Posted on Apr 17, 2020, 12 p.m.
Symptoms of this virus are similar to the flu, it can be mild similar to a cold and it can even have the resemblance of allergies making it hard to know the difference. However, while having a fever, cough and shortness of breath may be the known classic symptoms of COVID-19 so far, there can also be gastrointestinal symptoms including diarrhea and nausea that may be getting missed according to a recent study.
The new study from Stanford Medicine has found that in addition to the upper respiratory symptoms a significant number of those who have been infected with this virus also suffered from loss of appetite, nausea, vomiting, and diarrhea.
This is one of the earliest studies on American COVID-19 patients, and it was very recently published in Gastroenterology with gastroenterology fellows George Cholankeril, MD, and Alexander Podboy, MD sharing the lead authorship, and the senior author was Aijaz Ahmed, MD, professor of gastroenterology and hepatology.
"COVID-19 is probably not just respiratory symptoms like a cough," Podboy said. "A third of the patients we studied had gastrointestinal symptoms. It's possible we may be missing a significant portion of patients sick with the coronavirus due to our current testing strategies focusing on respiratory symptoms alone."
"George recognized early on that since Stanford was among the first hospitals to get COVID-19 patients in the U.S., that any type of early experience would be important," he said. "We were in a unique position to look into this subject of gastrointestinal symptoms among coronavirus patients at Stanford."
The team had been following the growing body of research emerging from Singapore and China showing the prevalence of GI tract symptoms in those infected with this virus, but they were not able to find any data on this topic involving American patients. Thus they designed their own study examining charts of the earliest groups of COVID-19 patients that were treated at Stanford Health Care.
Data was analyzed from 116 patients who were confirmed to be infected with the virus from March 4-24, 2020, with the majority being treated and released from a hospital ER or clinic, 33 of whom were hospitalized and 8 of those were in an intensive care unit. Median age was 50 with 53% of them being men and only one death was reported within this grouping.
In this grouping of COVID-19 patients gastrointestinal symptoms were reported by 31.9% of the patients with the majority of this group describing their symptoms as being mild; 22% reported experiencing loss of appetite, 22% experienced nausea and vomiting, and 12% experienced diarrhea according to the study.
"We also noticed that 40% of patients had elevated levels of an abnormal liver enzyme, and that those with high levels required more hospitalization," Cholankeril said.
Based on their findings, although this is early data from a single institution, there is indication of the possibility that those exposed to COVID-19 who are experiencing gastrointestinal symptoms and not just respiratory symptoms may also be infected and should also be tested.
"In our current cohort of patients, all patients had respiratory symptoms prior to the development of gastrointestinal symptoms," Podboy said. "No patients had gastrointestinal symptoms prior to the development of respiratory symptoms or as their only manifestation of COVID-19. However, that may be a product of who we were testing. Currently, testing is only offered for patients that meet specific criteria—criteria that often require the presence of pulmonary symptoms."
"We had six fellows working together and we were able to go through these charts pretty quickly," Cholankeril said. "It was a terrific collaboration between colleagues to be able to join forces to study this new disease. We think that by looking at patients here at Stanford, it can help improve our understanding of this emerging disease."
The team plans to continue their investigations to study the role of GI tract symptoms in COVID-19 and the implications on disease severity and outcomes, according to Cholankeril.
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