complications and high risk of death. During this pandemic, the most effective safety measures are social distancing for the general public and the adequate availability and use of PPE in the healthcare field. The treatment of other chronic diseases, such as cancer, should be continued, as the damming of cases of these diseases will have a deleterious effect on the public healthcare system.

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Gastrointestinal symptoms as Covid-19 onset in hospitalized Italian patients

Cited by 5 publications

References 10 publications

COVID‐19, nausea, and vomiting

COVID‐19, nausea, and vomiting

Gastrointestinal symptoms among patients with COVID-19 and their relation with co-morbidities

Recommendations for head and neck surgical procedures during the COVID-19 pandemic

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