Beware: Gastrointestinal symptoms can be a manifestation of COVID-19

Abstract

Background: There is an increasing number of reports on the presentation of gastrointestinal symptoms in cases of COVID-19.

Aim: To review the studies reporting gastrointestinal symptoms in COVID-19.

Results: Fifteen articles (2,800 patients) were identified. Gastrointestinal symptom frequency varied from 3.0% to 39.6% and included diarrhea (7.5%), náusea (4.5%), anorexia (4.4%), vomiting (1.3%), abdominal pain (0.5%), and belching/reflux (0.3%). Those symptoms can be the first manifestation of COVID-19, but whether they reflect a better or worse prognosis, is controversial. The potential relation of the angiotensin converting enzyme 2 receptor in the digestive tract as an entry route for the virus is discussed.

Conclusion: Gastrointestinal symptoms may be common in COVID-19, in some cases appearing as the first manifestation, even before fever and respiratory symptoms. Therefore, clinicians and gastroenterologists must be aware of those atypical cases during the current pandemic, as well as of the fecal-oral route and corresponding preventive measures.

Keywords: COVID-19; Diarrea; Diarrhea; Fecal-oral transmission; Gastrointestinal symptoms; Prognosis; Pronóstico; Síntomas gastrointestinales; Transmisión fecal-oral.