Gastrointestinal Manifestations and Outcomes of COVID-19: A Comprehensive Systematic Review and Meta-analysis

Deep Mehta; Raveena Kelkar; Neel Patel; Parth D Trivedi; Sameer Dawoodi; Dhruvan Patel; Dhanshree Solanki; Akbar Hussain; Sanchitha Nagaraj; Azadeh Khayat; Vikramaditya Samala Venkata; Uvesh Mansuri; Urvish K Patel; Henry Sacks; Ashish Atreja

doi:10.7759/cureus.47028

Gastrointestinal Manifestations and Outcomes of COVID-19: A Comprehensive Systematic Review and Meta-analysis

Cureus. 2023 Oct 14;15(10):e47028. doi: 10.7759/cureus.47028. eCollection 2023 Oct.

Authors

Deep Mehta^{1

2}, Raveena Kelkar^{3

2}, Neel Patel⁴, Parth D Trivedi⁵, Sameer Dawoodi^{6

7}, Dhruvan Patel^{8

9}, Dhanshree Solanki¹⁰, Akbar Hussain¹¹, Sanchitha Nagaraj¹², Azadeh Khayat¹³, Vikramaditya Samala Venkata¹⁴, Uvesh Mansuri¹⁵, Urvish K Patel¹⁶, Henry Sacks¹⁷, Ashish Atreja^{18

19}

Affiliations

¹ Internal Medicine, Capital Health Regional Medical Center, Trenton, USA.
² Clinical Research, Icahn School of Medicine at Mount Sinai, New York, USA.
³ Internal Medicine, Cleveland Clinic Akron General, Akron, USA.
⁴ Public Health, Icahn School of Medicine at Mount Sinai, New York, USA.
⁵ Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, USA.
⁶ Gastroenterology, State University of New York Downstate Medical Center, New York, USA.
⁷ Internal Medicine, Yale New Haven Hospital, New Haven, USA.
⁸ Gastroenterology, Mercy Fitzgerald Hospital, Darby, USA.
⁹ Gastroenterology, University of Pennsylvania, Philadelphia, USA.
¹⁰ Hospital Administration, Rutgers University, New Brunswick, USA.
¹¹ Internal Medicine, Appalachian Regional Healthcare, Hazard, USA.
¹² Internal Medicine, Ramaiah Medical College, Banagalore, IND.
¹³ Pathology and Laboratory Medicine, Brown University, Providence, USA.
¹⁴ Internal Medicine, Cheshire Medical Center, Dartmouth-Hitchcock, Keene, USA.
¹⁵ Medicine, MedStar Union Memorial Hospital, Baltimore, USA.
¹⁶ Public Health and Neurology, Icahn School of Medicine at Mount Sinai, New York, USA.
¹⁷ Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, USA.
¹⁸ Internal Medicine (Division of Gastroenterology), Icahn School of Medicine at Mount Sinai, New York, USA.
¹⁹ Digital Health, University of California Davis Health, Sacramento, USA.

Abstract

Introduction Pulmonary symptoms are the most prominent manifestations of Coronavirus disease 2019 (COVID-19). However, gastrointestinal (GI) symptoms have been reported widely as well. Literature describing the relation of these symptoms with outcomes of COVID-19 patients is limited in terms of sample size, geographic diversity, and the spectrum of GI symptoms included. We aim to evaluate the association of GI symptoms with outcomes of hospitalized COVID-19 patients. Methods A systematic review and meta-analysis of observational studies assessing GI symptoms and outcomes in COVID-19 patients were undertaken using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria and the Meta-analysis of Observational Studies in Epidemiology (MOOSE) checklist. Details on outcomes included ICU vs. non-ICU admission, severe vs. non-severe disease, invasive mechanical ventilation (IMV) vs. no-IMV use, oxygen saturation <90% vs. >90%, in-hospital mortality vs. discharged alive and survivors. We obtained the odds ratio (OR), 95% confidence interval (95%CI), and forest plots. Sensitivity analysis was used to analyze publication bias and heterogeneity. Results In 35 studies with 7931 confirmed COVID-19 patients, we found that anorexia (pooled OR:2.05; 95%CI: 1.36-3.09, p=0.0006) and abdominal pain (OR 2.80; 95%CI: 1.41-5.54, p=0.003) were associated with a higher risk of poor outcomes and no such association was found for diarrhea (OR 1.04; 95%CI: 0.85-1.26, p=0.71), nausea (OR 0.73; 95%CI: 0.38-1.39, p=0.34) and vomiting (OR 1.24; 95%CI 0.86-1.79, p=0.25). Conclusion The meta-analysis concludes that anorexia and abdominal pain are associated with poor outcomes in hospitalized COVID-19 patients, while diarrhea, nausea, and vomiting have no association. Future research should focus on whether detecting GI invasion in conjunction with fecal polymerase chain reaction (PCR) testing can aid in the early triage of high-risk individuals and improve outcomes.

Keywords: abdominal pain; anorexia; covid-19; diarrhea; gastrointestinal symptoms; nausea; outcomes; vomiting.

Publication types

Review