AGA releases recommendations for management of COVID-19 in patients with GI, liver manifestations
The American Gastroenterological Association released guidance on consultative management of COVID-19 among patients with gastrointestinal and liver manifestations.
Researchers performed a systematic literature search using Ovid Medline and pre-print servers to identify 118 studies on GI and liver manifestations of COVID-19 up to April 5, 2020. Investigators evaluated 47 the 118 studies that included 10,890 patients. With Grade, they assessed the prevalence of diarrhea, nausea, vomiting and abdominal pain as well as liver function test abnormalities using a fixed effect model and assessed the certainty of evidence. Total prevalence of GI symptoms included diarrhea at 7.7% (95% CI, 7.2-8.2), nausea/vomiting at 7.8% (95% CI, 7.1-8.5), abdominal pain at 2.7% (95% CI, 2-3.4) and elevated liver abnormalities including aspartate aminotransferase at 15% (13.6 to 16.5) and alanine aminotransferase at 15% (13.6 to 16.4).
“When analyzed comparing data from China to studies from countries other than China, diarrhea, nausea/vomiting, liver abnormalities were more prevalent outside of China with diarrhea reported in 18.3% (16.6 to 20.1),” the researchers wrote.
The Best Practice Statements for consultative Management of COVID-19 based on results included:
In outpatients with new onset diarrhea, ascertain information about high risk contact exposure, obtain a history of symptoms correlated with COVID-19 and obtain history of Gl symptoms, including nausea, vomiting and abdominal pain;
COVID-19 testing should be considered in outpatients with new onset Gl symptoms and monitored for symptoms linked to COVID-19 as GI symptoms may come before COVID-related symptoms;
In hospitalized patients with suspected or known COVID-19, obtain a history of GI symptoms including onset, characteristics, duration and severity;
There is not sufficient evidence to support stool tests for diagnosis or monitoring of COVID-19 as part of routine clinical practice;
Evaluate patients with elevated liver function tests for alternative etiologies in context of suspected or known COVID-19;
Obtain baseline liver function tests at the time of admission, and consider liver function test monitoring throughout the hospitalization, particularly in the context of drug treatment for COVID-19 in hospitalized patients with suspected or known COVID-19; and
Evaluate for treatment-related Gl and hepatic adverse effects in hospitalized patients who undergo drug treatment for COVID-19. – by Monica Jaramillo
Sultan S, et al on behalf of the AGA. AGA Institute Rapid Review of the GI and Liver Manifestations of COVID-19, Meta-Analysis of International Data, and Recommendations for the Consultative Management of Patients with COVID-19. Available at: https://els-jbs-prod-cdn.jbs.elsevierhealth.com/pb/assets/raw/Health%20Advance/journals/ygast/AGA_COVID_GI_Rapid_Review.pdf. Accessed May 4, 2020.
Disclosure: The authors report no relevant financial disclosures.