Manifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19: a systematic review and meta-analysis
Open accessAbstract
Background The prevalence and prognosis of digestive system involvement, including gastrointestinal symptoms and liver injury, in patients with COVID-19 remains largely unknown. We aimed to quantify the effects of COVID-19 on the digestive system.Methods In this systematic review and meta-analysis, we systematically searched PubMed, Embase, and Web of Science for studies published between Jan 1, 2020, and April 4, 2020. The websites of WHO, CDC, and major journals were also searched. We included studies that reported the epidemiological and clinical features of COVID-19 and the prevalence of gastrointestinal findings in infected patients, and excluded preprints, duplicate publications, reviews, editorials, single case reports, studies pertaining to other coronavirus-related illnesses, and small case series (<10 cases). Extracted data included author; date; study design; country; patient demographics; number of participants in severe and non-severe disease groups; prevalence of clinical gastrointestinal symptoms such as vomiting, nausea, diarrhoea, loss of appetite, abdominal pain, and belching; and digestive system comorbidities including liver disease and gastrointestinal diseases. Raw data from studies were pooled to determine effect estimates.Findings We analysed findings from 35 studies, including 6686 patients with COVID-19, that met inclusion criteria. 29 studies (n=6064) reported gastrointestinal symptoms in patients with COVID-19 at diagnosis, and the pooled prevalence of digestive system comorbidities was 4% (95% CI 2-5; range 0-15; I 2=74%). The pooled prevalence of digestive symptoms was 15% (10-21; range: 2-57; I 2=96%) with nausea or vomiting, diarrhoea, and loss of appetite being the three most common symptoms. The pooled prevalence of abnormal liver functions (12 studies, n=1267) was 19% (9-32; range 1-53; I 2=96%). Subgroup analysis showed patients with severe COVID-19 had higher rates of abdominal pain (odds ratio [OR] 7·10 [95% CI 1·93-26·07]; p=0·003; I 2=0%) and abnormal liver function including increased ALT (1·89 [1·30-2·76]; p=0·0009; I 2=10%) and increased AST (3·08 [2·14-4·42]; p<0·00001; I 2=0%) compared with those with non-severe disease. Patients in Hubei province, where the initial COVID-19 outbreak occurred, were more likely to present with abnormal liver functions (p<0·0001) compared with those outside of Hubei. Paediatric patients with COVID-19 had a similar prevalence of gastrointestinal symptoms to those of adult patients. 10% (95% CI 4-19; range 3-23; I 2=97%) of patients presented with gastrointestinal symptoms alone without respiratory features. Patients who presented with gastrointestinal system involvement had delayed diagnosis (standardised mean difference 2·85 [95% CI 0·22-5·48]; p=0·030; I 2=73%). Patients with gastrointestinal involvement tended to have a poorer disease course (eg, acute respiratory distress syndrome OR 2·96 [95% CI 1·17-7·48]; p=0·02; I 2=0%).Interpretation Our study showed that digestive symptoms and liver injury are not uncommon in patients with COVID-19. Increased attention should be paid to the care of this unique group of patients.Funding None.
