The Spectrum of Gastrointestinal Symptoms in Patients With Coronavirus Disease-19: Predictors, Relationship With Disease Severity, and Outcome

Abstract

INTRODUCTION: We prospectively studied the frequency, spectrum, and predictors of gastrointestinal (GI) symptoms among patients with coronavirus disease-19 (COVID-19) and the relationship between GI symptoms and the severity and outcome. METHODS: Consecutive patients with COVID-19, diagnosed in a university hospital referral laboratory in northern India, were evaluated for clinical manifestations including GI symptoms, their predictors, and the relationship between the presence of these symptoms, disease severity, and outcome on univariate and multivariate analyses. RESULTS: Of 16,317 subjects tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in their oropharyngeal and nasopharyngeal swabs during April–May 2020, 252 (1.5%) were positive. Of them, 208 (82.5%) were asymptomatic; of the 44 symptomatic patients, 18 (40.9%) had non-GI symptoms, 15 (34.1%) had a combination of GI and non-GI symptoms, and 11 (25.0%) had GI symptoms only. Thirty-three had mild-to-moderate disease, 8 severe, and 5 critical. Five patients (1.98%) died. On multivariate analysis, the factors associated with the presence of GI symptoms included the absence of contact history and presence of non-GI symptoms and comorbid illnesses. Patients with GI synptoms more often had severe, critical illness and fatal outcome than those without GI symptoms. DISCUSSION: Eighty-two percent of patients with COVID-19 were asymptomatic, and 10.3% had GI symptoms; severe and fatal disease occurred only in 5% and 2%, respectively. The presence of GI symptoms was associated with a severe illness and fatal outcome on multivariate analysis. Independent predictors of GI symptoms included the absence of contact history, presence of non-GI symptoms, and comorbid illnesses. JOURNAL/cltg/04.03/01720094-202012000-00003/inline-graphic1/v/2023-10-25T013615Z/r/image-tiff

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“…al., 252 SARS-CoV-2 positive patients, 208 of whom were asymptomatic, were assessed for gastrointestinal symptoms and other factors like co-morbidities, inflammatory bowel diseases, and age. 36 25% of symptomatic individuals had gastrointestinal distress and a higher rate of co-morbidities, while those who developed no symptoms had a far lower rate. As of yet there are no published studies examining the gut microbiota between asymptomatic and symptomatic individuals, but a currently recruiting clinical trial in Germany is underway to examine the oral microbiome of approximately 500 asymptomatic subjects (NCT04345510).”…”

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“…In comparison, 252 (1.5%) of the 16,317 non-IBD controls were positive for SARS-CoV-2 RNA based on their naso-oropharyngeal samples (P = NS). 20 Most of them reported being healthy (32; 0.196% reported having comorbidity).…”

Severe Acute Respiratory Syndrome Coronavirus-2 genome sequence variations relate to morbidity and mortality in Coronavirus Disease-19

“…Apart from SARS-CoV-2 genome variations, host and host-agent interactions may impact the outcome of SARS-CoV-2 infection. The host factors may include, patients' age, the degree of immune response to the virus due to difference in degree of T regulatory response (hygiene hypothesis), presence of co-morbid illness, Bacillus Calmette-Guerin (BCG) vaccination, and variation in the gut microbiota [4][5][6][7] . In a well-designed lone GWAS study on host genetics, genetic susceptibility loci in COVID-19 patients with rs11385942 at locus 3p21.31 and rs657152 at locus 9q34.2 were found significant at the genome-wide level of significance (P<5×10−8).…”

“…Of particular note are metabolic syndrome, cardiac diseases and respiratory pre-disposition, which adversely affect the eventual outcome in these patients 29,30 . Another important factor that has been suggested to affect COVID-19 disease severity is the gut microbiome 5 . Interestingly, a gut-lung axis has been suggested to influence the lung's susceptibility to viral infections 31 .…”

“…Whereas the "A" (the ancestral type such as the bat coronavirus) and "C" are prevalent in the United States of America and Europe, the "B" subtype has been shown to be prevalent in East Asia 2,3 Earlier, we proposed the following factors that might predict the severity and outcome of SARS-CoV-2 infection; (A) host factors 4,5 : (i) age of the patients, (ii) presence of co-morbid illness, (iii) variation in the host's immune response to the virus due to difference in degree of T regulatory response (hygiene hypothesis), (iv) Bacillus Calmette-Guerin (BCG) vaccination, (v) variation in the gut microbiota 6,7 ; (B) agent (viral) factors: (i) viral load, and (ii) viral genome sequences. In our earlier study, we found that there was no difference in viral load among patients with and without gastrointestinal (GI) symptoms, the presence of which was independently associated with severe COVID-19 5 . Some studies focusing on the viral genome variations have reported that the variability in the symptoms could be linked to a few variations in the viral genome 8,9 .…”