In a recent study from Union Hospital and Tongji Medical College, researchers found gut symptoms in COVID-19 patients with 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 80% or more of patients who do not have severe or critical conditions.
The study is published in The American Journal of Gastroenterology.
In the study, 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).
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 team concludes 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.
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