GI symptoms in COVID-19 have been reported at rates as low as 5% and as high as 50%. This short clinical update highlights what is known and how to care for GI patients.
Cough, fever, fatigue, or sore throat are the most common symptoms of COVID-19, however there is recent evidence suggesting the potential for coronavirus transmission through droplets and perhaps fecal shedding. While new science is coming out all the time about novel coronavirus and the resulting disease, here we will review the current understanding from a GI perspective along with current recommendations from the American College of Gastroenterology.
Special considerations for GI conditions
The incidence of nausea and/or diarrhea in COVID-19 is not completely known since there are some reports of these symptoms ocurring in less than 5% of patients and others at that say as high as 50%.
However, there have been some reports of isolated diarrhea preceding cough and fever.
Currently, GI societies have put out statements that asymptomatic spread can occur during the prodromal phase, with viral shedding greatest when symptoms begin. It has been demonstrated that viral RNA is detectable in stool and for this reason, potential fecal-oral transmission must be considered
Along with GI symptoms, abnormal liver enzymes have been recorded in 20 to 30% of patients with COVID-19 infection. The other associated laboratory abnormalities are seen in the complete blood count.
Specifically, a leukocyte count drop or elevated WBC is a poor prognostic sign in COVID-19 infection.
Caring for patients with GI conditions
There will be an expected increase in GI procedures in the post-quarantine era as the elective procedures that were rescheduled need to be performed. Working with your gastroenterology colleagues to help prioritize cases will be most effective as the backlog is being sorted. Together we will succeed in caring for our patients during their time of need.
Gu J, Han B, Wang J. COVID-19: Gastrointestinal manifestations and potential fecal-oral transmission. Gastroenterology. 2020 Mar 3. pii: S0016-5085(20)30281-X. [Epub ahead of print] https://doi.org/10.1053/j.gastro.2020.02.054
Huang C, Wang Y, Li X, Ren L, Hao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395: 497-506 https://doi.org/10.1016/S0140-6736(20)30183-5
WEO ALERT: Wuhan proposal for Safety in Digestive Endoscopy. http://www.worldendo.org/2020/02/05/weo-alert-wuhan-proposal-for-safety-in-digestive-endoscopy/
Xiao F, Tang M, et al. Evidence for gastrointestinal infection of SARS-CoV-Gastroenterology. 2020 Mar 3. pii: S0016-5085(20)30282-1. [Epub ahead of print] https://doi.org/10.1053/j.gastro.2020.02.055