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VOLUME 12 , ISSUE 1 ( January-June, 2022 ) > List of Articles

Original Article

In COVID-19 Patients, the Identified Gastrointestinal Symptoms in Tertiary Care Center of India

Malarvizhi Murugesan, Ramkumar Govindarajan, Lakshmi Prakash, Chandra Kumar Murugan, J Janifer Jasmine, Narayanasamy Krishnasamy

Keywords : Angiotensin-converting enzyme 2, COVID-19, Ferritin, GI symptoms, Loss of smell, Loss of taste, Loss of appetite, SARS-CoV-2

Citation Information : Murugesan M, Govindarajan R, Prakash L, Murugan CK, Jasmine JJ, Krishnasamy N. In COVID-19 Patients, the Identified Gastrointestinal Symptoms in Tertiary Care Center of India. Euroasian J Hepatogastroenterol 2022; 12 (1):24-30.

DOI: 10.5005/jp-journals-10018-1371

License: CC BY-NC 4.0

Published Online: 13-07-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Aim: This study aimed to assess the demographic details of coronavirus disease-2019 (COVID-19) patients, their comorbid conditions, preexisting illnesses such as tuberculosis (TB), the prevalence of gastrointestinal (GI) symptoms, duration of GI symptoms, gender-wise distribution of GI symptoms, age-wise distribution of GI symptoms, lab investigation, and computed tomography (CT) scanning was done to record the grading. Materials and methods: In total, 956 COVID-19 patients admitted to an isolation ward of a tertiary care center were screened for 3 months. Patients were confirmed positive for SARS-CoV-2 virus by real-time polymerase chain reaction (RT-PCR) test with a throat swab. Patient's age, demographic details, preexisting illness, and GI symptoms such as fever, impairment of appetite, loss of taste, loss of smell, hiccups, nausea, vomiting, diarrhea, abdominal pain, symptom's duration, history of chronic drug intake, biological markers, CT scanning, and comorbidities were recorded. Based on the provided protocol, standard care management was given to the admitted COVID-19 patients. Statistical analysis was performed using SPSS version 20.0. Frequencies with percentages, median (min, max), Chi-square test, and Mann–Whitney U test were used to test the statistical significance, and a p-value of <0.05 was considered statistically significant. Results: In our prospective study of 956 COVID-19 hospitalized patients, details were analyzed and the results are: the median age was 45 years, 70% of male, 60% were above 35 years, comorbidities like diabetes present in 42%, hypertension in 36%, asthma in 8%, cardiovascular diseases (CVD) in 5%, and history of chronic drug intake in 21%. Among 956 COVID-19 patients, GI symptoms were loss of smell (29.2%), loss of taste (26.4%) for 3 days; nausea (10%), vomiting (7.1%), abdominal pain (12.7%), and fever (42.5%) were observed for 2 days among the 36–45 years of age-group; and the loss of appetite (19%) for 3 days among the age-group of 46–55 years. The loss of appetite (23.7 vs 16.9%) (p = 0.014), taste (32.4 vs 23.8%) (p = 0.005), nausea (14.6 vs 8.2%) (p = 0.003), and vomiting (10.8 vs 5.5%) (p = 0.004) were higher in females than in males. No gender difference was observed in loss of smell (p = 0.057), abdominal pain (12 vs 14.3%) (p = 0.491), hiccups (4 vs 2.1%) (p = 0.132), and fever (41.3 vs 45.3%) (p = 0.329). Females had significantly higher levels of C-reactive protein (CRP) than males (6.1 vs 3.8) (p = 0.002). No gender difference was observed in neutrophil/lymphocyte ratio (NLR) (p = 0.772), ferritin, and lactate dehydrogenase (LDH). CT-grade IV was higher in males than in females (1.7 vs 1.5%), but the rest of the CT grades were higher in females than in males. Conclusion: In conclusion, GI symptoms are the onset of symptoms that are first expressed after being infected with the SARS-CoV-2 virus. Several studies showed the GI symptoms but did not analyze the age and gender that are risk factors for any disease, but our study showed all GI symptoms and their association with age and gender, which will shed light for our clinicians for early symptom identification, diagnosis, and appropriate treatment.


