Gastrointestinal Symptoms in Covid-19 Patients

ABSTRACT

Aim: Gastrointestinal (GI) symptoms have been reported with coronavirus disease (COVID-19), but our understanding of their clinical significance is limited and this can be a safety concern for surgeons as patients might present with GI symptoms only. Method(s) A prospectively maintained database of emergency patients was reviewed between 20/03/2020 and 20/04/2020 (Cohort A) and 05/01/2021-26/ 01/2021. (Cohort B) All of them had a positive Polymerase Chain Reaction (PCR) COVID-19 test. We evaluated the prevalence of GI symptoms and their association with the severity of COVID-19 and looked at the prevalence of symptoms in different ethnicities. Chi-squared test in R software environment was used to analyse the data. Result(s) Cohort A consisted of 189 patients (100 male) 14 had nausea, 18 vomiting, 39 diarrhoea and 9 abdominal pain. 17 had ITU admissions and 68 died. Cohort B consisted of 348 patients (185 male) 50 had nausea, 46 vomiting, diarrhoea 84 and 23 had abdominal pain. 30 had ITU admissions and 75 died. In this cohort the COVID-19 Alpha Variant was making up nearly 100% of cases. Nausea was more common in Cohort B 50/348 (P = 0.01641) There was no difference in vomiting (18/189 Cohort A P = 0.198898), diarrhoea (39/189 Cohort A, P = 0.3385) and abdominal pain (9/189 Cohort A P = 0.379). There was no difference in GI symptoms for the severe and non-severe cases in Cohort A (P = 0.150813) but they were more prevalent in the non-severe group of Cohort B (P = 0.008). There was no diifference between ethnic groups in terms of GI symptoms (Cohort A 35 Black patients,17 Asian, 102 White and 35 Other Ethnicities, Cohort B 40 Black, 33 Asian, 174 White and 101 Other Ethnicities). Conclusion(s) Acute GI symptoms associated with COVID-19 are highly prevalent and were seen more often in non-severe cases of Cohort B. The SARS-CoV- 2 Alpha Variant was endemic in our region and the UK vaccination programme was being rolled out at the time of our study. More research is required to establish the significance of these factors.