Gastrointestinal symptoms among COVID-19 patients presenting to a primary health care center of Nepal: A cross-sectional study

Shekhar Gurung; Saurab Karki; Bishnu Deep Pathak; Gopal K Yadav; Gaurab Bhatta; Sumin Thapa; Sabin Banmala; Anil J Thapa; Kumar Roka

doi:10.1002/hsr2.1568

Gastrointestinal symptoms among COVID-19 patients presenting to a primary health care center of Nepal: A cross-sectional study

Health Sci Rep. 2023 Sep 14;6(9):e1568. doi: 10.1002/hsr2.1568. eCollection 2023 Sep.

Authors

Shekhar Gurung¹, Saurab Karki², Bishnu Deep Pathak³, Gopal K Yadav⁴, Gaurab Bhatta⁵, Sumin Thapa⁶, Sabin Banmala², Anil J Thapa², Kumar Roka²

Affiliations

¹ Department of Internal Medicine Bharatpur Hospital Chitwan Nepal.
² Nepalese Army Institute of Health Sciences (NAIHS) Shree Birendra Hospital, Chhauni Kathmandu Nepal.
³ Jibjibe PHC Rasuwa Nepal.
⁴ Department of Internal Medicine Pokhariya Hospital Parsa Nepal.
⁵ Sundarbazar Hospital Lamjung Nepal.
⁶ Mechalkuna Hospital Surkhet Nepal.

Abstract

Background and aim: Coronavirus disease 2019 (COVID-19) is a major public health problem causing significant morbidity and mortality worldwide. Apart from respiratory symptoms, gastrointestinal symptoms like nausea, vomiting, diarrhea, and abdominal discomfort are quite common among COVID-19 patients. The gastrointestinal tract can be a potential site for virus replication and feces a source of transmission. Thus, ignorance of enteric symptoms can hinder effective disease control. The objective of this study is to see the gastrointestinal manifestation of the disease and its effect on morbidity and mortality.

Methods: This observational cross-sectional retrospective study was carried out among 165 laboratory-confirmed COVID-19 patients in primary health care of Gorkha, Nepal from March 1, 2021 to March 1, 2022. A systematic random sampling method was adopted while data were entered and analyzed by Statistical Package for Social Sciences version 21.

Results: Of 165 patients, 97 patients (58.78%) had enteric involvement. Among gastrointestinal symptoms, diarrhea in 67 patients (40.6%) and nausea and/or vomiting in 66 patients (40%) were the most common symptoms, followed by abdominal pain in 27 patients (16.4%) and anorexia in 19 patients (11.5%). Of the majority of cases with gastrointestinal involvement, 63 (63%) were below 50 years of age. Many of the patients who received vaccination had gastrointestinal symptoms (79%). Complications like acute respiratory distress syndrome, shock, and arrhythmia developed in 9.7% of patients, with the death of eight patients. COVID-19 vaccination was associated with 4.32 times higher odds of having gastrointestinal involvement in subsequent COVID-19 infection.

Conclusions: Diarrhea followed by nausea/vomiting was among the most common gastrointestinal symptoms affecting younger age groups in our study. Enteric symptoms were more common among vaccinated people rather than among nonvaccinated ones.

Keywords: gastroenterology/hepatology; infectious diseases; virology.