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Cites
Bias in meta-analysis detected by a simple, graphical test
Egger, M., Smith, G. D., Schneider, M., & Minder, C. (1997) · BMJ · doi:10.1136/bmj.315.7109.629 · Cited by 56,722 · see citing works
Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China
Huang, C., Wang, Y., Li, X., Ren, L., Zhao, J., Hu, Y., Zhang, L., Fan, G., Xu, J., Gu, X., et al. (2020) · The Lancet · doi:10.1016/s0140-6736(20)30183-5 · Cited by 48,884 · see citing works
Self-citationClinical characteristics of coronavirus disease 2019 in China
Guan, W.-J., Ni, Z.-Y., Hu, Y., Liang, W.-H., Ou, C.-Q., He, J.-X., Liu, L., Shan, H., Lei, C.-L., Hui, D. S. C., et al. (2020) · New England Journal of Medicine · doi:10.1056/nejmoa2002032 · Cited by 30,246 · see citing works
Self-citationZhou, F., Yu, T., Du, R., Fan, G., Liu, Y., Liu, Z., Xiang, J., Wang, Y., Song, B., Gu, X., et al. (2020) · The Lancet · doi:10.1016/s0140-6736(20)30566-3 · Cited by 27,263 · see citing works
Chen, N., Zhou, M., Dong, X., Qu, J., Gong, F., Han, Y., Qiu, Y., Wang, J., Liu, Y., Wei, Y., et al. (2020) · The Lancet · doi:10.1016/s0140-6736(20)30211-7 · Cited by 21,415 · see citing works
Self-citationWang, D., Hu, B., Hu, C., Zhu, F., Liu, X., Zhang, J., Wang, B., Xiang, H., Cheng, Z., Xiong, Y., et al. (2020) · JAMA · doi:10.1001/jama.2020.1585 · Cited by 20,148 · see citing works
La certeza de lo impredecible: Cultura Educación y Sociedad en tiempos de COVID19
Martínez González, M. (2020) · DSPACE System - Metalibrary (University of the Coast) · Cited by 18,463 · see citing works
Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia
Li, Q., Guan, X., Wu, P., Wang, X., Zhou, L., Tong, Y., Ren, R., Leung, K. S. M., Lau, E. H. Y., Wong, J. Y., et al. (2020) · New England Journal of Medicine · doi:10.1056/nejmoa2001316 · Cited by 16,575 · see citing works
Yang, X., Yu, Y., Xu, J., Shu, H., Xia, J., Liu, H., Wu, Y., Zhang, L., Yu, Z., Fang, M., et al. (2020) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(20)30079-5 · Cited by 10,066 · see citing works
Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1
van Doremalen, N., Bushmaker, T., Morris, D. H., Holbrook, M. G., Gamble, A., Williamson, B. N., Tamin, A., Harcourt, J. L., Thornburg, N. J., Gerber, S. I., et al. (2020) · New England Journal of Medicine · doi:10.1056/nejmc2004973 · Cited by 9,951 · see citing works
Estimating the mean and variance from the median, range, and the size of a sample
Hozo, S. P., Djulbegovic, B., & Hozo, I. (2005) · BMC Medical Research Methodology · doi:10.1186/1471-2288-5-13 · Cited by 9,062 · see citing works
Pathological findings of COVID-19 associated with acute respiratory distress syndrome
Xu, Z., Shi, L., Wang, Y., Zhang, J., Huang, L., Zhang, C., Liu, S., Zhao, P., Liu, H., Zhu, L., et al. (2020) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(20)30076-x · Cited by 8,545 · see citing works
Self-citationChan, J., Yuan, S.-F., Kok, K.-H., To, K., Chu, H., Yang, J., Xing, F., Liu, J.-L., Yip, C., Poon, R., et al. (2020) · The Lancet · doi:10.1016/s0140-6736(20)30154-9 · Cited by 8,450 · see citing works
Wu, C., Chen, X., Cai, Y., Xia, J., Zhou, X., Xu, S., Huang, H., Zhang, L., Zhou, X., Du, C., et al. (2020) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2020.0994 · Cited by 8,249 · see citing works
Virological assessment of hospitalized patients with COVID-2019
Wölfel, R., Corman, V. M., Guggemos, W., Seilmaier, M., Zange, S., Müller, M. A., Niemeyer, D., Jones, T. C., Vollmar, P., Rothe, C., et al. (2020) · Nature · doi:10.1038/s41586-020-2196-x · Cited by 6,661 · see citing works
