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Cited by 110COVID-19 Clinical Research StudiesLong-Term Effects of COVID-19Dermatological and COVID-19 studies

The DOI matches its Crossref record; 22 of the 22 references it cites were found in a registry or an index.

Digestive Manifestations in Patients Hospitalized With Coronavirus Disease 2019

Open access
Elmunzer, B. Joseph, Spitzer, Rebecca L., Foster, Lydia D., Merchant, Ambreen A., Howard, Eric F., Patel, Vaishali A., West, Mary K., Qayed, Emad, Nustas, Rosemary, Zakaria, Ali, Piper, Marc S., Taylor, Jason R., Jaza, Lujain, Forbes, Nauzer, Chau, Millie, Lara, Luis F., Papachristou, Georgios I., Volk, Michael L., Hilson, Liam G., Zhou, Selena, Kushnir, Vladimir M., Lenyo, Alexandria M., McLeod, Caroline G., Amin, Sunil, Kuftinec, Gabriela N., Yadav, Dhiraj, Fox, Charlie, Kolb, Jennifer M., Pawa, Swati, Pawa, Rishi, Canakis, Andrew, Huang, Christopher, Jamil, Laith H., Aneese, Andrew M., Glamour, Benita K., Smith, Zachary L., Hanley, Katherine A., Wood, Jordan, Patel, Harsh K., Shah, Janak N., Agarunov, Emil, Sethi, Amrita, Fogel, Evan L., McNulty, Gail, Haseeb, Abdul, Trieu, Judy A., Dixon, Rebekah E., Yang, Jeong Yun, Mendelsohn, Robin B., Calo, Delia, Aroniadis, Olga C., LaComb, Joseph F., Scheiman, James M., Sauer, Bryan G., Dang, Duyen T., Piraka, Cyrus R., Shah, Eric D., Pohl, Heiko, Tierney, William M., Mitchell, Stephanie, Condon, Ashwinee, Lenhart, Adrienne, Dua, Kulwinder S., Kanagala, Vikram S., Kamal, Ayesha, Singh, Vikesh K., Pinto-Sanchez, Maria Ines, Hutchinson, Joy M., Kwon, Richard S., Korsnes, Sheryl J., Singh, Harminder, Solati, Zahra, Willingham, Field F., Yachimski, Patrick S., Conwell, Darwin L., Mosier, Evan, Azab, Mohamed, Patel, Anish, Buxbaum, James, Wani, Sachin, Chak, Amitabh, Hosmer, Amy E., Keswani, Rajesh N., DiMaio, Christopher J., Bronze, Michael S., Muthusamy, Raman, Canto, Marcia I., Gjeorgjievski, V. Mihajlo, Imam, Zaid, Odish, Fadi, Edhi, Ahmed I., Orosey, Molly, Tiwari, Abhinav, Patwardhan, Soumil, Brown, Nicholas G., Patel, Anish A., Ordiah, Collins O., Sloan, Ian P., Cruz, Lilian, Koza, Casey L., Okafor, Uchechi, Hollander, Thomas, Furey, Nancy, Reykhart, Olga, Zbib, Natalia H., Damianos, John A., Esteban, James, Hajidiacos, Nick, Saul, Melissa, Mays, Melanie, Anderson, Gulsum, Wood, Kelley, Mathews, Laura, Diakova, Galina, Caisse, Molly, Wakefield, Lauren, Nitchie, Haley, Waljee, Akbar K., Tang, Weijing, Zhang, Yueyang, Zhu, Ji, Deshpande, Amar R., Rockey, Don C., Alford, Teldon B., Durkalski, Valerie·2021·Clinical Gastroenterology and Hepatology
DOI 10.1016/j.cgh.2020.09.041

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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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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
Venue
Clinical Gastroenterology and Hepatology
Publisher
Elsevier BV
Published
2021-07
Volume
19
Issue
7
Pages
1355-1365.e4
ISSN
1542-3565 (ISSN-L)
DOI
10.1016/j.cgh.2020.09.041
OpenAlex
W3090871555
Cited by
110
References
22
Citations by year
2026: 2 · 2025: 3 · 2024: 11 · 2023: 19 · 2022: 28 · 2021: 37
FWCI
3.08
Type
journal article
Language
en
Open access
Licence
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 › Clinical 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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