March 20, 2020
Evidence suggests that as many as half of COVID-19 patients experience a range of digestive symptoms related to the disease, according to new research out of China's hard-hit Hubei province.
Most accounts of the symptoms of caused by coronavirus infection, particularly advanced cases, focus on respiratory issues that can become life-threatening. The primary early symptoms are fever and a dry cough.
An analysis of 204 COVID-19 patients in Hubei province, whose capital city of Wuhan became the world's first coronavirus epicenter, found that diarrhea and other digestive symptoms were the main complaint in nearly half of patients, according to the study published in the American Journal of Gastroenterology.
The data, reviewed by the Wuhan Medical Treatment Expert Group, noted loss of appetite in 84% of patients, diarrhea in 29% of patients, vomiting in .8% of patients and abdominal pain in .4% of patients.
"Clinicians must bear in mind 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 these cases rather than waiting for respiratory symptoms to emerge," the group's reported stated.
The average age of the patients included in the analysis was 55 years old. All patients in the study were admitted to three hospitals in the Hubei province between Jan. 18 and Feb. 28.
Notably, the study found that those with digestive symptoms had a longer time from symptom onset to hospital admission than those without these symptoms. It took them an average of nine days to be admitted compared to 7.3 days for those with evident respiratory symptoms. It's believed that these patients sought care later than others because they were not yet exhibiting the more commonly described respiratory symptoms of COVID-19.
The study also found that digestive symptoms increased in severity as these cases worsened overall. Those without digestive systems (60%) were more likely to be cured and discharged from hospitals than those with them (34%), according to the study.
"In this study, COVID-19 patients with digestive symptoms have a worse clinical outcome and higher risk of mortality compared to those without digestive symptoms, emphasizing the importance of including symptoms like diarrhea to suspect COVID-19 early in the disease course before respiratory symptoms develop," said Brennan M.R. Spiegel, co-editor-in-chief of The American Journal of Gastroenterology. "This may lead to earlier diagnosis of COVID-19, which can lead to earlier treatment and more expeditious quarantine to minimize transmission from people who otherwise remain undiagnosed."
The presence of digestive symptoms such as diarrhea and reduced appetite do not necessarily indicate COVID-19 infection. The study aims to put these symptoms on the radar of clinicians who are examining people for symptoms of the illness.
Wuhan for the first time on Wednesday reported no new cases of the coronavirus following the aggressive measures taken by the Chinese government. The city of 11 million has been in lockdown since Jan. 24.
In the United States, overwhelmed health systems and a shortage of tests have led to recommendations that only patients who have symptoms consistent with COVID-19 seek testing.
"If clinicians solely monitor for respiratory symptoms to establish case definitions for COVID-19, they may miss cases initially presenting with extra-pulmonary symptoms, or the disease may not be diagnosed later until respiratory symptoms emerge," Spiegel said.