First case of 2019 novel coronavirus in the United States
Holshue, M. L., DeBolt, C., Lindquist, S., Lofy, K. H., Wiesman, J., Bruce, H., Spitters, C., Ericson, K., Wilkerson, S., Tural, A., et al. (2020) · New England Journal of Medicine · doi:10.1056/nejmoa2001191 · Cited by 6,030 · see citing works
A Trial of Lopinavir–Ritonavir in Adults Hospitalized with Severe Covid-19
Cao, B., Wang, Y., Wen, D., Liu, W., Wang, J., Fan, G., Ruan, L., Song, B., Cai, Y., Wei, M., et al. (2020) · New England Journal of Medicine · doi:10.1056/nejmoa2001282 · Cited by 5,187 · see citing works
Self-citationAssociation of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China
Shi, S., Qin, M., Shen, B., Cai, Y., Liu, T., Yang, F., Gong, W., Liu, X., Liang, J., Zhao, Q., et al. (2020) · JAMA Cardiology · doi:10.1001/jamacardio.2020.0950 · Cited by 4,349 · see citing works
Self-citationClinical characteristics of 140 patients infected with SARS‐CoV‐2 in Wuhan, China
Zhang, J., Dong, X., Cao, Y., Yuan, Y.-D., Yang, Y., Yan, Y., Akdiş, C. A., & Gao, Y. (2020) · Allergy · doi:10.1111/all.14238 · Cited by 4,004 · see citing works
Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study
Shi, H., Han, X., Jiang, N., Cao, Y., Alwalid, O., Gu, J., Fan, Y., & Zheng, C. (2020) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(20)30086-4 · Cited by 3,664 · see citing works
Evidence for gastrointestinal infection of SARS-CoV-2
Xiao, F., Tang, M., Zheng, X., Liu, Y., Li, X., & Shan, H. (2020) · Gastroenterology · doi:10.1053/j.gastro.2020.02.055 · Cited by 2,836 · see citing works
Self-citationSARS-CoV-2 Infection in Children
Lü, X., Zhang, L., Du, H. N., Zhang, J., Li, Y. Y., Qu, J., Zhang, W., Wang, Y., Bao, S., Li, Y., et al. (2020) · New England Journal of Medicine · doi:10.1056/nejmc2005073 · Cited by 2,423 · see citing works
Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington State
Arentz, M., Yim, E., Klaff, L., Lokhandwala, S., Riedo, F. X., Chong, M., & Lee, M. (2020) · JAMA · doi:10.1001/jama.2020.4326 · Cited by 2,259 · see citing works
Epidemiologic Features and Clinical Course of Patients Infected With SARS-CoV-2 in Singapore
Young, B. E., Ong, S. W. X., Kalimuddin, S., Low, J. G. H., Tan, S. Y., Loh, J., Ng, O. T., Marimuthu, K., Ang, L. W., Mak, T. M., et al. (2020) · JAMA · doi:10.1001/jama.2020.3204 · Cited by 2,058 · see citing works
Self-citationXu, X., Wu, X., Jiang, X., Xu, K., Ying, L.-J., Ma, C., Li, S., Wang, H., Zhang, S., Gao, H., et al. (2020) · BMJ · doi:10.1136/bmj.m606 · Cited by 2,047 · see citing works
Self-citationLiu, Y., Yang, Y., Zhang, C., Huang, F., Wang, F., Yuan, J., Wang, Z., Li, J., Li, J., Feng, C., et al. (2020) · Science China Life Sciences · doi:10.1007/s11427-020-1643-8 · Cited by 2,037 · see citing works
Liver injury in COVID-19: management and challenges
Zhang, C., Shi, L., & Wang, F. (2020) · The Lancet. Gastroenterology & hepatology · doi:10.1016/s2468-1253(20)30057-1 · Cited by 1,941 · see citing works
Pan, L., Mu, M., Yang, P., Sun, Y., Wang, R., Yan, J., Li, P., Hu, B., Wang, J., Hu, C., et al. (2020) · American Journal of Gastroenterology · doi:10.14309/ajg.0000000000000620 · Cited by 1,823 · see citing works
Functional exhaustion of antiviral lymphocytes in COVID-19 patients
Zheng, M., Gao, Y., Wang, G., Song, G., Liu, S., Sun, D., Xu, Y., & Tian, Z. (2020) · Cellular & Molecular Immunology · doi:10.1038/s41423-020-0402-2 · Cited by 1,768 · see citing works
Viral load of SARS-CoV-2 in clinical samples.