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  1. Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019. New Engl J Med 2020;382(8):727–733. DOI: 10.1056/NEJMoa2001017.
  2. Woolf SH, Chapman DA, Lee JH. COVID-19 as the leading cause of death in the United States. JAMA 2021;325(2):123–124. DOI: 10.1001/jama.2020.24865.
  3. CDC. Coronavirus (COVID-19) 2020. Accessed https://www.cdc.gov/coronavirus/2019-ncov/index.html.
  4. Zhang J, Garrett S, Sun J. Gastrointestinal symptoms, pathophysiology, and treatment in COVID-19. Genes Dis 2021;8(4):385–400. DOI: 10.1016/j.gendis.2020.08.013.
  5. Coronavirus 2019-nCoV C. Coronavirus 2019-nCoV global cases by Johns Hopkins CSSE. Accessed https://gisanddata.maps.arcgis.com/apps/opsdashboard/index. html#/bda7594740fd40299423467b48e9ecf6.
  6. Burgueño JF, Reich A, Hazime H, et al. Expression of SARS-CoV-2 entry molecules ACE2 and TMPRSS2 in the gut of patients with IBD. Inflamm Bowel Dis 2020;26(6):797–808. DOI: 10.1093/ibd/izaa085.
  7. Xiao F, Tang M, Zheng X, et al. Evidence for gastrointestinal infection of SARS-CoV-2. Gastroenterology 2020;158(6):1831–1833.e3. DOI: 10.1053/j.gastro.2020.02.055.
  8. Du M, Cai G, Chen F, et al. Multiomics evaluation of gastrointestinal and other clinical characteristics of COVID-19. Gastroenterology 2020;158(8):2298–2301.e7. DOI: 10.1053/j.gastro.2020.03.045.
  9. Lin L, Jiang X, Zhang Z, et al. Gastrointestinal symptoms of 95 cases with SARS-CoV-2 infection. Gut 2020;69(6):997–1001. DOI: 10.1136/gutjnl-2020-321013.
  10. Effenberger M, Grabherr F, Mayr L, et al. Faecal calprotectin indicates intestinal inflammation in COVID-19. Gut 2020;69(8):1543–1544. DOI: 10.1136/gutjnl-2020-321388.
  11. Han C, Duan C, Zhang S, et al. Digestive symptoms in COVID-19 patients with mild disease severity: clinical presentation, stool viral RNA testing, and outcomes. Am J Gastroenterol 2020;115(6):916–923. DOI: 10.14309/ajg.0000000000000664.
  12. Holshue ML, DeBolt C, Lindquist S, et al. First case of 2019 novel coronavirus in the United States. New Engl J Med 2020;382(10): 929–936. DOI: 10.1056/NEJMoa2001191.
  13. Young BE, Ong SW, Kalimuddin S, et al. Epidemiologic features and clinical course of patients infected with SARS-CoV-2 in Singapore. JAMA 2020;323(15):1488–1494. DOI: 10.1001/jama.2020.3204.
  14. Pan Y, Zhang D, Yang P, et al. Viral load of SARS-CoV-2 in clinical samples. Lancet Infect Dis 2020;20(4):411–412. DOI: 10.1016/S1473-3099(20)30113-4.
  15. Cook JD, Lipschitz DA, Miles LE, et al. Serum ferritin as a measure of iron stores in normal subjects. Am J Clin Nutr 1974;27(7):681–687. DOI: 10.1093/ajcn/27.7.681.
  16. Tillett WS, Francis T. Serological reactions in pneumonia with a non-protein somatic fraction of pneumococcus. J Exp Med 1930;52(4): 561–571. DOI: 10.1084/jem.52.4.561.
  17. Bhagavan NV. CHAPTER 27-nucleotide metabolism. Medical Biochemistry (4th ed.), Academic Press,- Cambridge, Massachusetts. US 2002:1016 pp. 615–644. https://doi.org/10.1016/B978-012095440-7/50029-9.
