Background: Multiple gastrointestinal (GI) symptoms including diarrhea, nausea/vomiting, and abdominal pain, as well liver enzyme abnormalities have been variably reported in patients with COVID-19. The AGA) Institute Clinical Guideline Committee and Clinical Practice Updates Committee performed a systematic review and meta-analysis of international data on GI and liver manifestations of COVID-19.
Methods: We performed a systematic literature search to identify published and unpublished studies using OVID Medline and pre-print servers (medRxiv, LitCovid, and SSRN) up until April 5 2020; major journal sites were monitored for US publications until April 19 2020. We analyzed the prevalence of diarrhea, nausea, vomiting, and abdominal pain as well as LFT abnormalities using a fixed effect model and assessed the certainty of evidence using GRADE.
Results: We identified 118 studies and used a hierarchal study selection process to identify unique cohorts. We performed a meta-analysis of 47 studies including 10,890 unique patients. Pooled prevalence estimates of GI symptoms was diarrhea 7.7% (95% CI 7.2-8.2), nausea/vomiting 7.8% (95% CI 7.1-8.5), abdominal pain 2.7% (95% CI 2.0-3.4). Most studies reported on hospitalized patients. The pooled prevalence of elevated liver abnormalities was: AST 15.0% (13.6 to 16.5) and ALT 15.0% (13.6 to 16.4). When analyzed comparing data from China to studies from countries other than China, diarrhea, nausea/vomiting, liver abnormalities were more prevalent outside of China with diarrhea reported in 18.3% (16.6 to 20.1). Isolated GI symptoms were rarely reported. We also summarized of the Gl and liver adverse effects of the most commonly utilized medications for COVID19 CONCLUSIONS: GI symptoms are associated with COVID-19 in less than 10% of patients. In studies outside of China, estimates are higher. Further studies are needed with standardized GI symptoms questionnaires and LFT checks on admission to better quantify and qualify the association of these symptoms with COVID-19. Based on findings from our meta-anlaysis, we make several Best Practice Statements for the consultative management of COVID-19.
Keywords: COVID-19; gastrointestinal and liver manifestations.
Copyright © 2020 AGA Institute. Published by Elsevier Inc. All rights reserved.
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