COVID-19 Resource Center
COVID-19 Resource Center
Perspective from Jean-Paul Achkar, MD
March 31, 2020
3 min read

Patients with COVID-19 GI symptoms experience delayed diagnosis, viral clearance

Perspective from Jean-Paul Achkar, MD
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Patients who develop new-onset digestive symptoms, like diarrhea, after a possible exposure to COVID-19 should be suspected for the illness, according to research published in The American Journal of Gastroenterology.

In the study, Xiaohua Hou, MD, PhD, of the division of gastroenterology at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology in Wuhan, China, and colleagues wrote that these patients should be suspected for COVID-19 even without common respiratory symptoms, such as cough, shortness of breath, sore throat or fever.

“This study is vital because it represents the 80% or more of patients who do not have severe or critical disease,” Brennan M.R. Spiegel, MD, MSHS, FACG, director of health research at Cedars Sinai, said in a press release issued by the American College of Gastroenterology. “This is about the more common scenario of people in the community struggling to figure out if they might have COVID-19 because of new-onset diarrhea, nausea, or vomiting.”

For the study, researchers identified patients with mild COVID-19 and one or more digestive symptoms (diarrhea, nausea or vomiting), with or without respiratory symptoms and compared them with a group of patients who presented only with respiratory symptoms. They followed the patients until they tested negative for COVID-19 on at least two sequential respiratory tract specimens collected at least 24 hours apart. Then, they compared clinical features between patients with digestive symptoms versus respiratory symptoms.

Of 206 total patients, 48 presented with only digestive symptoms, 69 presented with both digestive and respiratory symptoms and 89 presented with only respiratory symptoms. In the two groups with digestive symptoms, 67 presented with diarrhea, and of those patients, 19.4% experienced diarrhea as their first symptom. Researchers found concurrent fever in 62.4% of patients with a digestive symptom.

Patients who experienced digestive symptoms presented for care later than those with respiratory symptoms (16±7.7 days vs. 11.6±5.1 days; P < .001). They also had a longer duration between symptom onset and viral clearance (P < .001) and were more likely to test fecal virus positive compared with patients who experienced respiratory symptoms (73.3% vs. 14.3%; P = .033).

“Clinicians should recognize that new-onset, acute digestive symptoms in a patient with a possible COVID-19 contact should at least prompt consideration of the illness, particularly during times of high COVID-19 incidence and prevalence,” Hou and colleagues wrote. “Failure to recognize these patients early and often may lead to unwitting spread of the disease among outpatients with mild illness who remain undiagnosed and unaware of their potential to infect others.” – by Alex Young


Han C, et al. “Prevalence and Clinical Characteristics of Mild Severity COVID-19 Patients with Digestive Symptoms.” Am J Gastroenterol. Pre-Print March 30, 2020.

Disclosure: The authors report no relevant financial disclosures.