Digestive Manifestations in Patients Hospitalized With Coronavirus Disease 2019
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Abstract
Background & aims The prevalence and significance of digestive manifestations in coronavirus disease 2019 (COVID-19) remain uncertain. We aimed to assess the prevalence, spectrum, severity, and significance of digestive manifestations in patients hospitalized with COVID-19.Methods Consecutive patients hospitalized with COVID-19 were identified across a geographically diverse alliance of medical centers in North America. Data pertaining to baseline characteristics, symptomatology, laboratory assessment, imaging, and endoscopic findings from the time of symptom onset until discharge or death were abstracted manually from electronic health records to characterize the prevalence, spectrum, and severity of digestive manifestations. Regression analyses were performed to evaluate the association between digestive manifestations and severe outcomes related to COVID-19.Results A total of 1992 patients across 36 centers met eligibility criteria and were included. Overall, 53% of patients experienced at least 1 gastrointestinal symptom at any time during their illness, most commonly diarrhea (34%), nausea (27%), vomiting (16%), and abdominal pain (11%). In 74% of cases, gastrointestinal symptoms were judged to be mild. In total, 35% of patients developed an abnormal alanine aminotransferase or total bilirubin level; these were increased to less than 5 times the upper limit of normal in 77% of cases. After adjusting for potential confounders, the presence of gastrointestinal symptoms at any time (odds ratio, 0.93; 95% CI, 0.76-1.15) or liver test abnormalities on admission (odds ratio, 1.31; 95% CI, 0.80-2.12) were not associated independently with mechanical ventilation or death.Conclusions Among patients hospitalized with COVID-19, gastrointestinal symptoms and liver test abnormalities were common, but the majority were mild and their presence was not associated with a more severe clinical course.
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In an extensive study on 1992 hospitalized patients for COVID-19 pneumonia from 36 centers, Elmunzer et al. found that the most frequent clinical signs reported were mild and self-limited in up to 74% of cases, consisting of diarrhea (34%), nausea (27%), vomiting (16%), and abdominal pain (11%).
“In an extensive study on 1992 hospitalized patients for COVID-19 pneumonia from 36 centers, Elmunzer et al. [7] found that the most frequent clinical signs reported were mild and self-limited in up to 74% of cases, consisting of diarrhea (34%), nausea (27%), vomiting (16%), and abdominal pain (11%).”
From Acute mesenteric ischemia in COVID-19 patients (2021) · cites this paper as [7]
Gastrointestinal features in COVID-19 disease are relatively frequently reported, varying from less than 10% in early studies from China to 30-60% in other reports.
“Gastrointestinal features in COVID-19 disease are relatively frequently reported, varying from less than 10% in early studies from China [7,8] to 30–60%, in other reports [9,10].”
From Acute mesenteric ischemia in COVID-19 patients (2021) · cites this paper as [7]
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COVID-19-induced liver injury in adult patients: A brief overview
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Impact of delayed transit in severe COVID 19 critical care patients: A retrospective analysis
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Smoking and COVID Living Review (v11): a bayesian analysisPreprint
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Post-infection gastrointestinal disorders and treatment options
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Features of Liver Injury in COVID-19 Pathophysiological, Biological and Clinical Particularities
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- Authors
- Elmunzer, B. J., Spitzer, R. L., Foster, L. D., Merchant, A. A., Howard, E. F., Patel, V. A., West, M. K., Qayed, E., Nustas, R., Zakaria, A., Piper, M. S., Taylor, J. R., Jaza, L., Forbes, N., Chau, M., Lara, L. F., Papachristou, G. I., Volk, M. L., Hilson, L. G., Zhou, S., Kushnir, V. M., Lenyo, A. M., McLeod, C. G., Amin, S., Kuftinec, G. N., Yadav, D., Fox, C., Kolb, J. M., Pawa, S., Pawa, R., Canakis, A., Huang, C., Jamil, L. H., Aneese, A. M., Glamour, B. K., Smith, Z. L., Hanley, K. A., Wood, J., Patel, H. K., Shah, J. N., Agarunov, E., Sethi, A., Fogel, E. L., McNulty, G., Haseeb, A., Trieu, J. A., Dixon, R. E., Yang, J. Y., Mendelsohn, R. B., Calo, D., Aroniadis, O. C., LaComb, J. F., Scheiman, J. M., Sauer, B. G., Dang, D. T., Piraka, C. R., Shah, E. D., Pohl, H., Tierney, W. M., Mitchell, S., Condon, A., Lenhart, A., Dua, K. S., Kanagala, V. S., Kamal, A., Singh, V. K., Pinto-Sanchez, M. I., Hutchinson, J. M., Kwon, R. S., Korsnes, S. J., Singh, H., Solati, Z., Willingham, F. F., Yachimski, P. S., Conwell, D. L., Mosier, E., Azab, M., Patel, A., Buxbaum, J., Wani, S., Chak, A., Hosmer, A. E., Keswani, R. N., DiMaio, C. J., Bronze, M. S., Muthusamy, R., Canto, M. I., Gjeorgjievski, V. M., Imam, Z., Odish, F., Edhi, A. I., Orosey, M., Tiwari, A., Patwardhan, S., Brown, N. G., Patel, A. A., Ordiah, C. O., Sloan, I. P., Cruz, L., Koza, C. L., Okafor, U., Hollander, T., Furey, N., Reykhart, O., Zbib, N. H., Damianos, J. A., Esteban, J., Hajidiacos, N., Saul, M., Mays, M., Anderson, G., Wood, K., Mathews, L., Diakova, G., Caisse, M., Wakefield, L., Nitchie, H., Waljee, A. K., Tang, W., Zhang, Y., Zhu, J., Deshpande, A. R., Rockey, D. C., Alford, T. B., & Durkalski, V.
