Epidemiological, clinical and virological characteristics of 74 cases of coronavirus-infected disease 2019 (COVID-19) with gastrointestinal symptoms

Jin, Xi; Lian, Jiang-Shan; Hu, Jian-Hua; Gao, Jianguo; Zheng, Lin; Zhang, Yi-Min; Hao, Shao-Rui; Jia, Hong-Yu; Cai, Huan; Zhang, Xiao-Li; Yu, Guo-Dong; Xu, Kai-Jin; Wang, Xiao-Yan; Gu, Jue-Qing; Zhang, Shan-Yan; Ye, Chan-Yuan; Jin, Ci-Liang; Lu, Ying-Feng; Yu, Xia; Yu, Xiao-Peng; Huang, Jian-Rong; Xu, Kang-Li; Ni, Qin; Yu, Cheng-Bo; Zhu, Biao; Li, Yong-Tao; Liu, Jun; Zhao, Hong; Zhang, Xuan; Yu, Liang; Guo, Yong-Zheng; Su, Jun-Wei; Tao, Jing-Jing; Lang, Guan-Jing; Wu, Xiao-Xin; Wu, Wen-Rui; Qv, Ting-Ting; Xiang, Dai-Rong; Yi, Ping; Shi, Ding; Chen, Yanfei; Ren, Yue; Qiu, Yun-Qing; Li, Lan-Juan; Sheng, Jifang; Yang, Yida

This study enrolled 651 patients with confirmed COVID-19 from 17 January 2020 to 8 February 2020 in Zhejiang province, among which 74 (11.4%) patients presented with at least one GI tract symptom (nausea, vomiting and diarrhoea), which was higher than previous Wuhan data (table 1) . In detail, of 74 patients with COVID-19 with GI symptoms, 53 patients had only the symptom of diarrhoea, 11 patients had only the symptom of vomiting and 10 patients had only the symptom of nausea. In addition, only three patients had all the GI symptoms of diarrhoea, vomiting and nausea, while four patients had the symptoms of both nausea and vomiting. Diarrhoea was the most common GI symptom in this study and accounted for 8.14% of the total enrolled 651 patients with COVID-19, which was higher than the rate of 3.8% reported previously. 14 Of 53 patients with COVID-19 with diarrhoea, the median duration period was 4 days (IQR: 3-6 days), with the shortest duration of 1 day and longest of 9 days. Most diarrhoea was self-limiting. The average age of the patients with GI symptoms was 46.14±14.19 years and the male:female ratio was 1:1. There were no coexisting conditions of cancer, chronic renal disease, pregnancy, chronic obstructive pulmonary disease or immunosuppression. Thirty-eight (51.35%) patients had a Wuhan exposure history and 32 (43.24%) patients had a history of contact with patients with COVID-19. Intriguingly, the rate of chronic liver disease was 10.81% in patients with COVID-19 with GI symptoms, which was significantly higher than that of 2.95% in those without GI symptoms (p=0.004). More importantly, the rate of the severe/critical type was also markedly increased in patients with COVID-19 with GI symptoms than in those without GI symptoms (22.97% vs 8.14%, p<0.001). Family clustering is another pivotal phenomenon of COVID-19. We identified that 23 (31.08%) patients with GI symptoms had family clustering, which was prominently higher than that in patients without GI symptoms (20.45%, p=0.037). Twenty-one patients with COVID-19 with GI symptoms and 195 without them had definite exposure times, with the median calculated incubation period as 4 days (IQR 3-7 days) and 5 days (IQR 3-8 days), respectively.