Diarrhea Often Present in Mild COVID-19 Disease

Coronavirus patients with digestive symptoms presented for care later than those with respiratory symptoms
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(Coronavirus Today)

A new study published by The American Journal of Gastroenterology is the first analysis of gastrointestinal symptoms reported by COVID-19 patients with mild disease, rather than those with a moderate or critical illness.

Published on March 30, 2020, this study also found a unique sub-group with low severity disease marked by the presence of digestive symptoms, most notably diarrhea. 

The authors from Union Hospital and Tongji Medical College in Wuhan, China report that among some of the patients included in the study, these digestive symptoms, particularly diarrhea, were the presentation of COVID-19, and were only later, or never, present with respiratory symptoms or fever.

According to Brennan M.R. Spiegel, MD, MSHS, FACG, Co-Editor-in-Chief of The American Journal of Gastroenterology, “This study is vital because it represents the 80 percent or more of patients who do not have the severe or critical disease.”

“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.”

This analysis included 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 percent presented with diarrhea, of whom about 20 percent experienced diarrhea as the first symptom in their illness course. 

The diarrhea average duration was 5 days and a frequency of around 4 bowel movements per day. 

Concurrent fever was found in 62 percent of patients with a digestive symptom, meaning that nearly one-third did not have a fever.

Furthermore, patients with digestive symptoms presented for care later than those with respiratory symptoms (16 day vs. 11 day delay, p<0.001) and this delay in care is consistent with a recent paper by Pan, et al. that analyzed 204 sicker patients from three hospitals in Wuhan, China that was published as a pre-print article in The American Journal of Gastroenterology on March 18, 2020.

In this analysis of patients with milder COVID-19 disease by Han, et al., those with digestive symptoms had a longer total course between symptom onset and viral clearance. 

Patients with digestive symptoms were more likely to be fecal virus-positive (73% versus 14%) and have a longer overall course of the illness versus those with respiratory symptoms.

The authors conclude the following: ‘Importantly, digestive symptoms are common in the community, and most instances of new-onset diarrhea, nausea, vomiting, or low appetite are not from COVID-19.’

‘Nonetheless, 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.’ 

‘Failure to recognize these patients early and often may lead to the unwitting spread of the disease among outpatients with mild illness who remain undiagnosed and unaware of their potential to infect others.’ 

‘The data in this study highlight the presence and features of this important subgroup of COVID-19 patients and should be confirmed in larger international studies.’

Founded in 1932, the American College of Gastroenterology (ACG) is an organization with an international membership of more than 14,000 individuals from 86 countries. www.gi.org. 

COVID-19 disease outbreak news published by Coronavirus Today.