Pan, Y., Zhang, D., Yang, P., Poon, L. L. M., & Wang, Q. (2020) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(20)30113-4 · Cited by 1,562 · see citing works
Prolonged presence of SARS-CoV-2 viral RNA in faecal samples
Wu, Y., Guo, C., Tang, L., Hong, Z., Zhou, J., Dong, X., Yin, H., Xiao, Q., Tang, Y., Qu, X., et al. (2020) · The Lancet. Gastroenterology & hepatology · doi:10.1016/s2468-1253(20)30083-2 · Cited by 1,550 · see citing works
Xu, Y., Li, X., Zhu, B., Liang, H., Fang, C., Gong, Y., Guo, Q., Sun, X., Zhao, D., Shen, J., et al. (2020) · Nature Medicine · doi:10.1038/s41591-020-0817-4 · Cited by 1,415 · see citing works
Self-citationClinical characteristics of novel coronavirus cases in tertiary hospitals in Hubei Province
Liu, K., Fang, Y.-Y., Deng, Y., Liu, W. Y., Wang, M., Ma, J.-P., Xiao, W. L., Wang, Y.-N., Zhong, M.-H., Li, C.-H., et al. (2020) · Chinese Medical Journal · doi:10.1097/cm9.0000000000000744 · Cited by 1,412 · see citing works
Diabetes is a risk factor for the progression and prognosis of <scp>COVID</scp>‐19
Guo, W., Li, M., Dong, Y., Zhou, H., Zhang, Z., Tian, C., Qin, R., Wang, H., Shen, Y., Du, K., et al. (2020) · Diabetes/Metabolism Research and Reviews · doi:10.1002/dmrr.3319 · Cited by 1,404 · see citing works
Jin, X., Lian, J., Hu, J., Gao, J., Zheng, L., Zhang, Y., Hao, S., Jia, H., Cai, H. Q., Zhang, X.-L., et al. (2020) · Gut · doi:10.1136/gutjnl-2020-320926 · Cited by 1,383 · see citing works
Self-citationQiu, H., Wu, J., Hong, L., Luo, Y., Song, Q., & Dong, C. (2020) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(20)30198-5 · Cited by 1,282 · see citing works
Wu, P., Duan, F., Luo, C., Liu, Q., Qu, X., Liang, L., & Wu, K. (2020) · JAMA Ophthalmology · doi:10.1001/jamaophthalmol.2020.1291 · Cited by 1,235 · see citing works
Emerging 2019 Novel Coronavirus (2019-nCoV) Pneumonia
Song, F., Shi, N., Shan, F., Zhang, Z., Shen, J., Lu, H., Ling, Y., Jiang, Y., & Shi, Y. (2020) · Radiology · doi:10.1148/radiol.2020200274 · Cited by 1,190 · see citing works
Self-citationImaging Profile of the COVID-19 Infection: Radiologic Findings and Literature Review
Ng, M., Lee, E. Y. P., Jin, Y., Yang, F., Li, X., Wang, H., Lui, M. M., Lo, C. S.-Y., Leung, B., Khong, P., et al. (2020) · Radiology Cardiothoracic Imaging · doi:10.1148/ryct.2020200034 · Cited by 1,141 · see citing works
Self-citationClinical and virological data of the first cases of COVID-19 in Europe: a case series
Lescure, F.-X., Bouadma, L., Nguyen, D. T., Parisey, M., Wicky, P.-H., Behillil, S., Gaymard, A., Bouscambert‐Duchamp, M., Donati, F., Hingrat, Q. L., et al. (2020) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(20)30200-0 · Cited by 1,079 · see citing works
Clinical Features of 69 Cases With Coronavirus Disease 2019 in Wuhan, China
Wang, Z., Yang, B., Li, Q., Wen, L., & Zhang, R. (2020) · Clinical Infectious Diseases · doi:10.1093/cid/ciaa272 · Cited by 1,063 · see citing works
Zeng, L., Xia, S., Yuan, W., Yan, K., Xiao, F., Shao, J., & Zhou, W. (2020) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/jamapediatrics.2020.0878 · Cited by 1,035 · see citing works
Yang, W., Cao, Q., Qin, L., Wang, X., Cheng, Z., Pan, A., Dai, J., Sun, Q., Zhao, F., Qu, J., et al. (2020) · Journal of Infection · doi:10.1016/j.jinf.2020.02.016 · Cited by 994 · see citing works
[A pathological report of three COVID-19 cases by minimal invasive autopsies].
