Review article: gastrointestinal features in COVID-19 and the possibility of faecal transmission
Open accessAbstract
BACKGROUND: There is little published evidence on the gastrointestinal features of COVID-19. AIMS: To report on the gastrointestinal manifestations and pathological findings of patients with COVID-19, and to discuss the possibility of faecal transmission. METHODS: We have reviewed gastrointestinal features of, and faecal test results in, COVID-19 from case reports and retrospective clinical studies relating to the digestive system published since the outbreak. RESULTS: With an incidence of 3% (1/41)-79% (159/201), gastrointestinal symptoms of COVID-19 included anorexia 39.9% (55/138)-50.2% (101/201), diarrhoea 2% (2/99)-49.5% (146/295), vomiting 3.6% (5/138)-66.7% (4/6), nausea 1% (1/99)-29.4% (59/201), abdominal pain 2.2% (3/138)-6.0% (12/201) and gastrointestinal bleeding 4% (2/52)-13.7% (10/73). Diarrhoea was the most common gastrointestinal symptom in children and adults, with a mean duration of 4.1 ± 2.5 days, and was observed before and after diagnosis. Vomiting was more prominent in children. About 3.6% (5/138)-15.9% (32/201) of adult and 6.5% (2/31)-66.7% (4/6) of children patients presented vomiting. Adult and children patients can present with digestive symptoms in the absence of respiratory symptoms. The incidence of digestive manifestations was higher in the later than in the early stage of the epidemic, but no differences in digestive symptoms among different regions were found. Among the group of patients with a higher proportion of severe cases, the proportion of gastrointestinal symptoms in severe patients was higher than that in nonsevere patients (anorexia 66.7% vs 30.4%; abdominal pain 8.3% vs 0%); while in the group of patients with a lower severe rate, the proportion with gastrointestinal symptoms was similar in severe and nonsevere cases (nausea and vomiting 6.9% vs 4.6%; diarrhoea 5.8% vs 3.5%). Angiotensin converting enzyme 2 and virus nucleocapsid protein were detected in gastrointestinal epithelial cells, and infectious virus particles were isolated from faeces. Faecal PCR testing was as accurate as respiratory specimen PCR detection. In 36% (5/14)-53% (39/73) faecal PCR became positive, 2-5 days later than sputum PCR positive. Faecal excretion persisted after sputum excretion in 23% (17/73)-82% (54/66) patients for 1-11 days. CONCLUSIONS: Gastrointestinal symptoms are common in patients with COVID-19, and had an increased prevalence in the later stage of the recent epidemic in China. SARS-CoV-2 enters gastrointestinal epithelial cells, and the faeces of COVID-19 patients are potentially infectious.
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Vomiting seems to be more prominent in children with COVID-19.
“Diarrhea seems to be the most common GI symptom in children and adults, with a mean duration of 4.1 ± 2.5 days, while vomiting seems to be more prominent in children (Tian et al., 2020).”
From Viral Infections, the Microbiome, and Probiotics (2021) · cites this paper as Tian et al., 2020
Diarrhea is the most common GI symptom in children and adults with COVID-19, with a mean duration of 4.1 ± 2.5 days.
“Diarrhea seems to be the most common GI symptom in children and adults, with a mean duration of 4.1 ± 2.5 days, while vomiting seems to be more prominent in children (Tian et al., 2020).”
From Viral Infections, the Microbiome, and Probiotics (2021) · cites this paper as Tian et al., 2020
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- Authors
- Tian, Y., Rong, L., Nian, W., & He, Y.
- Affiliations
- Peking University First Hospital (CN)
- Corresponding author
- Rong, Long
- Venue
- Alimentary Pharmacology & Therapeutics
- Publisher
- Wiley
- Published
- 2020-03-31
- Volume
- 51
- Issue
- 9
- Pages
- 843-851
- ISSN
- 0269-2813 (ISSN-L)
- 1365-2036
- PMC
- PMC7161803
- OpenAlex
- W3013328465
- Cited by
- 832
- References
- 36
- Citations by year
- 2026: 2 · 2025: 13 · 2024: 28 · 2023: 69 · 2022: 137 · 2021: 229 · 2020: 352 · 2019: 2
- FWCI
- 9.30
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Alimentary Pharmacology & Therapeutics (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
- Health Sciences › Medicine › Infectious Diseases › Viral gastroenteritis research and epidemiology
- Keywords
- COVID-19 pandemic, gastrointestinal symptoms, SARS-CoV-2, diarrhea, vomiting, anorexia, abdominal pain, gastrointestinal bleeding, pediatric patients, disease severity, enteric transmission, viral gastroenteritis, enteric viral infection, intestinal parasites, intestinal helminths, intestinal protozoa
- MeSH terms
- Betacoronavirus, COVID-19, SARS-CoV-2, Adult, Child, China, Diarrhea, Disease Outbreaks, Feces, Gastrointestinal Diseases, Humans, Pneumonia, Viral, Vomiting, Incidence, Coronavirus Infections, Pandemics
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