Digestive Manifestations in Patients Hospitalized With Coronavirus Disease 2019

• Authors: Joseph B Elmunzer, Medical University of South Carolina; Rebecca L Spitzer, Medical University of South Carolina; Lydia D Foster, Medical University of South Carolina; Ambreen A Merchant, Emory University; Eric F Howard, Vanderbilt University; Vaishali Patel, Emory University; Mary K West, Vanderbilt University; Emad Qayed, Emory University; Rosemary Nustas, Emory University; Ali Zakaria, Michigan State University; Marc S Piper, Michigan State University; Jason R Taylor, Saint Louis University; Lujian Jaza, Saint Louis University; Nauzer Forbes, University of Calgary; Millie Chau, University of Calgary; Lusi F Lara, Ohio State University; Georgios I Papachristou, Ohio State University; Michael L Volk, Loma Linda University; Liam G Hilson, University of Southern California; Selena Zhou, University of Southern California; Vladimar M Kushnir, Washington University in St. Louis; Alexandria M Lenyo, Washington University in St. Louis; Caroline G McLeod, Medical University of South Carolina; Sunil Amin, University of Miami; Gabriela N Kuftinec, University of Miami; Dhiraj Yadav, University of Pittsburgh; Charlie Fox, University of Colorado, Aurora; Jennifer M Kolb, University of Colorado, Aurora; Swati Pawa, Wake Forest University; Rishi Pawa, Wake Forest University; Andrew Canakis, Boston University; Christopher Huang, Boston University; Laith H Jamil, Beaumont Health; Andrew M Aneese, Beaumont Health; Benita K Glamour, University Hospitals of Cleveland; Zachary L Smith, University Hospitals of Cleveland; Katherine A Hanley, Northwestern University; Jordan Wood, Northwestern University; Harsh K Patel, Ochsner Health; Janak N Shah, Ochsner Health; Emil Agarunov, Columbia University; Amrita Sethi, Columbia University; Evan L Fogel, Indiana University; Gail McNulty, Indiana University; Abdul Haseeb, Loyola University; Judy A Trieu, Loyola University; Rebekah E Dixon, Icahn School of Medicine at Mount Sinai; Jeong Yun Yang, Icahn School of Medicine at Mount Sinai; Robin B Mendelsohn, Memorial Sloan Kettering Cancer Center; Delia Calo, Memorial Sloan Kettering Cancer Center; Olga C Aroniadis, Stony Brook University; Joseph F LaComb, Stony Brook University; James M Scheiman, University of Virginia; Bryan G Sauer, University of Virginia; Duyen T Dang, Henry Ford Health System; Cyrus R Piraka, Henry Ford Health System; Eric D Shah, Dartmouth-Hitchcock Health; Heiko Pohl, Dartmouth-Hitchcock Health; William M Tierney, University of Oklahoma Health Sciences Center,; Stephanie Mitchell, University of Oklahoma Health Sciences Center,; Ashwinee Condon, University of California Los Angeles; Adrienne Lenhart, University of California Los Angeles; Kulwinder S Dua, Medical College of Wisconsin; Vikram S Kanagala, Medical College of Wisconsin; Ayesha Kamal, Johns Hopkins Medical Institutions; Viskeh K Singh, Johns Hopkins Medical Institutions; Maria Ines Pinto-Sanchez, McMaster University Hamilton Health Sciences; Joy M Hutchinson, McMaster University Hamilton Health Sciences; Richard S Kwon, Michigan Medicine; Sheryl J Korsnes, Michigan Medicine; Harminder Singh, University of Manitoba; Zahra Solati, University of Manitoba; Field Willingham, Emory University; Patrick S Yachimski, Vanderbilt University; Darwin L Conwell, Ohio State University; Evan Mosier, Loma Linda University; Mohamed Azab, Loma Linda University; Anish Patel, Loma Linda University; James Buxbaum, University of Southern California; Sachin Wani, University of Colorado; Amitabh Chak, University Hospitals of Cleveland; Amy E Hosmer, University Hospitals of Cleveland; Rajesh N Keswani, Northwestern University; Christopher J DiMaio, Icahn School of Medicine at Mount Sinai; Michael S Bronze, University of Oklahoma; Raman Muthusamy, University of California Los Angeles; Marcia I Canto, Medical College of Wisconsin; Mihajlo V Gjeorgjievski, Beaumont Health; Zaid Imam, Beaumont Health; Fadi Odish, Beaumont Health; Ahmed I Edhi, Beaumont Health; Molly Orosey, Beaumont Health; Abhinav Tiwari, Beaumont Health; Soumil Patwardhan, Beaumont Health; Nicholas G Brown, Columbia University; Anish A Patel, Columbia University; Collins O Ordiah, Medical University of South Carolina; Ian P Sloan, Washington University; Lilian Cruz, Stony Brook University; Casey L Koza, Vanderbilt University; Uchechi Okafor, Ohio State University; Thomas Hollander, Washington University; Nancy Furey, University Hospitals of Cleveland; Olga Reykhart, SUNY Stony Brook; Natalia H Zbib, Dartmouth-Hitchcock Health; John A Damianos, Dartmouth-Hitchcock Health; James Esteban, Medical College of Wisconsin; Nick Hajidiacos, University of Manitoba; Melisaa Saul, University of Pittsburgh; Melanie Mays, University of Pittsburgh; Gulsum Anderson, University of Pittsburgh; Kelley Wood, University of Pittsburgh; Laura Mathews, University of Pittsburgh; Galina Diakova, University of Virginia; Molly Caisse, Dartmouth Hitchcock Hlth; Lauren Wakefield, Medical University of South Carolina; Haley Nitchie, Medical University of South Carolina; Akbar K Waljee, Michigan Medicine; Weijing Tang, University of Michigan; Yueyang Zhang, University of Michigan; Ji Zhu, University of Michigan; Amar R Deshpande, University of Miami; Don C Rockey, Medical University of South Carolina; Teldon B Alford, Medical University of South Carolina; Valerie Durkalski, Medical University of South Carolina
• Journal Title: CLINICAL GASTROENTEROLOGY AND HEPATOLOGY
• Volume: Volume 19, Number 7
• Publisher: ELSEVIER SCIENCE INC | 2021-06-17, Pages 1355-+
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1016/j.cgh.2020.09.041
• Subjects: Health Sciences, Medicine and Surgery; Health Sciences, Nutrition
• Keywords: Science & Technology; Life Sciences & Biomedicine; Gastroenterology & Hepatology; COVID-19; SARS-CoV-2; Digestive Manifestations; Gastrointestinal Symptoms; Hepatic Manifestations