Yao, X. H., Li, T. Y., He, Z. C., Ping, Y. F., Liu, H. W., Yu, S. C., Mou, H. M., Wang, L. H., Zhang, H. R., Fu, W. J., et al. (2020) · PubMed · doi:10.3760/cma.j.cn112151-20200312-00193 · Cited by 963 · see citing works
Specific ACE2 Expression in Cholangiocytes May Cause Liver Damage After 2019-nCoV Infection
Chai, X., Hu, L., Zhang, Y., Han, W., Lu, Z., Ke, A., Zhou, J., Shi, G., Fang, N., Fan, J., et al. (2020) · doi:10.1101/2020.02.03.931766 · Cited by 952 · see citing works
Clinical Features of COVID-19-Related Liver Functional Abnormality
Fan, Z., Chen, L., Li, J., Cheng, X., Yang, J., Tian, C., Zhang, Y., Huang, S., Liu, Z., & Cheng, J. (2020) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2020.04.002 · Cited by 949 · see citing works
Jiehao, C., Jin, X., Lin, D., Zhi, Y., Xu, L., Qu, Z., Yuehua, Z., Hua, Z., Jia, R., Liu, P., et al. (2020) · Clinical Infectious Diseases · doi:10.1093/cid/ciaa198 · Cited by 919 · see citing works
Qi, F., Qian, S., Zhang, S., & Zhang, Z. (2020) · Biochemical and Biophysical Research Communications · doi:10.1016/j.bbrc.2020.03.044 · Cited by 905 · see citing works
Yu, N., Li, W., Kang, Q., Xiong, Z. L., Wang, S., Lin, X., Liu, Y., Xiao, J., Liu, H., Deng, D., et al. (2020) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(20)30176-6 · Cited by 859 · see citing works
Enteric involvement of coronaviruses: is faecal–oral transmission of SARS-CoV-2 possible?
