Prevalence and Mortality of COVID-19 patients with Gastrointestinal Symptoms: A Systematic Review and Meta-analysis

Tariq, Raseen; Saha, Srishti; Furqan, Fateeha; Hassett, Leslie; Pardi, Darrell; Khanna, Sahil

Abstract Objectives To perform a systematic review and meta-analysis evaluating the prevalence of gastrointestinal (GI) symptoms and mortality in patients diagnosed with coronavirus disease 2019 (COVID-19). Methods A systematic search of MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and Scopus was performed from 2019 to May 7th, 2020. Observational studies including adults with COVID-19 infection and reporting GI symptoms were included. Primary outcome was assessing weighted pooled prevalence (WPP) of GI symptoms in patients with COVID-19. Secondary outcomes were WPP of overall mortality, and mortality in COVID-19 patients with GI symptoms. Results A total of 78 studies with 12797 patients were included. Among GI symptoms (at onset of illness in 6, at admission in 17, data given separately for both in 3, data unavailable in 52 studies), WPP of diarrhea was 12% (95% CI, 8%-17%), I 2 =94%, nausea and/or vomiting was 9.0% (95% CI, 5.5%-12.9%). I 2 =93%, loss of appetite was 22.3% (95% CI, 11.2%-34.6%, I 2 =94%, and that of abdominal pain was 6.2% (95% CI, 2.6%-10.3%, I 2 =92%. Mortality among patients with GI symptoms [0.4% (95% CI, 0%-1.1%), I 2 =74%] was similar to overall mortality [2.1% (95% CI, 0.2%-4.7%), I 2 =94%], p=0.15. Majority of studies had high risk of bias and overall quality of evidence was low to very low for all outcomes. Conclusions Gastrointestinal symptoms are seen in up to one in five patients with COVID-19. More high quality evidence is needed to confirm these findings and to explore factors causing mortality in these patients.