Prevalence, Mechanisms, and Implications of Gastrointestinal Symptoms in COVID-19

Abstract

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. The infection started as an outbreak of pneumonia-like symptoms in Wuhan, China. Within a few weeks, it spread across the entire globe resulting in millions of cases and thousands of deaths. While respiratory symptoms and complications are well-defined and can be severe, non-respiratory symptoms of COVID-19 are increasingly being recognized. Gastrointestinal manifestations such as nausea, vomiting, diarrhea, and abdominal pain have been added to the list of common COVID-19 symptoms. Their prevalence has been increasing, probably due to increased recognition and experience with the pandemic. Furthermore, diarrhea and stool testing may change prevalence and transmission rates due to suspicion for fecal-oral transmission of the COVID-19. Due to this risk, various countries have started testing wastewater and sewage systems to examine its role in the spread of SARS-CoV-2 among communities. In this review article, we describe the common gastrointestinal manifestations in COVID-19, their prevalence based upon the current literature, and highlight the importance of early recognition and prompt attention. We also note the role of fecal-oral transmission. Furthermore, the mechanisms of these symptoms, the role of medications, and potential contributing factors are also elaborated.

Keywords: COVID-19; SARS-CoV-2; diarrhea; endoscopy; fecal-oral transmission; gastrointestinal symptoms.

Figure 1

Schematic representation of various gastrointestinal (GI) manifestations with their mechanisms. SARS-CoV-2 gains entry via mucous membranes of the oral cavity enters the stomach and small intestine to exert its cytopathic effect. Additionally, gut inflammation, altered gut flora, drug-induced changes, worsening of pre-existing GI condition, and secondary infections could contribute to these symptoms.