Yeo, C., Sanghvi, K., & Yeo, D. X. W. (2020) · The Lancet. Gastroenterology & hepatology · doi:10.1016/s2468-1253(20)30048-0 · Cited by 818 · see citing works
Imaging and clinical features of patients with 2019 novel coronavirus SARS-CoV-2
Xu, X. Z., Yu, C., Qu, J. T., Zhang, L., Jiang, S., Huang, D., Chen, B., Zhang, Z., Guan, W., Ling, Z., et al. (2020) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-020-04735-9 · Cited by 790 · see citing works
Chang, D., Lin, M., Wei, L., Xie, L., Zhu, G., Cruz, C. S. D., & Sharma, L. (2020) · JAMA · doi:10.1001/jama.2020.1623 · Cited by 696 · see citing works
Clinical characteristics of 82 cases of death from COVID-19
Zhang, B., Zhou, X., Qiu, Y., Feng, F., Feng, J., Feng, J., Zhu, H., Hu, K., JiaSheng, L., Liu, Z., et al. (2020) · PLoS ONE · doi:10.1371/journal.pone.0235458 · Cited by 688 · see citing works
Self-citationWu, J., Liu, J., Zhao, X., Liu, C., Wang, W., Wang, D., Xu, W., Zhang, C., Yu, J., Jiang, B., et al. (2020) · Clinical Infectious Diseases · doi:10.1093/cid/ciaa199 · Cited by 628 · see citing works
Han, C., Duan, C., Zhang, S., Spiegel, B., Shi, H., Wang, W., Zhang, L., Lin, R., Liu, J., Ding, Z., et al. (2020) · American Journal of Gastroenterology · doi:10.14309/ajg.0000000000000664 · Cited by 587 · see citing works
Ghinai, I., McPherson, T. D., Hunter, J. C., Kirking, H. L., Christiansen, D., Joshi, K., Rubin, R., Morales-Estrada, S., Black, S. R., Pacilli, M., et al. (2020) · The Lancet · doi:10.1016/s0140-6736(20)30607-3 · Cited by 578 · see citing works
Wang, Z., Chen, X., Lu, Y., Chen, F., & Zhang, W. (2020) · BioScience Trends · doi:10.5582/bst.2020.01030 · Cited by 545 · see citing works
Study quality assessment tools
Graves, N., Wloch, C., Wilson, J. A., Barnett, A. G., Sutton, A. J., Cooper, N. J., Merollini, K. M. D., McCreanor, V., Cheng, Q., Burn, E., et al. (2016) · Cited by 440 · see citing works
Don't Overlook Digestive Symptoms in Patients With 2019 Novel Coronavirus Disease (COVID-19)
Luo, S., Zhang, X., & Xu, H. (2020) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2020.03.043 · Cited by 349 · see citing works
SARS-CoV-2 induced diarrhoea as onset symptom in patient with COVID-19
Song, Y., Liu, P., Shi, X., Chu, Y., Zhang, J., Xia, J., Gao, X. Z., Qu, T., & Wang, M. (2020) · Gut · doi:10.1136/gutjnl-2020-320891 · Cited by 342 · see citing works
Clinical characteristics of 82 death cases with COVID-19Preprint
Zhang, B., Zhou, X., Qiu, Y., et al. (2020) · medRxiv · doi:10.1101/2020.02.26.20028191 · Cited by 249 · see citing works
Self-citationEffect of Gastrointestinal Symptoms in Patients With COVID-19
Zhou, Z., Zhao, N., Shu, Y., Han, S., Chen, B., & Shu, X. (2020) · Gastroenterology · doi:10.1053/j.gastro.2020.03.020 · Cited by 244 · see citing works
Chen, C., Gao, G., Xu, Y., Pu, L., Wang, Q., Wang, L., Wang, W., Song, Y., Chen, M., Wang, L., et al. (2020) · Annals of Internal Medicine · doi:10.7326/m20-0991 · Cited by 232 · see citing works
Self-citationCarvalho, A., Alqusairi, R., Adams, A., Paul, M., Kothari, N. J., Peters, S. L., & DeBenedet, A. T. (2020) · The American Journal of Gastroenterology · doi:10.14309/ajg.0000000000000667 · Cited by 186 · see citing works
Clinical Features of COVID-19-Related Liver DamagePreprint
