Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Sep 12;4(6):1096-1101.
doi: 10.1002/jgh3.12394. eCollection 2020 Dec.

Gastrointestinal manifestation as clinical predictor of severe COVID-19: A retrospective experience and literature review of COVID-19 in Association of Southeast Asian Nations (ASEAN)

Natsuda Aumpan  1 , Pongjarat Nunanan  1 , Ratha-Korn Vilaichone  1   2   3
Affiliations

Gastrointestinal manifestation as clinical predictor of severe COVID-19: A retrospective experience and literature review of COVID-19 in Association of Southeast Asian Nations (ASEAN)

Natsuda Aumpan et al. JGH Open. .

Abstract

Background and aim: Coronavirus disease 19 (COVID-19) has caused over 200 000 deaths worldwide. Thailand announced the first confirmed case outside mainland China in January 2020. The disease also spread widely across Association of Southeast Asian Nations (ASEAN). Gastrointestinal manifestations could be presenting symptoms of COVID-19. This study aimed to determine the prevalence of gastrointestinal manifestations of COVID-19 patients in Thailand and review important aspects of this disease in ASEAN.

Methods: Thai patients diagnosed with COVID-19 at Thammasat University Hospital, Thailand, were evaluated between 1 January 2020 and 30 April 2020. Patients' data, clinical presentation, exposure risk, past medical history, laboratory results, and treatment outcomes were extensively reviewed.

Results: A total of 352 COVID-19 tests were performed, and 40 patients with positive tests were studied. The mean age was 30.5 years, and 55% were female. Most (82.5%) had no underlying diseases. Comorbidities were associated with severe COVID-19 (odds ratio [OR] 29.93; 95% confidence interval [CI] 2.31-388.40, P = 0.009). Gastrointestinal symptoms were present in 12 patients (30%). The most common presenting symptoms were anorexia (17.5%) and diarrhea (15%). Gastrointestinal symptoms developed before (9.1%), concurrent with (63.6%), and after (27.3%) respiratory symptoms. Diarrhea was significantly associated with severe COVID-19 (OR 38.52; 95% CI 3.11-476.70, P = 0.004). Twenty-four patients (60%) received antiviral drugs; 40% had only supportive care. Only one patient required intensive care. No patient died.

Conclusions: Gastrointestinal manifestations in COVID-19 patients are common symptoms and can occur anytime during the disease course. Patients presenting with only gastrointestinal symptoms should raise clinical suspicion for COVID-19 in areas with high disease incidence. Clinically severe COVID-19 was associated with comorbidities and diarrhea.

Keywords: Association of Southeast Asian Nations (ASEAN); COVID‐19; gastrointestinal manifestations.

PubMed Disclaimer

Figures

Figure 1
Figure 1
The geographic distribution of COVID‐19 patients in Thailand (left) and ASEAN (right). The official data of all confirmed cases in Thailand were retrieved from the Department of Disease Control, Ministry of Public Health, Thailand, as of 1 May 2020. The official data of all confirmed cases in ASEAN were obtained from World Health Organization as of 1 May 2020.
Figure 2
Figure 2
Total case trend in ASEAN. The official data of all confirmed cases in ASEAN were obtained from World Health Organization between 1 April 2020 and 1 May 2020.
See this image and copyright information in PMC

References

    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: 536–44. - PMC - PubMed
    1. Huang C, Wang Y, Li X et al Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020; 395: 497–506. - PMC - PubMed
    1. Wang D, Hu B, Hu C et al Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus‐Infected Pneumonia in Wuhan, China. JAMA. 2020; 323: 1061–9. - PMC - PubMed
    1. Aguila EJT, Cua IHY, Dumagpi JEL et al COVID‐19 and its effects on the digestive system and endoscopy practice. JGH Open. 2020; 4: 324–31. - PMC - PubMed
    1. Ling KL, Hilmi I, Raja Ali RA et al Asian Pacific Association of Gastroenterology (APAGE) Inflammatory Bowel Disease (IBD) Working Party guidelines on IBD management during the COVID‐19 pandemic. JGH Open. 2020; 4: 320–3. - PMC - PubMed