AGA Institute Rapid Review of the Gastrointestinal and Liver Manifestations of COVID-19, Meta-Analysis of International Data, and Recommendations for the Consultative Management of Patients with COVID-19
Open accessAbstract
Background & aims Multiple gastrointestinal (GI) symptoms, including diarrhea, nausea/vomiting, and abdominal pain, as well as liver enzyme abnormalities, have been variably reported in patients with coronavirus disease 2019 (COVID-19). This document provides best practice statements and recommendations for consultative management based on a systematic review and meta-analysis of international data on GI and liver manifestations of COVID-19.Methods We performed a systematic literature search to identify published and unpublished studies using OVID Medline and preprint servers (medRxiv, LitCovid, and SSRN) up until April 5, 2020; major journal sites were monitored for US publications until April 19, 2020. We pooled the prevalence of diarrhea, nausea, vomiting, and abdominal pain, as well as liver function tests abnormalities, using a fixed-effect model and assessed the certainty of evidence using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework.Results We identified 118 studies and used a hierarchal study selection process to identify unique cohorts. We performed a meta-analysis of 47 studies including 10,890 unique patients. Pooled prevalence estimates of GI symptoms were as follows: diarrhea 7.7% (95% confidence interval [CI], 7.2%-8.2%), nausea/vomiting 7.8% (95% CI, 7.1%-8.5%), and abdominal pain 2.7% (95% CI, 2.0%-3.4%). Most studies reported on hospitalized patients. The pooled prevalence estimates of elevated liver abnormalities were as follows: aspartate transaminase 15.0% (95% CI, 13.6%-16.5%) and alanine transaminase 15.0% (95% CI, 13.6%-16.4%). When we compared studies from China to studies from other countries in subgroup analyses, diarrhea, nausea/vomiting, and liver abnormalities were more prevalent outside of China, with diarrhea reported in 18.3% (95% CI, 16.6%-20.1%). Isolated GI symptoms were reported rarely. We also summarized the Gl and liver adverse effects of the most commonly utilized medications for COVID-19.Conclusions GI symptoms are associated with COVID-19 in <10% of patients. In studies outside of China, estimates are higher. Further studies are needed with standardized GI symptoms questionnaires and liver function test checks on admission to better quantify and qualify the association of these symptoms with COVID-19. Based on findings from our meta-analysis, we provide several Best Practice Statements for the consultative management of COVID-19.
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Clinical Characteristics of Coronavirus Disease 2019 in Hainan, ChinaPreprint
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The Risk of SARS-CoV-2 in Immunosuppressed IBD Patients
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Will the Quality of Research Remain the Same During the COVID-19 Pandemic?
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Charakteristik von 50 hospitalisierten COVID-19-Patienten mit und ohne ARDS
Dreher, M., Bickenbach, J., Marx, N., et al. (2020) · RWTH Publications (RWTH Aachen) · Cited by 36 · see citing works
Ai, J., Chen, J., Wang, Y., Liu, X., Fan, W., Qu, G., Zhang, M., Pei, S.-D., Tang, B., Yuan, S., et al. (2020) · medRxiv · doi:10.1101/2020.02.19.20025023 · Cited by 32 · see citing works
Clinical characteristics associated with COVID-19 severity in California
Rubin, S. J. S., Falkson, S. R., Degner, N. R., et al. (2020) · Journal of Clinical and Translational Science · doi:10.1017/cts.2020.40 · Cited by 30 · see citing works
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COVID-19, Australia: Epidemiology Report 6: Reporting week ending 1900 AEDT 7 March 2020
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Digestive Manifestations in Patients Hospitalized With Coronavirus Disease 2019
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- Authors
- Sultan, S., Altayar, O., Siddique, S. M., Davitkov, P., Feuerstein, J. D., Lim, J. K., Falck-Ytter, Y., & El-Serag, H. B.
- Affiliations
- University of Minnesota (US)
- Washington University in St. Louis (US)
- University of Pennsylvania (US)
- VA Northeast Ohio Healthcare System (US)
- Beth Israel Deaconess Medical Center (US)
- Yale University (US)
- ORCID
- Venue
- Gastroenterology
- Publisher
- Elsevier BV
- Published
- 2020-07
- Volume
- 159
- Issue
- 1
- Pages
- 320-334.e27
- ISSN
- 0016-5085 (ISSN-L)
- PMC
- PMC7212965
- OpenAlex
- W3022504328
- Cited by
- 437
- References
- 113
- Citations by year
- 2026: 12 · 2025: 16 · 2024: 15 · 2023: 54 · 2022: 107 · 2021: 142 · 2020: 90
- FWCI
- 4.64
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Gastroenterology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Scholarly Commons @ Case Western Reserve University (submittedVersion)
- Funders
- National Institutes of Health (UL1TR001863)
- National Center for Advancing Translational Sciences
- 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 manifestations, diarrhea, nausea and vomiting, abdominal pain, liver enzyme abnormalities, aspartate aminotransferase, alanine aminotransferase, prevalence, hospitalized patients, adverse drug reactions, best practice recommendations
- MeSH terms
- Betacoronavirus, COVID-19, SARS-CoV-2, COVID-19 Testing, Antiviral Agents, Gastroenterology, Gastrointestinal Diseases, Humans, Liver, Liver Diseases, Liver Function Tests, Pneumonia, Viral, Referral and Consultation, Societies, Medical, United States, Prevalence, Practice Guidelines as Topic, Coronavirus Infections, Clinical Laboratory Techniques, Gastrointestinal Tract, Pandemics
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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