Can Covid-19 (Coronavirus disease 2019) cause gastrointestinal symptoms?

From the Guidelines

Yes, COVID-19 can cause gastrointestinal symptoms, including diarrhea, nausea, vomiting, abdominal pain, and loss of appetite, which may occur with or without typical respiratory symptoms like cough and fever. These GI symptoms may be present in up to 37% of patients with COVID-19, as reported in a study published in Gastroenterology 1. The virus can directly infect the cells lining the digestive tract because these cells contain ACE2 receptors, which serve as entry points for the SARS-CoV-2 virus. Viral RNA has been detected in stool samples of infected individuals, suggesting direct viral involvement in the digestive system 1. Some key points to consider:

• Gastrointestinal symptoms, including diarrhea, nausea, vomiting, abdominal pain, and loss of appetite, are common in patients with COVID-19, with a prevalence of up to 37% 1.
• These symptoms may occur with or without typical respiratory symptoms like cough and fever.
• The virus can directly infect the cells lining the digestive tract because these cells contain ACE2 receptors, which serve as entry points for the SARS-CoV-2 virus 1.
• Viral RNA has been detected in stool samples of infected individuals, suggesting direct viral involvement in the digestive system 1.
• If you experience unexplained gastrointestinal symptoms, especially if accompanied by other COVID-19 symptoms or after potential exposure, you should consider getting tested for COVID-19 and follow isolation guidelines if positive.
• Treatment for COVID-19 gastrointestinal symptoms is generally supportive, focusing on maintaining hydration and managing specific symptoms as needed. It is essential to note that the prevalence of gastrointestinal symptoms in COVID-19 patients may vary depending on the population studied and the criteria used to define these symptoms 1. However, the available evidence suggests that gastrointestinal symptoms are a common manifestation of COVID-19 infection.

From the Research

Gastrointestinal Symptoms of Covid-19

• Covid-19 can cause gastrointestinal symptoms, with studies reporting that 11.4-61.1% of individuals with Covid-19 experience GI manifestations 2.
• The most common gastrointestinal symptoms include anorexia, diarrhea, nausea, vomiting, and abdominal pain/discomfort 2, 3, 4.
• A minority of patients may present with more severe gastrointestinal symptoms, such as acute pancreatitis, acute appendicitis, intestinal obstruction, bowel ischemia, hemoperitoneum, or abdominal compartment syndrome 2.
• The gastrointestinal tract can be a potential site for virus replication, and feces can be a source of transmission 4, 5.

Pathophysiology and Transmission

• The mechanism underlying gastrointestinal symptoms may involve damage to the intestinal mucosal barrier and promotion of the production of inflammatory factors 5.
• The virus can affect the gut and liver, with evidence of acute hepatocellular injury and elevated liver enzymes 6.
• Fecal-oral transmission of Covid-19 is suspected due to the presence of Covid-19 RNA in stool samples of Covid-19-positive patients 5, 6.

Prevalence and Characteristics

• A cross-sectional study found that 58.78% of Covid-19 patients had enteric involvement, with diarrhea and nausea/vomiting being the most common symptoms 4.
• Gastrointestinal symptoms were more common among vaccinated individuals than non-vaccinated ones, with Covid-19 vaccination associated with 4.32 times higher odds of having gastrointestinal involvement 4.
• The majority of cases with gastrointestinal involvement were below 50 years of age 4.