Digestive Symptoms in COVID-19 Patients With Mild Disease Severity: Clinical Presentation, Stool Viral RNA Testing, and Outcomes

Coronavirus disease 2019 (COVID-19) most commonly presents with respiratory symptoms, including cough, shortness of breath, and sore throat. However, digestive symptoms also occur in patients with COVID-19 and are often described in outpatients with less severe disease. In this study, we sought to d...

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Bibliographic Details
Published in:The American journal of gastroenterology Vol. 115; no. 6; pp. 916 - 923
Main Authors: Han, Chaoqun, Duan, Caihan, Zhang, Shengyan, Spiegel, Brennan, Shi, Huiying, Wang, Weijun, Zhang, Lei, Lin, Rong, Liu, Jun, Ding, Zhen, Hou, Xiaohua
Format: Journal Article
Language:English
Published: United States Wolters Kluwer 01.06.2020
Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins
Subjects:
Betacoronavirus - isolation & purification
China - epidemiology
Clinical Laboratory Techniques - methods
Coronavirus Infections - complications
Coronavirus Infections - diagnosis
Coronavirus Infections - epidemiology
Coronaviruses
COVID-19
COVID-19 diagnostic tests
COVID-19 Testing
Diarrhea
Diarrhea - diagnosis
Diarrhea - etiology
Digestive System Diseases - diagnosis
Digestive System Diseases - physiopathology
Digestive System Diseases - virology
Disease transmission
Feces - virology
Female
Fever
Gastroenterology
Hospitals
Humans
Illnesses
Male
Middle Aged
Nausea
Outcome Assessment, Health Care
Pandemics
Patients
Pneumonia, Viral - complications
Pneumonia, Viral - diagnosis
Pneumonia, Viral - epidemiology
Quarantine
RNA, Viral - analysis
SARS-CoV-2
Severity of Illness Index
Statistical analysis
Symptom Assessment - methods
Variables
China
ISSN:0002-9270, 1572-0241, 1572-0241
Online Access:Get full text
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Summary:Coronavirus disease 2019 (COVID-19) most commonly presents with respiratory symptoms, including cough, shortness of breath, and sore throat. However, digestive symptoms also occur in patients with COVID-19 and are often described in outpatients with less severe disease. In this study, we sought to describe the clinical characteristics of COVID-19 patients with digestive symptoms and mild disease severity. We identified COVID-19 patients with mild disease and one or more digestive symptoms (diarrhea, nausea, and vomiting), with or without respiratory symptoms, and compared them with a group presenting solely with respiratory symptoms. We followed up patients clinically until they tested negative for COVID-19 on at least 2 sequential respiratory tract specimens collected ≥24 hours apart. We then compared the clinical features between those with digestive symptoms and those with respiratory symptoms. There were 206 patients with low severity COVID-19, including 48 presenting with a digestive symptom alone, 69 with both digestive and respiratory symptoms, and 89 with respiratory symptoms alone. Between the 2 groups with digestive symptoms, 67 presented with diarrhea, of whom 19.4% experienced diarrhea as the first symptom in their illness course. The diarrhea lasted from 1 to 14 days, with an average duration of 5.4 ± 3.1 days and a frequency of 4.3 ± 2.2 bowel movements per day. Concurrent fever was found in 62.4% of patients with a digestive symptom. Patients with digestive symptoms presented for care later than those with respiratory symptoms (16.0 ± 7.7 vs 11.6 ± 5.1 days, P < 0.001). Nevertheless, patients with digestive symptoms had a longer duration between symptom onset and viral clearance (P < 0.001) and were more likely to be fecal virus positive (73.3% vs 14.3%, P = 0.033) than those with respiratory symptoms. We describe a unique subgroup of COVID-19 patients with mild disease severity marked by the presence of digestive symptoms. These patients are more likely to test positive for viral RNA in stool, to have a longer delay before viral clearance, and to experience delayed diagnosis compared with patients with only respiratory symptoms.
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ISSN:0002-9270
1572-0241
1572-0241
DOI:10.14309/ajg.0000000000000664