Abstract
COVID-19 AND THE GASTROINTESTINAL SYSTEM: A SYSTEMATIC REVIEW AND METANALYSIS

Nidhi Patel*, Qingqing Wen, George Fahad Sayegh, Onaolapo O. Oluwatayo, Nawal Rafiq, Nouman Anthony, Farzan Salehi, Nabeel Hussain, Febin Prince, Raj Kumary, Rida Tafveez, Eli C Garcia Bautista, Lea Bach-Bachich and Relfa Dellanira Proano

ABSTRACT

Objective: At present, the novel coronavirus disease (COVID-19) is causing a major pandemic. COVID-19 is caused by Severe Acute Respiratory Syndrome-2 (SARS-COV-2). In COVID-19, the patient generally presents with fever, dry cough, and respiratory signs and symptoms. Involvement of other systems has also been reported. Abdominal pain, diarrhea, vomiting, and nausea are the predominant gastrointestinal symptoms, underlined in the literature. In this article, we summarized the important GIT characteristics of the disease. Methods: We conducted a literature search using four databases (PubMed, Google Scholar, Web of Science, and Clinicaltrials.gov). Our search strategy included MeSH terms and keywords for COVID-19, SARS-CoV-2, and gastrointestinal system from inception to December 2020. After excluding review articles, duplicates, and non-relevant, we included 60 studies out of 558 articles reporting gastrointestinal (GI) manifestations such as nausea, vomiting, abdominal pain, and diarrhea. Using the 'meta' package (Schwarzer et al.) in the R programming language, version 4.0.2, a compute pooled analysis using the random effect model was performed. Results: The overall prevalence of GI signs and symptoms in affected patients with COVID-19, was 27% (95% CI: 21-35) (p<0.05) (I2 =94%). GI inolvement as an initial presentation was reported in six studies with prevalence of 6% (95% CI: 05-83) (p<0.01) (I2 =88%), with diarrhea being 17% (95% CI: 12-19) (p=0.01) (I2 =94), anorexia being 34% (95% CI: 22-38) (p<0.01) (I2 =96%), abdominal pain being 16% (95% CI: 11-20) (p<0.01) (I2 =95%), and nausea/vomiting nearing 17% (95% CI: 13-22) (p<0.01) (I2 =88%). Severe COVID-19 with GI symptoms were reported with prevalence of 16% (95%CI: 19-31) (p<0.01) (I2 =90%). Hepatic abnormalities in COVID-19 were reported with prevalence of 28% (95% CI: 14-33) (p<0.01) (I2 =97%). Conclusion: We perceive that COVID-19 may have several gastrointestinal manifestations, and in many cases, GI involvement may precede typical upper respiratory tract symptoms. Holistic knowledge of the spectrum of the COVID-19 GI consequences is crucial to get a hold of the virus spread.

Keywords: COVID-19, SARS-COV-2, Gastrointestinal, Hepatic manifestation.


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