Abstract

Background & Aims: The prevalence and significance of digestive manifestations in coronavirus disease 2019 (COVID-19) remain uncertain. We aimed to assess the prevalence, spectrum, severity, and significance of digestive manifestations in patients hospitalized with COVID-19. Methods: Consecutive patients hospitalized with COVID-19 were identified across a geographically diverse alliance of medical centers in North America. Data pertaining to baseline characteristics, symptomatology, laboratory assessment, imaging, and endoscopic findings from the time of symptom onset until discharge or death were abstracted manually from electronic health records to characterize the prevalence, spectrum, and severity of digestive manifestations. Regression analyses were performed to evaluate the association between digestive manifestations and severe outcomes related to COVID-19. Results: A total of 1992 patients across 36 centers met eligibility criteria and were included. Overall, 53% of patients experienced at least 1 gastrointestinal symptom at any time during their illness, most commonly diarrhea (34%), nausea (27%), vomiting (16%), and abdominal pain (11%). In 74% of cases, gastrointestinal symptoms were judged to be mild. In total, 35% of patients developed an abnormal alanine aminotransferase or total bilirubin level; these were increased to less than 5 times the upper limit of normal in 77% of cases. After adjusting for potential confounders, the presence of gastrointestinal symptoms at any time (odds ratio, 0.93; 95% CI, 0.76–1.15) or liver test abnormalities on admission (odds ratio, 1.31; 95% CI, 0.80–2.12) were not associated independently with mechanical ventilation or death. Conclusions: Among patients hospitalized with COVID-19, gastrointestinal symptoms and liver test abnormalities were common, but the majority were mild and their presence was not associated with a more severe clinical course.