  18. Richmond, Caroline. “Obituary-Sir Godfrey Hounsfield”. BMJ 2004;329(7467):687. DOI: 10.1136/bmj.329.7467.687.
  19. Cevik M, Bamford CGG, Ho A. COVID-19 pandemic—a focused review for clinicians. Clin Microbiol Infect 2020;26(7):842–847. DOI: 10.1016/j.cmi.2020.04.023.
  20. Cevik M, Kuppalli K, Kindrachuk J, et al. Virology, transmission, and pathogenesis of SARS-CoV-2. BMJ 2020;371:m3862. DOI: 10.1136/bmj.m3862.
  21. Guan W-J, Ni Z-Y, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. New Engl J Med 2020;382(18):1708–1720. DOI: 10.1056/NEJMoa2002032.
  22. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet 2020;395(10229):1054–1062. DOI: 10.1016/S0140-6736(20)30566-3.
  23. Deng G, Yin M, Chen X, et al. Clinical determinants for fatality of 44,672 patients with COVID-19. Crit Care 2020;24(1):1–3. DOI: 10.1186/s13054-020-02902-w.
  24. Ielapi N, Licastro N, Provenzano M, et al. Cardiovascular disease as a biomarker for an increased risk of COVID-19 infection and related poor prognosis. Biomark Med 2020;14(9):713–716. DOI: 10.2217/bmm-2020-0201.
  25. Madjid M, Safavi-Naeini P, Solomon SD, et al. Potential effects of coronaviruses on the cardiovascular system: a review. JAMA Cardiol 2020;5(7):831–840. DOI: 10.1001/jamacardio.2020.1286.
  26. Docherty AB, Harrison EM, Green CA, et al. Features of 20 133 UK patients in hospital with Covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study. BMJ 2020;369:m1985. DOI: 10.1136/bmj.m1985.
  27. Song Y, Liu P, Shi XL, et al. SARS-CoV-2 induced diarrhoea as onset symptom in patient with COVID-19. Gut 2020;69(6):1143–1144. DOI: 10.1136/gutjnl-2020-320891.
  28. Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. JAMA 2020;323(11):1061–1069. DOI: 10.1001/jama.2020.1585.
  29. Wiersinga WJ, Rhodes A, Cheng AC, et al. Pathophysiology, transmission, diagnosis, and treatment of coronavirus disease 2019 (COVID-19): a review. JAMA 2020;324(8):782–793. DOI: 10.1001/jama.2020.12839.
  30. Graham CW, Dela CC, Cao B, et al. Novel Wuhan (2019-NCoV) coronavirus. Am J Respir Crit Care Med 2020;201(4):7–8. DOI: 10.1164/rccm.2014P7.
  31. Giacomelli A, Pezzati L, Conti F, et al. Self-reported olfactory and taste disorders in patients with severe acute respiratory coronavirus 2 infection: a cross-sectional study. Clin Infect Dis 2020;71(15):889–890. DOI: 10.1093/cid/ciaa330.
  32. Chen A, Agarwal A, Ravindran N, et al. Are gastrointestinal symptoms specific for coronavirus 2019 infection? A prospective case-control study from the United States. Gastroenterology 2020;159(3): 1161–1163.e2. DOI: 10.1053/j.gastro.2020.05.036.
  33. Yang L, Tu L. Implications of gastrointestinal manifestations of COVID-19. Lancet Gastroenterol Hepatol 2020;5(7):629–630. DOI: 10.1016/S2468-1253(20)30132-1.
  34. Cholankeril G, Podboy A, Aivaliotis VI, et al. High prevalence of concurrent gastrointestinal manifestations in patients with severe acute respiratory syndrome coronavirus 2: early experience from California. Gastroenterology 2020;159(2):775–777. DOI: 10.1053/j.gastro.2020.04.008.
