Gastrointestinal and hepatic manifestations of COVID‐19: A systematic review and meta‐analysis

• Published in: JGH Open 2021-01, Vol.5 (1), p.107-115
• Main Authors: Dorrell, Robert D, Dougherty, Michael K, Barash, Eric L, Lichtig, Asher E, Clayton, Steven B, Jensen, Elizabeth T
• Format: Article
• Language: English
• Subjects: Abdomen; Anorexia; Bias; Coronaviruses; COVID-19; Diarrhea; Fever; gastrointestinal; Medical personnel; Meta-analysis; Nausea; Original; Pain; SARS‐CoV‐2; Severe acute respiratory syndrome coronavirus 2; Systematic review; Vomiting
• ISSN: 2397-9070; 2397-9070
• DOI: 10.1002/jgh3.12456

Background and Aim This review investigates the role of gastrointestinal and hepatic manifestations in COVID‐19, particularly with regard to the prevalence of isolated gastrointestinal (GI) symptoms. Methods We searched PubMed, Embase, and Cochrane library for COVID‐19 publications from 1 December 2019 to 18 May 2020. We included any study that reported the presence of GI symptoms in a sample of >5 COVID‐19 patients. Data collection and risk of bias assessment were performed independently by two reviewers. Where ≥3 studies reported data sufficiently similar to allow calculation of a pooled prevalence, we performed random effects meta‐analysis. Results This review included 17 776 COVID‐19 patients from 108 studies. Isolated GI symptoms only occurred in 1% (95% confidence interval [CI] 0–6%) of patients. GI symptoms were reported in 20% (95% CI 15–24%) of patients. The most common were anorexia (21%, 95% CI 15–27%), diarrhea (13%, 95% CI 11–16%), nausea or vomiting (8%, 95% CI 6–11%), and abdominal pain (4%, 95% CI 2–6%). Transaminase elevations were present in 24% (95% CI 17–31%) of patients. Higher prevalence of GI symptoms were reported in studies published after 1st April, with prevalence of diarrhea 16% (95% CI 13–20), nausea or vomiting 12% (95% CI 8–16%), and any GI symptoms 24% (95% CI 18–34%). GI symptoms were associated with severe COVID‐19 disease (odds ratio [OR] 2.1, 95% CI 1.3–3.2), but not mortality (OR 0.90, 95% CI 0.52–1.54). Conclusions Patients with isolated GI symptoms may represent a small but significant portion of COVID‐19 cases. When testing resources are abundant, clinicians should still consider testing patients with isolated GI symptoms or unexplained transaminase elevations for COVID‐19. More recent studies estimate higher overall GI involvement in COVID‐19 than was previously recognized. This review is a systematic review and meta‐analysis to characterize the prevalence of gastrointestinal (GI) and hepatic involvement in COVID‐19 and specifically assess the prevalence of GI symptoms in isolation. This review included 17 776 COVID‐19 patients from 108 studies. Isolated GI symptoms occurred in 1% (95% confidence interval 0–6%) of patients.