GI symptoms as a presentation of COVID-19 Patients

Pan L, et al. Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: a descriptive, cross-sectional, multicenter study. Am J Gastroenterol. 2020.


Since the outbreak of Corona Virus Disease 2019 (COVID-19) in December 2019, 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 COVID19 patients with digestive 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 RT-PCR and were analyzed for clinical characteristics, laboratory data, and treatment. Data were followed up until March 5th, 2020.


In the present study, 204 patients with COVID-19 and full laboratory, imaging, and historical data were analyzed. The average age was 54.9 years (SD +15.4), including 107 men and 97 women. We found that 99 patients (48.5%) presented to the hospital with digestive symptoms as their chief complaint. 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). Patients with digestive symptoms had a variety of manifestations, such as anorexia (83 [83.8%] cases), diarrhea (29 [29.3%] cases), vomiting (8 [0.8%] cases), and abdominal pain (4 [0.4%] cases). In 7 cases, there were digestive symptoms but no respiratory symptoms. As the severity of the disease increased, digestive symptoms became more pronounced. Patients without digestive symptoms were more likely to be cured and discharged than patients with digestive symptoms (60% vs. 34.3%). Laboratory data revealed no significant liver injury in this case series.


We found that digestive symptoms are common in patients with COVID-19. Moreover, these patients have a longer time from onset to admission and their prognosis is worse than patients without digestive symptoms. Clinicians should recognize that digestive symptoms, such as diarrhea, may be a presenting feature of COVID-19, and that the index of suspicion may need to be raised earlier in at-risk patients presenting with digestive symptoms rather than waiting for respiratory symptoms to emerge. However, further large sample studies are needed to confirm these findings.

Commentary by George Martin, MD:

Digestive symptoms are an initial chief complaint in 48.5% of patients.  Anorexia (83.8%) was the most commonly found GI symptom. Diarrhea  (29.3%) made up a significant subgroup of patients. The finding of diarrhea is consistent with the fact SARA-CoV-2 is found in the stool thus creating yet another good reason for hand washing. Uncommon findings were vomiting (<1%) abdominal pain (<0.5%). There was no significant liver injury. Patients with digestive symptoms had a worse prognosis and they were slower to be cured and discharged from the hospital.  In 7 of the 204  (~3%) of patients studied, there were GI symptoms but NO respiratory symptoms.