- Affiliations
- Medical University of South Carolina (US)
- Emory University (US)
- Vanderbilt University Medical Center (US)
- Grady Memorial Hospital (US)
- Ascension Providence Hospital (US)
- Saint Louis University (US)
- University of Calgary (CA)
- The Ohio State University Wexner Medical Center (US)
- Loma Linda University (US)
- University of Southern California (US)
- Washington University in St. Louis (US)
- University of Miami (US)
- University of Pittsburgh Medical Center (US)
- University of Colorado Anschutz (US)
- Wake Forest University Health Sciences (US)
- Boston University (US)
- Oakland University (US)
- Beaumont Health (US)
- University Hospitals of Cleveland (US)
- Northwestern University (US)
- Ochsner Health System (US)
- Columbia University Irving Medical Center (US)
- Indiana University Indianapolis (US)
- Loyola University Medical Center (US)
- Icahn School of Medicine at Mount Sinai (US)
- Memorial Sloan Kettering Cancer Center (US)
- Stony Brook University (US)
- University of Virginia Medical Center (US)
- Henry Ford Health (US)
- Dartmouth–Hitchcock Medical Center (US)
- University of Oklahoma Health Sciences Center (US)
- University of California, Los Angeles (US)
- Medical College of Wisconsin (US)
- Johns Hopkins University (US)
- Hamilton Health Sciences (CA)
- University of Michigan (US)
- University of Manitoba (CA)
- Corresponding author
- Elmunzer, B. Joseph
- ORCID
- Foster, Lydia D.
- Merchant, Ambreen A.
- Patel, Vaishali A.
- Qayed, Emad
- Zakaria, Ali
- Piper, Marc S.
- Forbes, Nauzer
- Lara, Luis F.
- Papachristou, Georgios I.
- Volk, Michael L.
- Zhou, Selena
- Kushnir, Vladimir M.
- Lenyo, Alexandria M.
- Amin, Sunil
- Yadav, Dhiraj
- Kolb, Jennifer M.
- Pawa, Swati
- Pawa, Rishi
- Canakis, Andrew
- Huang, Christopher
- Jamil, Laith H.
- Aneese, Andrew M.
- Smith, Zachary L.
- Patel, Harsh K.
- Shah, Janak N.
- Sethi, Amrita
- Fogel, Evan L.
- McNulty, Gail
- Haseeb, Abdul
- Trieu, Judy A.
- Dixon, Rebekah E.
- Yang, Jeong Yun
- Mendelsohn, Robin B.
- Aroniadis, Olga C.
- LaComb, Joseph F.
- Sauer, Bryan G.
- Piraka, Cyrus R.
- Shah, Eric D.
- Pohl, Heiko
- Lenhart, Adrienne
- Dua, Kulwinder S.
- Kamal, Ayesha
- Singh, Vikesh K.
- Hutchinson, Joy M.
- Kwon, Richard S.
- Korsnes, Sheryl J.
- Singh, Harminder
- Willingham, Field F.
- Yachimski, Patrick S.
- Conwell, Darwin L.
- Buxbaum, James
- Wani, Sachin
- Chak, Amitabh
- Hosmer, Amy E.
- Keswani, Rajesh N.
- DiMaio, Christopher J.
- Bronze, Michael S.
- Canto, Marcia I.
- Imam, Zaid
- Edhi, Ahmed I.
- Orosey, Molly
- Tiwari, Abhinav
- Brown, Nicholas G.
- Cruz, Lilian
- Hollander, Thomas
- Damianos, John A.
- Esteban, James
- Saul, Melissa
- Nitchie, Haley
- Waljee, Akbar K.
- Zhang, Yueyang
- Zhu, Ji
- Deshpande, Amar R.
- Rockey, Don C.
- Venue
- Clinical Gastroenterology and Hepatology
- Publisher
- Elsevier BV
- Published
- 2021-07
- Volume
- 19
- Issue
- 7
- Pages
- 1355-1365.e4
- ISSN
- 1542-3565 (ISSN-L)
- OpenAlex
- W3090871555
- Cited by
- 110
- References
- 22
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 11 · 2023: 19 · 2022: 28 · 2021: 37 · 2020: 10
- FWCI
- 3.08
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Locations
- Clinical Gastroenterology and Hepatology (publishedVersion)
- medRxiv (acceptedVersion)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- IUScholarWorks (Indiana University) (submittedVersion)
- PMC
- Publisher
- Clinical Gastroenterology and Hepatology
- Funders
- National Cancer Institute (P30CA008748)
- National Institute of General Medical Sciences (P20GM130457)
- National Institute of Diabetes and Digestive and Kidney Diseases (T35DK111373, P30DK123704)
- Topics
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
- Health Sciences › Medicine › Dermatology › Dermatological and COVID-19 studies
- Keywords
- COVID-19 pandemic, SARS-CoV-2, gastrointestinal symptoms, diarrhea, nausea, vomiting, abdominal pain, alanine aminotransferase, hyperbilirubinemia, mechanical ventilation, mortality, disease severity, hospitalized patients
- MeSH terms
- COVID-19, Adolescent, Adult, Aged, Aged, 80 and over, Female, Gastrointestinal Diseases, Humans, Male, Middle Aged, North America, Young Adult
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