Fan, Z., Chen, L., Li, J., et al. (2020) · medRxiv · doi:10.1101/2020.02.26.20026971 · Cited by 165 · see citing works
Multiomics Evaluation of Gastrointestinal and Other Clinical Characteristics of COVID-19
Du, M., Cai, G., Chen, F., Christiani, D. C., Zhang, Z., & Wang, M. (2020) · Gastroenterology · doi:10.1053/j.gastro.2020.03.045 · Cited by 134 · see citing works
Clinical characteristics of 36 non-survivors with COVID-19 in Wuhan, ChinaPreprint
Huang, Y., Yang, R., Xü, Y., & Gong, P. (2020) · medRxiv · doi:10.1101/2020.02.27.20029009 · Cited by 120 · see citing works
The clinical dynamics of 18 cases of COVID-19 outside of Wuhan, China
Wang, L., Gao, Y., Lou, L.-L., et al. (2020) · European Respiratory Journal · doi:10.1183/13993003.00398-2020 · Cited by 111 · see citing works
Luo, C., Yao, L., Zhang, L., Yao, M., Chen, X., Wang, Q., & Shen, H. (2020) · JAMA Network Open · doi:10.1001/jamanetworkopen.2020.4583 · Cited by 100 · see citing works
A report of clinical diagnosis and treatment of nine cases of coronavirus disease 2019
Chen, Q., Quan, B., Li, X., Gao, G., Zheng, W., Zhang, J., Zhang, Z., Liu, C., Li, L., Wang, C., et al. (2020) · Journal of Medical Virology · doi:10.1002/jmv.25755 · Cited by 77 · see citing works
Self-citationClinical Features and Treatment of 2019-nCov Pneumonia Patients in Wuhan: Report of A Couple Cases
Zhang, Z., Li, X., Zhang, W., et al. (2020) · Virologica Sinica · doi:10.1007/s12250-020-00203-8 · Cited by 67 · see citing works
Self-citationHosoda, T., Sakamoto, M., Shimizu, H., et al. (2020) · Infection Control and Hospital Epidemiology · doi:10.1017/ice.2020.87 · Cited by 38 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- [52]Jin X Lian J Hu J Epidemiological, clinical and virological characteristics of 74 cases of coronavirus-infected disease 2019 (COVID-19) with gastrointestinal symptoms Gut 2020 published online March 24. 10.1136/gutjnl-2020-320926 PMC7133387 32213556 · DOI
Cited by
Sorted by citations
Wiersinga, W. J., Rhodes, A., Cheng, A. C., Peacock, S. J., & Prescott, H. C. (2020) · JAMA · doi:10.1001/jama.2020.12839 · Cited by 4,609 · see citing works
Extrapulmonary manifestations of COVID-19
Gupta, A., Madhavan, M. V., Sehgal, K., Nair, N., Mahajan, S., Sehrawat, T. S., Bikdeli, B., Ahluwalia, N., Ausiello, J. C., Wan, E. Y., et al. (2020) · Nature Medicine · doi:10.1038/s41591-020-0968-3 · Cited by 3,185 · see citing works
Long COVID or post-COVID-19 syndrome: putative pathophysiology, risk factors, and treatments
Yong, S. J. (2021) · Infectious Diseases · doi:10.1080/23744235.2021.1924397 · Cited by 1,339 · see citing works
Symptoms, complications and management of long COVID: a review
Aiyegbusi, O. L., Hughes, S. E., Turner, G., Rivera, S. C., McMullan, C., Chandan, J. S., Haroon, S., Price, G., Davies, E. H., Nirantharakumar, K., et al. (2021) · Journal of the Royal Society of Medicine · doi:10.1177/01410768211032850 · Cited by 969 · see citing works
A Mouse-Adapted SARS-CoV-2 Induces Acute Lung Injury and Mortality in Standard Laboratory Mice
Leist, S. R., Dinnon, K. H., Schäfer, A., Tse, L. V., Okuda, K., Hou, Y. J., West, A., Edwards, C. E., Sanders, W., Fritch, E. J., et al. (2020) · Cell · doi:10.1016/j.cell.2020.09.050 · Cited by 613 · see citing works
Digestive Manifestations in Patients Hospitalized With Coronavirus Disease 2019
