Gastrointestinal symptoms in patients with coronavirus disease 2019 (COVID-19) - friend or foe?

Konrad Lewandowski; Magdalena Kaniewska; Mariusz Rosołowski; Adam Tworek; Grażyna Rydzewska

doi:10.5114/pg.2021.111000

Gastrointestinal symptoms in patients with coronavirus disease 2019 (COVID-19) - friend or foe?

Prz Gastroenterol. 2022;17(3):219-226. doi: 10.5114/pg.2021.111000. Epub 2021 Nov 18.

Authors

Konrad Lewandowski¹, Magdalena Kaniewska¹, Mariusz Rosołowski^{2

3}, Adam Tworek¹, Grażyna Rydzewska^{1

4}

Affiliations

¹ Clinical Department of Internal Medicine and Gastroenterology with Inflammatory Bowel Disease Unit, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland.
² Department of Internal Medicine and Hypertension, Medical University of Bialystok, Bialystok, Poland.
³ Department of Hypertension, Gastroenterology and Internal Medicine, Medical University of Bialystok Clinical Hospital, Bialystok, Poland.
⁴ Collegium Medicum, Jan Kochanowski University, Kielce, Poland.

Abstract

Introduction: Gastrointestinal (GI) symptoms can be considered as a manifestation of coronavirus disease 2019 (COVID-19).

Aim: Our study analysed GI symptoms depending on their occurrence, and their possible causes and impact on the course of COVID-19.

Material and methods: A retrospective, single-centre assessment of the frequency, risk factors, and impact of GI symptoms in 441 patients with COVID-19.

Results: A statistically significant reduction in the length of stay (LOS) (15 days vs. 17 days; p = 0.04), intensive care unit admission (ICU) (16.9% vs. 26.8%; p = 0.02), and need for mechanical ventilation (14.1% vs. 23.4%; p = 0.02) in the group who had experienced GI symptoms before hospitalization was noticed. For comparison, patients who developed GI symptoms during hospitalization had statistically significantly longer LOS (21 days vs. 15 days; p = 0.0001), were more frequently admitted to the ICU (38.1% vs. 18.6%; p = 0.0003), and had a higher need for mechanical ventilation (32.7% vs. 16.2%; p < 0.001). Risk factors for GI symptoms during hospitalization in COVID-19 patients included age, Clostridioides difficile infection, and receiving certain treatment (antibiotics and lopinavir + ritonavir).

Conclusions: The GI symptoms that developed before admission to hospital correlated with reduced severity of the course of COVID-19. However, in the group of patients who developed GI symptoms during hospitalization, attention should be paid to concomitant treatment. The use of antibiotics should be limited because they are associated with the deterioration of the course of COVID-19; one of the reasons might be changes in the intestinal microbiome.

Keywords: coronavirus disease 2019 (COVID-19); coronavirus disease 2019 treatment; gastrointestinal symptoms.