  35. Andrews PLR, Cai W, Rudd JA, et al. COVID-19-19, nausea, and vomiting. J Gastroenterol Hepatol 2021;36(3):646–656. DOI: 10.1111/jgh.15261.
  36. Cholankeril G, Podboy A, Aivaliotis VI, et al. Association of digestive symptoms and hospitalization in patients with SARS-CoV-2 infection. Am J Gastroenterol 2020. DOI: 10.14309/ajg.00000000 00000712.
  37. Remes-Troche JM, Ramos-de-la-Medina A, Manríquez-Reyes M, et al. Initial gastrointestinal manifestations in patients with severe acute respiratory syndrome coronavirus 2 infection in 112 patients from Veracruz in southeastern Mexico. Gastroenterology 2020;159(3): 1179–1181. DOI: 10.1053/j.gastro.2020.05.055.
  38. Ferm S, Fisher C, Pakala T, et al. Analysis of gastrointestinal and hepatic manifestations of SARS-CoV-2 infection in 892 patients in Queens, NY. Clin Gastroenterol Hepatol 2020 1;18(10):2378–2379.e1. DOI: 10.1016/j.cgh.2020.05.049.
  39. Redd WD, Zhou JC, Hathorn KE, et al. Prevalence and characteristics of gastrointestinal symptoms in patients with severe acute respiratory syndrome coronavirus 2 infection in the United States: a multicenter cohort study. Gastroenterology 2020;159(2):765–767.e2. DOI: 10.1053/j.gastro.2020.04.045.
  40. Rokkas T. Gastrointestinal involvement in COVID-19: a systematic review and meta-analysis. Ann Gastroenterol 2020;33(4):355–365. DOI: 10.20524/aog.2020.0506.
  41. Elliott J, Whitaker M, Bodinier B, et al. Predictive symptoms for COVID-19 in the community: REACT-1 study of over 1 million people. PLoS Med 2021;18(9):e1003777. DOI: 10.1371/journal.pmed.1003777.
  42. Renaud M, Thibault C, Le Normand F, et al. Clinical outcomes for patients with Anosmia 1 year after COVID-19 diagnosis. JAMA Netw Open 2021;4(6):e2115352. DOI: 10.1001/jamanetworkopen.2021.15352.
  43. Shelton JF, Shastri AJ, Fletez-Brant K, et al. The UGT2A1/UGT2A2 locus is associated with COVID-19-related loss of smell or taste. Nat Genet 2022;54(2):121–124. DOI: 10.1038/s41588-021-00986-w.
  44. Wong SH, Lui RN, Sung JJ. COVID-19 and the digestive system. J Gastroenterol Hepatol 2020;35(5):744–748. DOI: 10.1111/jgh.15047.
  45. Hopkins C, Surda P, Kumar N. Presentation of new onset anosmia during the COVID-19 pandemic. Rhinology 2020;58(3):295–298. DOI: 10.1111/jgh.15047.
  46. Wu J, Liu J, Zhao X, et al. Clinical characteristics of imported cases of coronavirus disease 2019 (COVID-19) in Jiangsu province: a multicenter descriptive study. Clin Infect Dis 2020;71(15):706–712. DOI: 10.1093/cid/ciaa199.
  47. Abbasinia M, Hormati A, Hossaini SKE, et al. Clinical manifestations of gastrointestinal symptoms in COVID-19 patients: an integrative review. Gastroenterol Nurs 2021;44(1):E1–E10. DOI: 10.1097/SGA.0000000000000584.
  48. Habibzadeh P, Stoneman EK. The novel coronavirus: a bird's eye view. Int J Occup Environ Med 2020;11(2):65–71. DOI: 10.15171/ijoem.2020.1921.
  49. Saeed GA, Gaba W, Shah A, et al. Correlation between chest CT severity scores and the clinical parameters of adult patients with COVID-19 pneumonia. Radiol Res Pract 2021; 6697677. DOI: 10.1155/2021/6697677.
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