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., et al. (2021) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2020.09.041 · Cited by 110 · see citing works
Poor outcome of intestinal ischemic manifestations of COVID-19
Norsa, L., Bonaffini, P. A., Indriolo, A., Valle, C., Sonzogni, A., & Sironi, S. (2020) · Gastroenterology · doi:10.1053/j.gastro.2020.06.041 · Cited by 47 · see citing works
Bowel ischemia in COVID‐19: A systematic review
Patel, S., Parikh, C., Verma, D., Sundararajan, R., Agrawal, U., Bheemisetty, N., Akku, R., Sánchez‐Velazco, D., & Waleed, M. S. (2021) · International Journal of Clinical Practice · doi:10.1111/ijcp.14930 · Cited by 31 · see citing works
Our early experience with mesenteric ischemia in COVID-19 positive patients
Al Mahruqi, G., Stephen, E., Abdelhedy, I., & Al Wahaibi, K. (2021) · Annals of Vascular Surgery · doi:10.1016/j.avsg.2021.01.064 · Cited by 29 · see citing works
Pneumatosis Intestinalis in the Setting of COVID-19: A Single Center Case Series From New York
Miyara, S. J., Becker, L. B., Guevara, S., Kirsch, C., Metz, C. N., Shoaib, M., Grodstein, E., Nair, V. V., Jandovitz, N., McCann-Molmenti, A., et al. (2021) · Frontiers in Medicine · doi:10.3389/fmed.2021.638075 · Cited by 9 · see citing works
COVID-19 induced mesenteric venous infarction
Calcagno, E., Sogunro, O., Nepal, P., Assaker, R., & Sapire, J. (2021) · Radiology Case Reports · doi:10.1016/j.radcr.2021.04.083 · Cited by 8 · see citing works
Plotz, B., Castillo, R., Melamed, J., Nuovo, G., Magro, C., Rosenthal, P., & Belmont, H. M. (2021) · Rheumatology · doi:10.1093/rheumatology/keaa627 · Cited by 8 · see citing works
- Authors
- Mao, R., Qiu, Y., He, J.-S., Tan, J.-Y., Li, X.-H., Liang, J., Shen, J., Zhu, L.-R., Chen, Y., Iacucci, M., Ng, S. C., Ghosh, S., & Chen, M.-H.
- Affiliations
- The First Affiliated Hospital, Sun Yat-sen University (CN)
- National Clinical Research Center for Digestive Diseases (CN)
- Shanghai Jiao Tong University (CN)
- Wuhan Union Hospital (CN)
- Second Affiliated Hospital of Zhejiang University (CN)
- University Hospitals Birmingham NHS Foundation Trust (GB)
- Chinese University of Hong Kong (HK)
- Corresponding author
- Mao, Ren
- ORCID
- Venue
- The Lancet Gastroenterology & Hepatology
- Publisher
- Elsevier BV
- Published
- 2020-07
- Volume
- 5
- Issue
- 7
- Pages
- 667-678
- ISSN
- 2468-1156 (ISSN-L)
- 2468-1253
- PMC
- PMC7217643
- OpenAlex
- W3025587545
- Cited by
- 1,056
- References
- 72
- Citations by year
- 2026: 16 · 2025: 29 · 2024: 75 · 2023: 146 · 2022: 277 · 2021: 317 · 2020: 195
- FWCI
- 11.05
- Type
- journal article
- Language
- en
- Update notices
- Open access
- bronze
- doi.org
- Locations
- The Lancet. Gastroenterology & hepatology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion, other-oa)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion, cc-by-nc-nd)
- 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, gastrointestinal symptoms, liver injury, abnormal liver function, nausea and vomiting, diarrhea, abdominal pain, appetite loss, alanine aminotransferase, disease severity, prognosis, SARS-CoV-2
- MeSH terms
- Betacoronavirus, COVID-19, SARS-CoV-2, Gastrointestinal Diseases, Humans, Liver Diseases, Pneumonia, Viral, Prognosis, Prevalence, Coronavirus Infections, Pandemics
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