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COVID-19 and the gastrointestinal tract: recent data
  1. R Mark Beattie1,
  2. James J Ashton1,2,
  3. Ian D Penman3
  1. 1 Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
  2. 2 Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
  3. 3 Centre for Liver & Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK
  1. Correspondence to Professor R Mark Beattie, Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK; Mark.beattie{at}

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The COVID-19 pandemic continues to have a tremendous impact on health and care provision internationally. There is a sustained increase in cases worldwide, accompanied by high morbidity and mortality. The gastrointestinal impact of the virus remains of great interest, both through direct manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the gastrointestinal system, and through the impact on patients with chronic gastrointestinal disorders, and how we care for them. Data to support public health and clinical guidance are evolving rapidly with the need to revise and update the guidance as evidence accumulates and larger data sets emerge.

We have previously reviewed the early publications.1 This article includes additional data published over the subsequent months which we feel has impacted on the evolving guidance. It raises issues that must be considered as we move forward and battle with this challenging virus, to reduce the longer-term impact both on our patients and also on ourselves and the wider population.

Gastrointestinal symptoms and COVID-19: case–control study from the USA

Gastrointestinal symptoms are common in COVID-19 and can be present prior to the onset or in the absence of respiratory symptoms. There are some data to suggest that their presence reflects more severe disease.2 In a case–control study, Nobel et al compared the prevalence of gut symptoms in patients referred for COVID-19 testing (standard criteria respiratory symptoms with the intent to hospitalise/respiratory symptoms in essential personnel) who tested positive (n=278) with those who tested negative (n=238).3 Patients who had gastrointestinal symptoms (diarrhoea or nausea/vomiting) were more likely to test positive (61% vs 39%, p=0.04). Patients without gastrointestinal symptoms were equally likely to test positive or negative. Following regression analysis, the OR of testing positive with gastrointestinal symptoms was 1.7 (95% CI 1.1–2.5). Patients with gastrointestinal symptoms had a longer illness duration (>1 week: 33% vs 22%, p=0.048). There …

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  • Twitter @James__Ashton, @GastronautIan

  • Funding JA is funded by an Action Medical Research Training fellowship and by an ESPEN personal fellowship.

  • Competing interests RMB is Editor-in-Chief of Frontline Gastroenterology. IDP is an Associate Editor of Frontline Gastroenterology and Vice President, Endoscopy of British Society of Gastroenterology. They have coauthored this article in a personal capacity.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Author note Twitter-

    RMB- @RMBeattie50

    JJA- @James__Ashton

    IDP- @GastronautIan