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COVID-19 and the gastrointestinal tract: emerging clinical 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 SO16 6YD, UK; Mark.beattie{at}uhs.nhs.uk

https://doi.org/10.1136/flgastro-2020-101507

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    Introduction

    The landscape of COVID-19 is rapidly changing, with new data emerging at an unprecedented rate. Making sense of these data, and interpreting what is important and high quality information is challenging. Within this article we have summarised key data published to date concerning COVID-19 and the gastrointestinal tract. We recognise the constantly changing literature and aim to update future publications with the most contemporary data.

    Clinical characteristics of COVID-19 in China

    How common are gastrointestinal symptoms? In a large series—1099 patients out of 7736 admissions—reported in the New England Journal of Medicine,1 symptoms at presentation were predominantly respiratory: cough (67.8%). Median age was 47 years, 60% were male. Fever was present on admission in 43.8% and during the hospital stay in 88.7%. Gastrointestinal symptoms were significantly less common, including nausea and vomiting (5%) and diarrhoea (3.8%). Mortality was low in this cohort. https://www.nejm.org/doi/full/10.1056/NEJMoa2002032

    Clinical characteristics of 138 hospitalised patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China

    Correctly attributing symptoms to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is crucial in order to make the correct diagnosis and not miss an alternative problem, such as a surgical abdomen. This retrospective, consecutive case series from Wuhan, China, highlighted the disease features of 138 patients presenting with SARS-CoV-2 pneumonia.2 Interestingly, 14 patients (10.1% of the cohort) presented initially with diarrhoea and nausea, preceding the development of fever and respiratory symptoms by 1–2 days. A single patient was triaged to surgery on admission due to abdominal pain but was later found to have SARS-CoV-2, with no surgical diagnosis. In those with severe disease requiring intensive care unit (ICU) admission, abdominal pain was more common (8.3% of ICU patients vs 0% non-ICU patients, p=0.02). Hospital-acquired SARS-CoV-2 infection was common, occurring in an estimated 41.3% of patients. The data suggest it is important to consider unusual presentations of COVID-19 to all specialties, with widespread testing being the best route to an early …

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    Footnotes

    • Twitter @RMBeattie50, @James__Ashton, @GastroRIE

    • Funding JJA is funded by an Action Medical Research training fellowship and by a personal ESPEN fellowship.

    • Competing interests MB 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 paper in a personal capacity.

    • Patient consent for publication Not required.

    • Provenance and peer review Commissioned; internally peer reviewed.