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Meta-Analysis
. 2020 May;7(1):e000417.
doi: 10.1136/bmjgast-2020-000417.

Novelty in the gut: a systematic review and meta-analysis of the gastrointestinal manifestations of COVID-19

Vishnu Charan Suresh Kumar  1 , Samiran Mukherjee  2 , Prateek Suresh Harne  2 , Abinash Subedi  2 , Muthu Kuzhali Ganapathy  3 , Venkata Suresh Patthipati  4 , Bishnu Sapkota  5   6
Affiliations
Meta-Analysis

Novelty in the gut: a systematic review and meta-analysis of the gastrointestinal manifestations of COVID-19

Vishnu Charan Suresh Kumar et al. BMJ Open Gastroenterol. 2020 May.

Abstract

Background: The COVID-19 epidemic has affected over 2.6 million people across 210 countries. Recent studies have shown that patients with COVID-19 experience relevant gastrointestinal (GI) symptoms. We aimed to perform a systematic review and meta-analysis on the GI symptoms of COVID-19.

Methods: A literature search was conducted via electronic databases, including PubMed, Embase, Scopus, and Google Scholar, from inception until 20 March 2020. Data were extracted from relevant studies. A systematic review of GI symptoms and a meta-analysis comparing symptoms in severe and non-severe patients was performed using RevMan V.5.3.

Results: Pooled data from 2477 patients with a reverse transcription-PCR-positive COVID-19 infection across 17 studies were analysed. Our study revealed that diarrhoea (7.8%) followed by nausea and/or vomiting (5.5 %) were the most common GI symptoms. We performed a meta-analysis comparing the odds of having GI symptoms in severe versus non-severe COVID-19-positive patients. 4 studies for nausea and/or vomiting, 5 studies for diarrhoea and 3 studies for abdominal pain were used for the analyses. There was no significant difference in the incidence of diarrhoea (OR=1.32, 95% CI 0.8 to 2.18, Z=1.07, p=0.28, I2=17%) or nausea and/or vomiting (OR=0.96, 95% CI 0.42 to 2.19, Z=0.10, p=0.92, I2=55%) between either group. However, there was seven times higher odds of having abdominal pain in patients with severe illness when compared with non-severe patients (OR=7.17, 95% CI 1.95 to 26.34, Z=2.97, p=0.003, I2=0%).

Conclusion: Our study has reiterated that GI symptoms are an important clinical feature of COVID-19. Patients with severe disease are more likely to have abdominal pain as compared with patients with non-severe disease.

Keywords: abdominal pain; diarrhoea; epidemiology; gastrointestinal pathology; infectious diarrhoea.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Study flow diagram. GI, gastrointestinal.
Figure 2
Figure 2
Forest plots comparing patients with severe versus non-severe disease based on symptoms. (A) Diarrhoea, (B) nausea and/or vomiting, (C) abdominal pain.
Figure 3
Figure 3
Funnel plots showing publication bias. (A) Abdominal pain, (B) diarrhoea, (C) nausea and/or vomiting.
Figure 4
Figure 4
Percentage of patients with gastrointestinal symptoms. AER, Australian epidemiological report.
See this image and copyright information in PMC

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