Gastrointestinal symptoms in patients with mild and severe COVID-19: a scoping review and meta-analysis

Abstract

Aim: The current research aimed to analyze and summarize observational studies that compared the incidence of gastrointestinal symptoms in mild and severe COVID-19 infection.

Background: Coronavirus disease 2019 (COVID-19) has been identified as a public health threat worldwide. Previous studies, however, have reported contradictory results of COVID-19-related gastrointestinal symptoms in severe and mild forms.

Methods: A search of Medline, ISI Web of Science, EMBASE, and Cochrane Library databases was conducted for articles published up to May 2020. Data from each study was combined using the random-effects model to calculate odds ratios (ORs) and 95% confidence intervals (95% CIs). Sensitivity was examined by sequentially excluding one study in each turn. Publication bias was evaluated using the Egger's and Begg's tests.

Results: Twenty studies (4,265 patients) were reviewed. It was found that the prevalence of diarrhea [OR (0.40), (95% CI 0.91, -2.16), p = 0.03, I2 = 88.1%, PHeterogenity = 0.00)] and nausea and vomiting [OR (0.27), (95% CI 0.07, 1.01), p = 0.05, I2 = 89.3%, PHeterogenity = 0.00)] increased significantly in the severe form compared to the mild form of COVID-19, while abdominal pain and anorexia had no significant increased prevalence in admitted and hospitalized COVID-19 patients. Moreover, COVID-19-related gastrointestinal symptoms were seen in higher rates in males [OR (1.42), (95% CI 1.23, 1.65), p < 0.05, I2= 18.4%, PHeterogenity = 0.23] than in females. No significant publication bias was observed in the meta-analysis. Sensitivity analyses showed a similar effect size while reducing the heterogeneity.

Conclusion: The data provides valuable information for the discovery of prognosis biomarkers to diagnosis more severe disease in the early stages of COVID-19.

Keywords: COVID-19; Coronavirus; Digestive symptoms; Gastrointestinal symptoms; Meta-analysis.

Figure 1

Flow chart of study selection for meta-analysis

Figure 2

Forest plots detailing odds ratio (OR) and 95% confidence intervals of the incidence of COVID-19-related gastrointestinal symptoms of a) diarrhea, b) nausea and vomiting, c) abdominal pain, and d) anorexia in admitted and hospitalized patients. Meta-analysis was performed using a random-effects model

Figure 3

Forest plots assessing odds ratio (OR) and 95% confidence intervals between genders, a) male and b) female, and risk of increased incidence of COVID-19-related gastrointestinal symptoms in admitted and hospitalized patients. Meta-analysis was performed using a random-effects model

Figure 4

Random effects funnel plots detailing publication bias in the studies investigating the gastrointestinal symptoms of a) diarrhea, b) nausea and vomiting, c) abdominal pain, and d) anorexia in severe and mild forms of COVID-19 in admitted and hospitalized patients after trimming and filling. Open circles represent observed published studies; closed circles represent imputed unpublished studies

Figure 5

Random effects meta-regression plots of the association between the prevalence of gastrointestinal symptoms in COVID-19 patients with the variable of gender. The size of each circle is inversely proportional to the variance of change. Meta-analysis was performed using a random-effects model