COVID-19 gastrointestinal manifestations: a systematic review

• Published in: Revista da Sociedade Brasileira de Medicina Tropical
• Main Authors: Filipe Antônio França da Silva, Breno Bittencourt de Brito, Maria Luísa Cordeiro Santos, Hanna Santos Marques, Ronaldo Teixeira da Silva Júnior, Lorena Sousa de Carvalho, Elise Santos Vieira, Márcio Vasconcelos Oliveira, Fabrício Freire de Melo
• Format: Article in Journal/Newspaper
• Language: English
• Published: Sociedade Brasileira de Medicina Tropical (SBMT) 2020
• Subjects: COVID-19; SARS-CoV-2; Gastrointestinal manifestation; Gastrointestinal symptom; Systematic review; Arctic medicine. Tropical medicine; RC955-962; Arctic; Jama
• Online Access: https://doi.org/10.1590/0037-8682-0714-2020; https://doaj.org/article/73f9601f8b724474a3d64dd1c6c05d33

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.