Gut symptoms are in mild COVID-19 disease, sometimes without fever

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In a new study, researchers did the first analysis of gastrointestinal symptoms reported by COVID-19 patients with the mild disease rather than those with a moderate or critical illness.

They found a unique sub-group with low severity disease marked by the presence of digestive symptoms, most notably diarrhea.

Among some of the patients included in the study, these digestive symptoms, particularly diarrhea, were the presentation of COVID-19, and were only later, or never, present with respiratory symptoms or fever.

This study is vital because it represents 80% or more of patients who do not have severe or critical conditions.

This is about the more common scenario of people in the community struggling to figure out if they might have COVID-19 because of new-onset diarrhea, nausea, or vomiting.

The research was conducted by a team from Union Hospital and Tongji Medical College in Wuhan, China.

The analysis included 206 patients with low severity COVID-19, including 48 presenting with a digestive symptom alone, 69 with both digestive and respiratory symptoms, and 89 with respiratory symptoms alone.

Between the two groups with digestive symptoms, 67 presented with diarrhea, of whom about one in five experienced diarrhea as the first symptom in their illness course.

Diarrhea lasted from 1 to 14 days, with an average duration of over five days and a frequency of around four bowel movements per day.

Concurrent fever was found in 62% of patients with a digestive symptom, meaning that nearly one-third did not have a fever.

Patients with digestive symptoms presented for care later than those with respiratory symptoms (16 days vs. 11-day delay, p<0.001) and this delay in care is consistent with a recent study that analyzed 204 sicker patients from three hospitals in Wuhan, China.

In the current analysis, those with digestive symptoms had a longer total course between symptom onset and viral clearance.

Patients with digestive symptoms were more likely to be fecal virus-positive (73% versus 14%) and have a longer overall course of the illness versus those with respiratory symptoms.

The authors conclude that digestive symptoms are common in the community, and most instances of new-onset diarrhea, nausea, vomiting, or low appetite are not from COVID-19.

Nonetheless, clinicians should recognize that new-onset, acute digestive symptoms in a patient with a possible COVID-19 contact should at least prompt consideration of the illness, particularly during times of high COVID-19 incidence and prevalence.

Failure to recognize these patients early and often may lead to the unwitting spread of the disease among outpatients with mild illness who remain undiagnosed and unaware of their potential to infect others.

The data in this study highlight the presence and features of this important subgroup of COVID-19 patients and should be confirmed in larger international studies.

The study is published in The American Journal of Gastroenterology.

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