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. 2020 Nov 25:53:e20200714.
doi: 10.1590/0037-8682-0714-2020. eCollection 2020.

COVID-19 gastrointestinal manifestations: a systematic review

Filipe Antônio França da Silva  1 , Breno Bittencourt de Brito  1 , Maria Luísa Cordeiro Santos  1 , Hanna Santos Marques  2 , Ronaldo Teixeira da Silva Júnior  1 , Lorena Sousa de Carvalho  1 , Elise Santos Vieira  1 , Márcio Vasconcelos Oliveira  1 , Fabrício Freire de Melo  1
Affiliations

COVID-19 gastrointestinal manifestations: a systematic review

Filipe Antônio França da Silva et al. Rev Soc Bras Med Trop. .

Abstract

Introduction: The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has greatly challenged public health worldwide. A growing number of studies have reported gastrointestinal (GI) symptoms. We performed a systematic review of GI symptoms associated with coronavirus disease 2019 (COVID-19) as well as of the serum levels of biomarkers related to liver function and lesion in SARS-CoV-2-infected individuals.

Methods: We surveyed relevant articles published in English, Spanish, and Portuguese up to July, 2020 in the PubMed, MEDLINE, SciELO, LILACS, and BVS databases. Moreover, we surveyed potentially important articles in journals such as the NEJM, JAMA, BMJ, Gut, and AJG.

Results: This systematic review included 43 studies, including 18,246 patients. Diarrhea was the most common GI symptom, affecting 11.5% of the patients, followed by nausea and vomiting (6.3%) and abdominal pain (2.3%). With regard to clinical severity, 17.5% of the patients were classified as severely ill, whereas 9.8% of them were considered to have a non-severe disease. Some studies showed increased aspartate transaminase and alanine aminotransferase levels in a portion of the 209 analyzed patients and two studies.

Conclusions: Our results suggest that digestive symptoms are common in COVID-19 patients. In addition, alterations in cytolysis biomarkers could also be observed in a lesser proportion, calling attention to the possibility of hepatic involvement in SARS-CoV-2-infected individuals.

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Conflict of interest statement

Conflict of Interest: The authors declare that there is no conflict of interest.

Figures

FIGURE 1:
FIGURE 1:. Summary of study selection process.
FIGURE 2:
FIGURE 2:. Geographical distribution of the studies.
FIGURE 3:
FIGURE 3:. Scatter plot of gastrointestinal symptoms in patients with COVID-19. Legend: Graph showing the number of COVID-19 positive patients and the gastrointestinal symptoms seen in 18,246 analyzed patients.
FIGURE 4:
FIGURE 4:. Quality analysis chart of included studies.
See this image and copyright information in PMC

References

    1. Phelan AL, Katz R, Gostin LO. The Novel Coronavirus Originating in Wuhan, China: Challenges for Global Health Governance. JAMA. 2020;323(8):709–710. - PubMed
    1. Sharma A, Tiwari S, Deb MK, Marty JL. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2): a global pandemic and treatment strategies. Int J Antimicrob Agents. 2020;56(2):106054–106054. - PMC - PubMed
    1. Cha MH, Regueiro M, Sandhu DS. Gastrointestinal and hepatic manifestations of COVID-19: A comprehensive review. World J Gastroenterol. 2020;26(19):2323–2332. - PMC - PubMed
    1. World Health Organization . Coronavirus disease 2019 (COVID-19) situation report 192; 2020. WHO; Geneva: 2020. [2020 september 4]. Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/2....
    1. Coronaviridae Study Group of the International Committee on Taxonomy of Viruses The species Severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2. Nat Microbiol. 2020;5(4):536–544. - PMC - PubMed

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