Digestive Manifestations in Patients Hospitalized With Coronavirus Disease 2019.


B Joseph Elmunzer
Rebecca L Spitzer
Lydia D Foster
Ambreen A Merchant
Eric F Howard
Vaishali A Patel
Mary K West
Emad Qayed
Rosemary Nustas
Ali Zakaria
Marc S Piper
Jason R Taylor
Lujain Jaza
Nauzer Forbes
Millie Chau
Luis F Lara
Georgios I Papachristou
Michael L Volk
Liam G Hilson
Selena Zhou
Vladimir M Kushnir
Alexandria M Lenyo
Caroline G McLeod
Sunil Amin
Gabriela N Kuftinec
Dhiraj Yadav
Charlie Fox
Jennifer M Kolb
Swati Pawa
Rishi Pawa
Andrew Canakis
Christopher Huang
Laith H Jamil, Beaumont Health
Andrew M Aneese, Beaumont Health
Benita K Glamour
Zachary L Smith
Katherine A Hanley
Jordan Wood
Harsh K Patel
Janak N Shah
Emil Agarunov
Amrita Sethi
Evan L Fogel
Gail McNulty
Abdul Haseeb
Judy A Trieu
Rebekah E Dixon
Jeong Yun Yang
Robin B Mendelsohn
Delia Calo
Olga C Aroniadis
Joseph F LaComb
James M Scheiman
Bryan G Sauer
Duyen T Dang
Cyrus R Piraka
Eric D Shah
Heiko Pohl
William M Tierney
Stephanie Mitchell
Ashwinee Condon
Adrienne Lenhart
Kulwinder S Dua
Vikram S Kanagala
Ayesha Kamal
Vikesh K Singh
Maria Ines Pinto-Sanchez
Joy M Hutchinson
Richard S Kwon
Sheryl J Korsnes
Harminder Singh
Zahra Solati
Field F Willingham
Patrick S Yachimski
Darwin L Conwell
Evan Mosier
Mohamed Azab
Anish Patel
James Buxbaum
Sachin Wani
Amitabh Chak
Amy E Hosmer
Rajesh N Keswani
Christopher J DiMaio
Michael S Bronze
Raman Muthusamy
Marcia I Canto
V Mihajlo Gjeorgjievski
Zaid Imam, Beaumont Health
Fadi Odish
Ahmed I Edhi, Beaumont Health
Molly Orosey, Beaumont Health
Abhinav Tiwari, Beaumont Health
Soumil Patwardhan
Nicholas G Brown
Anish A Patel
Collins O Ordiah
Ian P Sloan
Lilian Cruz
Casey L Koza
Uchechi Okafor
Thomas Hollander
Nancy Furey
Olga Reykhart
Natalia H Zbib
John A Damianos
James Esteban
Nick Hajidiacos
Melissa Saul
Melanie Mays
Gulsum Anderson
Kelley Wood
Laura Mathews
Galina Diakova
Molly Caisse
Lauren Wakefield
Haley Nitchie
Akbar K Waljee
Weijing Tang
Yueyang Zhang
Ji Zhu
Amar R Deshpande
Don C Rockey
Teldon B Alford
Valerie Durkalski

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Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association


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.





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