COVID-19 and gastrointestinal injury: a brief systematic review and data from Bulgaria

Infez Med. 2020 Jun 1;28(suppl 1):37-41.


In December 2019, a new Coronavirus (SARS-CoV-2) emerged in China, causing the pandemic disease COVID-19. The clinical presentation is variable, but the predominant symptoms are those of the upper respiratory tract.

Aim: The aim of the current study is to describe the incidence and type of the gastrointestinal injury (GI) in COVID-19, as well as their prognostic value.

Materials and methods: We conducted a coincidental search on this topic in PubMed, Web of Science and EMBASE. We also followed a group of 31 Bulgarian COVID-19 patients throughout the course of their disease and analyzed their symptoms (catarrhal and other) and outcome.

Results: The publications concerning our survey followed a total of 1509 COVID-19 patients. In the Bulgarian cohort, only 14 from the 31 patients were laboratory-confirmed COVID-19 cases. Approximately 1/3 of the infected individuals presented with GI. In some patients this was the first, or only, symptom of the disease. It was also indicative of a more severe disease course.

Conclusion: GI may be an important symptom and prognostic factor in COVID-19. Therefore, patients with acute gastrointestinal symptoms must be actively tested for SARS-CoV-2.

Publication types

  • Systematic Review

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Bulgaria / epidemiology
  • Child
  • Child, Preschool
  • Clinical Laboratory Techniques
  • Common Cold / etiology
  • Coronavirus Infections / complications*
  • Coronavirus Infections / diagnosis
  • Coronavirus Infections / epidemiology
  • Diarrhea / epidemiology
  • Diarrhea / etiology*
  • Female
  • Fever / etiology
  • Gastrointestinal Hemorrhage / epidemiology
  • Gastrointestinal Hemorrhage / etiology
  • Hepatitis, Viral, Human / epidemiology
  • Hepatitis, Viral, Human / etiology
  • Humans
  • Incidence
  • Infant
  • Infant, Newborn
  • Male
  • Middle Aged
  • Nausea / epidemiology
  • Nausea / etiology*
  • Pandemics
  • Pneumonia, Viral / complications*
  • Pneumonia, Viral / diagnosis
  • Pneumonia, Viral / epidemiology
  • Symptom Assessment
  • Vomiting / epidemiology
  • Vomiting / etiology*
  • Young Adult

Supplementary concepts

  • COVID-19
  • COVID-19 diagnostic testing